The Republican strategy of repealing the Patient Protection and Affordable Care Act (PPACA) before devising a replacement plan has the support of only one in five Americans, according to a new survey by the Kaiser Family Foundation. The poll also disclosed that shrinking the federal government’s involvement and spending in health care—the long-sought goal of many Republican lawmakers—is less important to most Americans than ensuring that medical care is affordable and available.

Views were split not only on partisan lines but also within the Republican Party, where nearly four in 10 thought the government should guarantee that health care is available to the elderly and to low-income people.

Despite the rout of Democrats in the election, which gave the GOP control of both the White House and Congress, the public’s views on the PPACA remain as divided as they were since the act was passed by congressional Democrats––without Republican participation––in 2010. Currently, 47% of the public wants to keep the act, which upended the way insurers do business and expanded coverage to an estimated 20 million Americans.

In the new survey, more respondents (28%) wanted a replacement plan announced before the PPACA is repealed than those who said the act needed to be dismantled immediately (20%).

The poll also found that Democratic fears that repeal of the PPACA will damage health care are not shared by most Americans. Sixty percent of the respondents believed that the quality of their care would remain the same after repeal, and only 20% thought that their care would worsen. Families in which someone had a serious medical condition were more worried, but even among them, only a third anticipated that the cost of their health care would suffer if the PPACA were dismantled.

Moreover, the poll found that the public’s most widely shared health goal is reducing the cost of care, with 67% of respondents calling it a top priority. Lowering the cost of prescription drugs was a top priority for 61% of respondents, followed by addressing prescription pain-killer addictions (45%). Repealing the PPACA was a top priority for 37% of respondents, primarily among Republicans.

The poll was conducted on December 13–19, 2016, among 1,204 adults.

Source: Kaiser Health News; January 6, 2017.

Managed Care’s Top Ten Articles of 2016

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.