By George W. Chapman
While the government is finally reopened, the fate of the tax subsidies remains in limbo.
Without tax credits, commercial premiums on the exchange are anticipated to increase 26%. That’s the largest increase in eight years.
According to the Kaiser Family Foundation, if enhanced tax credits (subsidies) are not extended, a family of four with income of $75,000 will pay $5,865 in premiums for a typical middle-of-the-road silver plan. That’s more than double the $2,500 they would ultimately pay with subsidies. Catastrophic plans sound cheaper but they cover far less and have deductibles up to $10,600 for individuals and $21,200 for families.
Let’s hope the government, now that it reopened, will settle the tax subsidy issue. For some inexplicable reason, the administration has floated the idea of removing the pre-existing condition requirement which gave us all the freedom to switch insurance companies without fearing a condition will not be covered. But health care sticker shock is not limited to the ACA. Commercial insurance for employers will increase around 6% next year. That is an astonishing $27,000 a year for family coverage. Employers kick in an average $6,850. Surprise: insurers cite drug prices as the main culprit for the increase.
Googling ‘Weight Loss’
Most of us will “Google” anything regarding our health as an informed consumer is a good thing. Right? However, if you search “weight loss drug” odds are Ozempic will pop up. The problem is Ozempic has not been approved for weight loss. It is approved to treat Type 2 diabetes. Your friendly drug manufacturer can circumvent rigid truth in advertising rules for TV and magazine ads by paying for non-regulated “sponsored search results” which drive you to their websites. It’s legitimate, but it’s sneaky.
Novo Nordisk’s Ozempic is on the Medicare drug negotiation hit list. So sponsored search results for Ozempic will probably increase “off label” sales to compensate for negotiated price reductions with Medicare. Novo spent an estimated $7.5 million over two years for more than 15,000 paid keywords related to weight loss searches resulting in 2.4 million visits to the Ozempic website.
Food Inspectors: Be Careful What You Eat!
Significant staff cuts by the administration of FDA food inspectors comes at a time when the U.S. is increasingly dependent on foreign food, especially seafood and fresh fruit.
Since the layoffs, foreign food products have increasingly been linked to outbreaks and foodborne illnesses. In 2011, the FDA was authorized to hold foreign food producers to the same standards as domestic food producers. Makes sense not only from a health and safety standpoint but from a competitive one as not having to comply with US standards means foreign producers can easily undercut domestic prices. In July, the administration further exacerbated things by slashing the Foodborne Diseases Active Surveillance Network. It now can only track salmonella and a type of E. coli. The network used to track eight foodborne illnesses. Be careful what you eat!
Mergers Down
The economic climate of chaos and uncertainty has impacted healthcare as well as all businesses. The result has been an 18% decrease in healthcare mergers and acquisitions through September of this year (1,015) compared to the same period last year, (1,238).
Inconsistent federal policies and regulations regarding mergers and acquisitions, reimbursement, foreign physicians and even tariffs (cost of drugs and medical equipment) have contributed to the decline. Most impacted by the decline would be small and rural hospitals and urban hospitals in medically underserved areas as merging with larger healthcare systems could be their only means of survival, especially when it comes to physician staffing.
Sustaining Rural Health
Considering mergers and acquisitions are declining and may continue to decline, rural and small hospitals cannot stand still waiting for a lifeline. The $50 billion Rural Health Transformation Program will not be sufficient to support and sustain rural providers. It is only $5 billion a year for 10 years.
There are about 1,800 rural hospitals left. So, the Health Policy Future Lab’s summit met in September to brainstorm around declining federal support and direction. Among their ideas are: enhanced planning, funding and collaboration with the state government; using pharmacists as workforce extenders; using EMS for more than transport; increasing remote monitoring, remote physician care and AI to expand services and capacity.
Healthcare is very labor intensive and expensive so increased use of technology (capital versus people) will be critical for rural and small hospital survival.
No Smoking: Country Bans Smoking
The Maldives (chain of islands south of India in the Indian ocean, pop, 500,000) is the first country in the world to outright ban smoking to anyone born after January 1, 2007. That includes purchasing or using tobacco. Vaping is already banned to all citizens of all ages. The tiny country has a universal healthcare system. New Zealand banned smoking then reversed. Apparently, politics eventually won the day over health. More than seven million people a year die from tobacco-related illnesses.
George W. Chapman is a retired healthcare business consultant who worked exclusively with physicians, hospitals and healthcare organizations. He used to operate GW Chapman Consulting based in Syracuse.