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The GOP healthcare "agenda" in 2023
Their lack of message in the 2022 SotU came back to haunt them in Nov. and is again
Good morning and happy Friday. Welcome to this week’s Friday Pulse Check; your weekly newsletter that shares some of the most interesting and relevant stories in the healthcare world.
Finding good healthcare news can be difficult. For example, several cable news outlets this morning spent their entire shows discussing the Biden and Trump documents that were both found where they shouldn’t have been. Those stories, while somewhat important, ignore the 99% of other important things going on in the world.
With that in mind, we’ll take a break from that and take a look at the other things going on that are more relevant to us in the news:
Corporate takeovers in healthcare could threaten cost and clinician autonomy
As we have discussed several times on the FLATLINING Podcast and here on the Friday Pulse Check, large retail entities are making moves into the healthcare sphere. “Big Retail” (for lack of a better term) has been making inroads into the primary care market. For example, Amazon.com (AMZN 0.00%↑) proposed a $3.9 billion purchase of OneMedical, CVS’ (CVS 0.00%↑) has planned an $8 billion acquisition of Signify Health and exploring a purchase of Oak Street Health, and Walmart (WMT 0.00%↑) , Optum, Humana (HUM 0.00%↑) , and Agilon Health (AGL 0.00%↑) are all looking into their own buys.
As Ron has said on the podcast, Amazon.com may be able to make primary care “better, cheaper, and more efficient.” Some researchers in the New England Journal of Medicine May disagree. In a recent article, they write that there may be potential for people who have insurance and there might be good IT and capital investments and good work/life balance for physicians, but they are concerned by the financial reasons these companies are moving in. Instead of starting a clinic based on some ethic or religious value, they’re purchasing them to make money. Their argument isn’t that different from those opposing private equity involvement in healthcare. They recommend more aggressive antitrust actions, that the Centers for Medicare and Medicaid Services be more vigilant of the risk-coding system for Medicare Advantage reimbursement, and more scrutiny or corporate-owned primary practice referrals. (I’ve provided such a long summary because this article may be paywalled for some readers). Read more in the New England Journal of Medicine 🔒.
How will the House GOP govern healthcare in 2023?
Some political commentators are catching up to what I said a year ago: Republicans wouldn’t (and didn’t) campaign on healthcare in the midterms. It may have even cost them their loss because it is an important issue for independents who swung to the left in November. So now the commentaries are coming out about what they should do. Some conservatives want to see the expansion of Healthcare Savings Accounts. As Ron and I have talked about on the podcast, while these are really good in concept, they have not been shown to lower healthcare costs (or more importantly in this case) in healthcare debt in reality. They’re too niche of a product and Americans aren’t great at saving anyway.
Secondly, they want to reform how the Food and Drug Administration approves drugs. They probably want to see this because of the COVID-19 vaccines, and not because the FDA approved a very expensive, ineffective Alzheimer’s drug last year that Republicans fought to be covered by Medicare.
Finally, some want to pass the Personal Option. I had to look this one up and when the outline is not front and center on the homepage, I’m already skeptical. But I did find it and it seems to be a laundry list of wants that will “fix the US healthcare system.” Including giving everyone an HSA (see above), promoting direct primary care, and having price transparency. Ron and I talked about the problems with Direct Primary Care on the podcast (click here to listen) and price transparency laws are already on the books but aren’t enforced by HHS. Plus, as we said this week on the podcast, they don’t really cause patients to shop around anyway.
I guess they get points for having an agenda when they didn’t a year ago?
Keep in mind, none of what they pass will become law. No formative healthcare reform will happen in 2023 or 2024 because it will not be agreed upon in the Democratic-controlled Senate and President Biden will not sign it.
The NC State Health Plan
In the podcast this week, Ron and I spent the entire episode discussing the North Carolina State Health Plan saga that has been ongoing since 2019. State Treasurer Dale Folwell announced earlier this month that the health plan network would be administered by Aetna instead of BlueCross BlueShield of North Carolina in 2025.
Obviously, this puts state employees and teacher patients in the middle of this battle. Aetna will likely be able to build a new network for the health plan but if Mr. Folwell is going to continue to demand the rates he demanded under BCBS NC, it will be a much smaller network than what he has now.
That leaves providers with an uncomfortable decision: join the new network at potentially lame rates or don’t see the thousands of state employees as patients.
Things will take a while to iron out and it is possible the deal won’t even go through. BCBS NC is suing to find out how Aetna won the bid. They will likely argue in court that Aetna isn’t going to be able to save the state any money because they’re not going to offer the state the same product. Whatever happens, we’ll tell you about it here on the Friday Pulse Check and on the FLATLINING Podcast.
Next week on the podcast…
Ron and I will be discussing how Congress avoided an 8% cut to the Medicare reimbursement rate. It is some interesting math that includes adding negatives and subtracting positives. We’ll break it down for you next week on the FLATLINING Podcast, so subscribe now wherever you listen to podcasts.
(Comments may be featured on the show!)
Ever wonder what it is like to see patients on the frontline of a warzone? Dr. Elena Molchanova spoke with Agence France-Presse about how her patient visits go in Bakhmut, Ukraine. Apparently, she is just one of five doctors who have remained in the city and must serve the 8,000 residents who have stayed amidst the Russian invasion. Read more in AFP via Yahoo! News.
For patients with type 2 diabetes, a new (old) piece of medical technology could automatically regulate insulin delivery. Type 1 diabetics have had access to the artificial pancreas for a while, an implant that produces insulin similarly to a pancreas. The device for type 1 diabetics requires user input; the patient must report to the system about the timing and the size of their food intake and then insulin delivery is automated after that. The new and improved version for type 2 diabetes requires no input. Roughly 20-30% of patients with type 2 diabetes require insulin therapy to manage the illness and this device would be for those patients. Read more in U.S. News.
Pro-tip: Don’t be like Biden and Trump and leave classified documents out. The same advice could be said for protected health information.
Have a good weekend,