Wellness programs don’t really work … except for employers

I’m a little slow on this but it seems companies really want to get genetic information on employees:

A little-noticed bill moving through Congress would allow companies to require employees to undergo genetic testing or risk paying a penalty of thousands of dollars, and would let employers see that genetic and other health information.

Employers got virtually everything they wanted for their workplace wellness programs during the Obama administration. The ACA allowed them to charge employees 30 percent, and possibly 50 percent, more for health insurance if they declined to participate in the “voluntary” programs, which typically include cholesterol and other screenings; health questionnaires that ask about personal habits, including plans to get pregnant; and sometimes weight loss and smoking cessation classes. And in rules that Obama’s Equal Employment Opportunity Commission issued last year, a workplace wellness program counts as “voluntary” even if workers have to pay thousands of dollars more in premiums and deductibles if they don’t participate.

That doesn’t sound very good but at least it helps the health of employees:

Rigorous studies by researchers not tied to the $8 billion wellness industry have shown that the programs improve employee health little if at all. An industry group recently concluded that they save so little on medical costs that, on average, the programs lose money. But employers continue to embrace them, partly as a way to shift more health care costs to workers, including by penalizing them financially.

and from here:

The so-called “Safeway Amendment” was added to the ACA. Now, if you fail, or refuse to take part in, your employer’s “voluntary” wellness test, it can increase your premium by 30 percent — or, if you’re a smoker who refuses to quit, by 50 percent.

There is no evidence that this new rule produced a significant drop in America’s health-care costs. And that isn’t terribly surprising — since Burd’s column was composed almost entirely of lies.

“[A] review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years, the Washington Postreported in January 2010. “Those costs did drop in 2006 — by 12.5 percent. That was when the company overhauled its benefits … the decline did not have anything to do with tying employees’ premiums to test results. That element of Safeway’s benefits plan was not implemented until 2009.”

In other words, Safeway reduced costs for a single year by raising its employees’ deductibles. It didn’t save money by encouraging its workers to lead healthier lives — it saved money by making its workers pay a larger portion of their health-care costs.

Gee, it doesn’t help the employees but does help the employers. What a shock. And it gets better:

The privacy concerns also arise from how workplace wellness programs work. Employers, especially large ones, generally hire outside companies to run them. These companies are largely unregulated, and they are allowed to see genetic test results with employee names.

They sometimes sell the health information they collect from employees. As a result, employees get unexpected pitches for everything from weight-loss programs to running shoes, thanks to countless strangers poring over their health and genetic information.

So, to summarize, Obama and Congress were convinced to put a provision into the ACA that did basically shifted costs from the employer to the employee for little or no health benefits and now the GOP wants to expand that provision. You have to love it.

Here’s the Trump/Republican agenda

Today we get an idea of what Trump and Republicans want to do:

The revised order is narrower and specifies that a 90-day ban on people from the six countries does not apply to those who already have valid visas or people with U.S. green cards.

According to the fact sheet, the Department of Homeland Security will conduct a country-by-country review of the information the six targeted nations provide to the U.S. for visa and immigration decisions. Those countries will then have 50 days to comply with U.S. government requests to update or improve that information.

Additionally, Trump’s order suspends the entire U.S. refugee program for 120 days, though refugees already formally scheduled for travel by the State Department will be allowed entry. When the suspension is lifted, the number of refugees allowed into the U.S. will be capped at 50,000 for fiscal year 2017.

This will probably cut the number of visitors to the US, cut the number of students who want to go to college in the US, and cut the number of people who want to work in the US. This will cost millions of jobs and redirect some of the best and brightest to Europe and Canada.

House Republicans on Monday released their long-awaited plan for unraveling former President Barack Obama’s health care law, a package that would scale back the government’s role in health care and likely leave more Americans uninsured.

House committees planned to begin voting on the 123-page legislation Wednesday, launching what could be the year’s defining battle in Congress.

GOP success is by no means a slam dunk. In perhaps their riskiest political gamble, the plan is expected to cover fewer than the 20 million people insured under Obama’s overhaul, including many residents of states carried by President Donald Trump in November’s election.

