The Census Bureau says the number of uninsured Americans dropped in 2000, for the second year in a row — a trend many experts doubt will continue, thanks to a weakening economy.

The number of uninsured dropped from 39.3 million in 1999 to 38.7 million. Fourteen percent of the population was uninsured in 2000, compared with 14.3 percent in 1999.

In addition, the number of uninsured children dropped, by 693,000, to 8.5 million; the number of poor children without insurance dropped, by 248,000, to 2.5 million. The number of low-income adults without insurance declined to 9.2 million, from 10 million in 1999.

The good news was fueled by an increase in enrollment in health coverage that is sponsored by employers. The number of people with employer-sponsored benefits rose by more than 3 million, to 177 million, according to the Census Bureau.

The bad news, though, is that the economy has been slowing. "I expect to see an increase in the number of uninsured in 2001 because people have been losing their jobs," says Kate Sullivan, director of health care policy at the U.S. Chamber of Commerce.

The Philadelphia Inquirer cites a report from the Center for Studying Health System Change, which says that in 2000, health costs increased by 7.2 percent — the largest increase in 10 years — and health premiums increased 11 percent.

There are indications that the Bush administration, though preoccupied with the war on terrorism, is forging a strategy for health issues. Health and Human Services Secretary Tommy Thompson tells Congress Daily that legislators may still find a way to address a number of health care initiatives.

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.