The winning health care message will be about out of pocket costs

Drew Altman, Kaiser Family Foundation April 1, 2019

As the 2020 campaign ramps up, Democrats may be able to rally their base by talking about universal coverage and making health care a right through Medicare-for-all. Republicans may be able to motivate their core voters by branding progressive Democratic ideas as socialism.

The catch: But it’s the candidates who can connect their plans and messages to voters’ worries about out of pocket costs who will reach beyond the activists in their base. And the candidates aren’t speaking to that much, at least so far.  

By the numbers:

• The anxiety over out of pocket costs is real. In a January 2017 Kaiser poll, 48 percent of voters worried about paying their health care bills.
• People who are sick are especially concerned, with 66 percent worried and 49 percent very worried.
• It isn’t just in their heads: a whopping half of people who are sick have a problem paying their medical bills over the course of a year. The health insurance system is not working for people who are sick.

Thanks in part to the Affordable Care Act, only 10 percent of the population remains uncovered. But that means many Americans are less focused on getting to universal coverage, even though candidate after candidate talks about it. They have insurance and are focused on their own, often crippling health care costs.

• Most Americans are healthy and don’t use much care, but almost everyone, not just people with a major illness, worries about what might happen if they or a family member get cancer or heart disease or suffer a permanent injury.
• That's what fuels health care as an issue: the fear of facing costs people know they cannot afford. And that’s why protections for people with pre-existing conditions broke through as a prominent issue in the midterm election.
• The debate and the Democratic message could shift back to the ACA again, after President Trump and the Justice Department’s surprise decision to push for throwing out the entire law in the courts. That move handed Democrats a political opportunity they will not ignore: a pre-existing conditions debate on steroids.

Recent trends have made problems with out of pocket costs worse:

• Deductibles rose eight times faster than wages between 2008 and 2018 for the 156 million Americans who get their insurance at work.
• Forty three percent of all insured Americans said in 2017 that it was difficult to pay their medical bills before their deductible kicked in, up from 34 percent just two years before.

Some of the administration’s policies are exacerbating the problem, such as their efforts to push cheaper short term insurance plans for the healthy, which drive up costs for the sick because they leave fewer healthy people in the regular insurance plans to help pay for sick people's costs.

• Several of the candidates' plans address out of pocket costs, including the Bernie Sanders plan, which eliminates them. Their advocates just don’t talk about it much.

The bottom line: It’s hard to see the new debate about the health system breaking out of familiar boxes unless the messaging changes. And when the general election comes, both parties will have to convince voters that they will do something about out of pocket costs if they want to reach beyond core base voters. 

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The Winning Health Care Message Will Be About Out of Pocket Costs

	Just Released
The Winning Health Care Message Will Be About Out of Pocket Costs Drew Altman analyzes health care messaging, concluding that it’s aimed mainly at activists in the base on both sides, and that the “The winning health care message will be about out of pocket costs,” in this Axios column. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.
Contact: Rakesh Singh | (650) 854-9400 | rsingh@kff.org
kff.org | kaiserhealthnews.org Connect with us:

Side-by-Side Tool Compares Key Bills to Expand Coverage Through Medicare-for-all and Other Public Plan Options

	Just Released
Side-by-Side Tool Compares Key Bills to Expand Coverage Through Medicare-for-all and Other Public Plan Options With a new Democratic House majority and many 2020 presidential candidates talking about next steps in health care, there’s renewed attention on legislation that would expand coverage and moderate costs, including a national Medicare-for-all plan and options to buy into public plans, both Medicare and Medicaid. A new KFF interactive tool captures the key provisions in five such bills introduced to date in the current Congress, allowing side-by-side comparisons of specific elements and features of each proposal. As of today, the interactive includes: S 3, Keeping Health Insurance Affordable Act of 2019 (Sen. Ben Cardin); S 470, Medicare at 50 Act (Sen. Debbie Stabenow); S 489/HR 1277, State Public Option Act (Sen. Brian Schatz/Rep. Ben Ray Lujan). HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 (Rep. Brian Higgins; and HR 1384, Medicare for All Act of 2019 (Rep. Pramila Jayapal); The five proposals vary significantly in approach, but each would broaden access to health coverage under a public plan. KFF will update the tool to include other bills after they are introduced in the 116th Congress. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.
Contact: Craig Palosky | (202) 347-5270 | cpalosky@kff.org
kff.org | kaiserhealthnews.org Connect with us:

Data Points: Managed care growing in Medicare, Medicaid

Modern Healthcare March 30, 2019 01:00 AM

Medicare Advantage and Medicaid managed-care plans continue to grow as policymakers at the state and federal levels look for ways to control healthcare spending.

https://www.modernhealthcare.com/insurance/data-points-managed-care-growing-medicare-medicaid

Policy Risks in a Budget Crunch

A central issue in the near-term policy outlook is the fate of the caps and sequester mechanism under the Budget Control Act (BCA). In the absence of a deal and accompanying legislation, the BCA will dictate sharp cuts to both non-defense and defense discretionary spending. The president’s budget accepts the cap on non-defense spending, but utilizes a budget gimmick (the Overseas Contingency Operations, or OCO, account) to add back $170 billion in defense spending. In contrast, the Senate Budget Committee passed a budget that accepts both caps, but embodies a mechanism to allow higher spending on both categories if the increases are offset.

That outlines the budgetary dimensions of a deal. But there is a risk that the dollars become divorced from the policy needs. Indeed, the BCA caps themselves are a tribute to this very risk. While they made the 10-year deficit smaller on paper, they were not built on a real policy foundation. Commenting on this defect in Simpson-Bowles, which featured similar caps, former Secretary of Defense Robert Gates once put it, “‘The truth of the matter is when it comes to the deficit, the Department of Defense is not the problem,' he said. 'I think in terms of the specifics they came up with, that is math not strategy.’” Nothing has changed in the interim.

Following the strategy of the president’s budget, for example, means that the $98 billion is in OCO. That means the budget isn’t scaled to anything like the budget caps. This exposes needed acquisition and modernization funding to funding risks. The National Defense Strategy (NDS) prioritized threats from near-peers (Russia and China) that will involve modernization to the nuclear triad. That means expensive systems such as the B-21 long-range bomber ($3 billion for FY2020), the Columbia-Class ($2.2 billion for FY2020), as well as improvement to ground-based weapons ($570 for FY2020), and nuclear command, control and communications systems ($2.5 billion for FY2020).

There are risks that are less high-profile, but not less important. For example, the current fleet is the smallest and oldest in the history of the U.S. Air Force and needs to purchase at least 72 tactical aircraft per year to support the NDS. Studies indicate the need for a future force structure that has equal parts of the latest generation (F-35 and modernized F-22) and previous generation fighters. The latest version of the F-15 (the F-15X) is the most economical way to make up the latter part of the force structure, as well as contribute to the homeland defense mission. These are often the jets “scrambled” to protect our cities, our major events and our people, coast to coast. One of the many issues facing Congress is funding the procurement of capabilities like the F-15X.

Policy decisions are rich with tradeoffs in the face of multiple threats. But those decisions should not be dictated strictly by budgetary considerations. 

Centene Corp. last week announced plans to...

...acquire WellCare Health Plans, Inc., a move that would create a giant in the growing managed Medicaid space. Centene is the top managed Medicaid insurer in the country, with 7.70 million members in 21 states, according to the latest update to AIS's Directory of Health Plans (DHP). WellCare ranks at No. 4, with 3.94 million members in 12 states. Overall, the combined entity would serve more than 17.6 million medical lives in all sectors.

From AIS’s Directory of Health Plans

New Postpartum Depression Drug Poses Challenges to Payers

By Judy Packer-Tursman

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.

Zulresso's initial U.S. list price "will be $7,450 per vial, resulting in a projected average course of therapy cost of $34,000 per patient before discounts," says Alexis Smith, a spokesperson for Zulresso's manufacturer, Sage Therapeutics, Inc.

As the medication must be administered as a 60-hour continuous intravenous infusion, it's a challenge for a new mother to be hospitalized in an approved facility for two-and-a-half days for an IV infusion, says Dea Belazi, Pharm.D., president and CEO of AscellaHealth. Moreover, he says, there is "the fact that there are possible extensive side effects and the data on its [Zulresso's] effectiveness [are] moderately better than placebo. The cost will also play a barrier," he adds.

Camille Hoffman, M.D., associate professor in the University of Colorado's Department of Ob/Gyn, describes the newly approved drug as "a breakthrough medication" that "rapidly improves postpartum depression out to, at least, 30 days following the one-time treatment."

She acknowledges that the need to administer Zulresso via a 60-hour IV drip and its restricted distribution might present challenges. However, she says, "I hope that payers will consider these potential barriers in light of how quickly it acts to help women with severe postpartum depression."

From RADAR on Drug Benefits