The proposal would continue the expansion of Medicaid to additional low-earning Americans until 2020. After that, states adding Medicaid recipients would no longer receive the additional federal funds Obama’s law has provided.

More significantly, Republicans would overhaul the federal-state Medicaid program, changing its open-ended federal financing to a limit based on enrollment and costs in each state.

The changes also might crash the individual market to make it impossible for tens of millions of Americans to get health insurance. That would be a plus for Republicans.

However, it was the next phrase Carson uttered that landed him in hot water.

“There were other immigrants who came here in the bottom of slave ships, worked even longer, even harder for less,” Carson said. “But they too had a dream that one day, their sons, daughters, grandsons, granddaughters. . . might pursue prosperity and happiness in this land. And do you know of all the nations in the world, this one, the United States of America, is the only one big enough and great enough to allow all those people to realize their dream.”

Ok, that seems a little unfair. Well:

The original nine plaintiffs claim that detainees are forced to work without pay and that those who refuse to do so are threatened with solitary confinement.

Specifically, the lawsuit claims, six detainees are selected at random every day and forced to clean the facility’s housing units. The lawsuit claims the practice violates the federal Trafficking Victims Protection Act, which prohibits modern-day slavery.

‘‘Forced labor is a particular violation of the statute that we’ve alleged,’’ Free said. ‘‘Whether you’re calling it forced labor or slavery, the practical reality for the plaintiffs is much the same. You’re being compelled to work against your will under the threat of force or use of force.’’

This has been going on for a while so it’s not just the new administration, except that President Obama tried to cut back on private prisons for this type of reason and the Trump administration wants to expand them:

Notably, the stocks of the two biggest private prison operators, Geo Group and CoreCivic (formerly known as Corrections Corporation of America), have surged since Trump’s election. The companies donated a total of $500,000 to Trump’s inaugural festivities, USA Today reported.

Since Trump took office, his administration has reversed the Obama administration’s policy to end the country’s reliance on private prisons.

And if a little slavery slips in, well all for the better. Just ask Ben Carson–immigration and slavery are basically the same thing.

Trumpcare=No Care

Via Kevin Drum, we see how well Donald Trump and Republicans have prepared for the elimination of Obamacare:

Congressional Republicans, despite pledging to quickly repeal the Affordable Care Act, are struggling with what parts of the law to roll back and how to lock up the votes they will need, particularly in the Senate, to push their ambitious plans.

Thirty-one states, including many with Republican governors, have expanded Medicaid through Obamacare and could lose billions of dollars if the law is cut back.

In Washington, Republicans are also struggling to figure out what to do with Obamacare insurance marketplaces that Republicans worked for years to dismantle. In a reversal, GOP leaders now are trying to figure out how to prevent their collapse, which would jeopardize coverage for millions more Americans.

Insurance experts, including leading industry officials, have repeatedly warned Republicans over the past several months that repealing the health law without a replacement risks destabilizing insurance markets and will push many insurers to simply stop selling health plans.

So, not only will the repeal likely lead to tens of millions of people losing their health insurance it might actually wreck the entire individual health insurance market. Things would be even worse than before the ACA was passed:

But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the startup years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

And now comes the reality of the “repeal and replace” initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.

Some in Congress seem to think that passing the “repeal” part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.

How does the Trump administration plan to deal with this?

The budget legislation gives congressional committees until Jan. 27 — a blink of an eye for lawmakers — to write legislation repealing major parts of the health care law. Likely targets include the law’s tax penalties for people who don’t obtain insurance, its requirement that many companies cover workers and tax increases on higher-earning individuals and many health care firms.

Aware they have no chance of quickly agreeing on replacement legislation, Republicans plan to delay when their repeal would actually take effect. A range of 18 months to three years — perhaps longer — has been under discussion.

Trump has provided few specifics about how he would revamp the nation’s $3 trillion-a-year health care system. Steps he and congressional Republicans have mentioned include greater reliance on tax credits to help people afford coverage.

