ACHP Media Monitoring Report: December 15, 2016

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Some Democrats willing to work on ACA replacement
Although Democratic senators will not support the repeal of the Affordable Care Act, many have indicated they would be open to helping Republicans craft a replacement, according to lawmakers. To enact alternate legislation, Republicans need at least eight Democrats on board in the Senate. More than 20 Democrats are up for re-election in 2018, which could help Republicans garner support from senators in states Donald Trump had won. Burgess Everett and Jennifer Haberkorn of Politico have the story.

More Americans enrolling in plans through HealthCare.gov
Sign-ups on HealthCare.gov, the website to enroll in plans through the Affordable Care Act, are outpacing last year. According to federal health officials, about 25 percent of individuals registering for health coverage are new customers. Amy Goldstein at The Washington Post shares between November 1 and December 10, about 4 million people selected a health plan.

Merger trials could reshape market definitions
Justice Department lawsuits against two different mergers have the potential to reshape how courts define markets and consider antitrust claims. The Justice Department has filed challenges to the merger of Anthem and Cigna and the merger of Aetna and Humana. In the Anthem and Cigna case, the judge could rule the merger of large insurers undermines competition for national customers across state lines, reshaping interpretations of marketplace competition, explains Shannon Muchmore of Modern Healthcare. In the Aetna and Humana case, the ruling could determine whether Medicare and Medicare Advantage are two separate markets or if they are functional substitutes for one another.

Tab for ACA subsidies rises
Taxpayers could collectively pay nearly $10 billion more than last year to cover premium hikes for subsidized insurance plans under the Affordable Care Act, according to the Center for Health and Economy. Premium subsidies currently cost about $32 billion and are projected to rise to about $42 billion next year. The Associated Press reports more than eight in 10 customers who purchase insurance through the marketplace are eligible for tax credits.

Logistics pose hurdle to quick ACA repeal
Republican plans to repeal the Affordable Care Act (ACA) immediately once Donald Trump takes office may underestimate the logistical difficulties, according to budget specialists. Because Republicans do not have enough votes in the Senate to avoid a filibuster, they cannot pass an outright repeal of the ACA. GOP legislators must rely on reconciliation, which requires passing an annual budget resolution and then reconciling existing spending, according to Julie Rovner of NPR. Experts are skeptical such a process could be completed in less than a few months and point out reconciliation allows Republicans to repeal only funded provisions of the ACA.

Studies of Note

In this feature, the Media Monitoring Report shares a selection of notable research studies within the health care industry.

Medicaid and Hospital Payment

Contrary to Popular Belief, Medicaid Hospital Admissions Are Often Profitable Because of Additional Medicare Payments
Health Affairs
December 2016
Medicare Payment Advisory Commission Principal Policy Analyst Jeffrey Stensland and colleagues examine how Medicaid admissions affect hospital profits. The study finds hospitals who see more Medicaid patients also receive higher profits from Medicare. For every additional Medicaid patient a hospital treats, Medicare payments rise by more than $300 dollars.

 

Utilizing Real-World Evidence

Real-World Evidence — What Is It and What Can It Tell Us?
The New England Journal of Medicine
December 8, 2016
Food and Drug Administration officials discuss how sources of real-world evidence, including electronic health records, billing data and information from health applications, can be used in research. The authors assert the source of real-world evidence, typically clinical care or community settings, distinguishes it from other types of data.

Pre-Existing Conditions

Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
Kaiser Family Foundation
December 12, 2016
The Kaiser Family Foundation estimates 27 percent of adults in the United States under the age of 65 would have been denied coverage based on pre-existing conditions under pre-ACA underwriting practices. Most of these 52 million Americans are covered through an employer or public program, but if they were to seek coverage on the individual market they would likely be denied.

Cost of Care at Clinics

Report Takes Deep Dive Into Minnesota Health Clinic Costs
Star Tribune
December 13, 2016
Minnesota Community Measurement, a nonprofit that analyzes claims data from health plans, has released a report that finds smaller, rural clinics tend to be more expensive overall. The nonprofit identified a few outliers to this trend. Clinics with expanded hours and initiatives to reduce unnecessary care were below state averages for patients’ visiting the emergency room and requiring inpatient hospital care. Reporter Jeremy Olson has the story.