Republicans don’t want to abruptly end health care coverage for millions of voters who live in GOP-represented districts and states, or cause chaos in health care markets and prompt insurance companies to stop selling policies. So they are considering including provisions in their repeal bill to protect consumers and insurers during the transition period.

Sen. John Thune, R-S.D., a member of the GOP Senate leadership, said that could include money to temporarily continue helping people afford to buy coverage and language letting the Department of Health and Human Services help stabilize insurance markets.

A few things:

  • Republicans have been talking about repealing the ACA since it was passed and they have no plan to replace it yet? Obviously they have never really planned a real replacement.
  • Given the above discussion, it’s very possible that the repeal of the ACA will crash the individual insurance market so it won’t matter if there are subsidies since there will be no companies willing to participate in the market. Why would a company participate in a market they know will be gone in a few years and which depends on Congress supporting them to break even–knowing that Congress reneged the last time such a promise was made?
  • Given all the complexities, they are going to write the repeal legislation very quickly. I’m sure they will be very well written and carefully vetted.

Donald Trump, being Donald Trump, is trying to get out the lie that any failure will be the fault of Democrats:

massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight – be careful!

Sorry Donald, this will all be on you and the Republicans. You will be responsible for tens of millions of Americans losing health insurance.

Trump will screw Trump states

Kevin Drum put this up:

Once Obamacare’s subsidies are repealed, it’s likely that 3 million people with expensive pre-existing conditions will be instantly tossed out of the health care system, unable to get insurance and unable to afford proper care.

He’s using the numbers from here. If you look at the chart in Kevin Drum’s post you notice that the states with the highest percent of people with pre-existing conditions voted for Trump. In fact, there are 23 states that are at or above the US average of 27% with pre-existing conditions–of these 4 voted for Clinton including Maine which split electoral votes (3 for Clinton, 1 for Trump). And all 11 with 30% or higher voted strongly for Trump (Clinton got less than 40% of the vote in all those states).

Hey, here’s a scatterplot (DC is the one in the upper left):

pre-exist

Donald Trump has said he wants to keep the ban on people being denied health insurance if the have pre-existing conditions but the health insurance companies will go bankrupt unless they’re allowed to charge them much more and/or force almost everyone to have insurance. Since the mandate to have insurance is not one of the things Trump wants to keep, health insurance will become unaffordable to a good chunk of these people which is why Kevin Drum says that 3 million of these people will be instantly tossed out of the health care system.

Trump voters really know how to stick it to themselves.

Mylan and the EpiPen

Heather Bresch and Mylan Pharmaceuticals are both clever and stupid. Mylan is the company that makes the EpiPen, you might have heard about this. They were clever enough to spread their increases over many years:

Since 2009, Mylan has jacked up the price of the lifesaving allergy treatment an incredible 15 times. The list price on a two-pack of EpiPens is $609, up 400% from seven years ago.

And they mostly tried to hide the price from consumers:

Mylan said the company never intended for patients to pay the full price, expecting insurers would carry the load.

“We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter,” chief executive Heather Bresch said in a statement.

But they’re also pretty stupid. At some point you can’t hide price hikes if you do it so many times and increase the price too much–they just got too greedy and now a bunch of Senators have sent them a letter noticing that price of the EpiPens has soared as the salary of the CEO has as well:

Reports emerged last week that the company had implemented a series of gradual price increases inflating the price of the drug from $56.64 to $317.82, a 461% increase in cost since Mylan acquired the rights to EpiPen in 2007. During that same time, Heather Bresch, chief executive officer of Mylan, saw her pay rise $2,453,456 to $18,931,068, a 671% increase. Last week, she sold 100,200 of her shares in the company for more than $5m.

What’s their explanation?

“We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter,” Bresch said in the company’s statement Thursday. “Patients deserve increased price transparency and affordable care, particularly as the system shifts significant costs to them. However, price is only one part of the problem that we are addressing with today’s actions.”

Given that one of the reasons insurance premiums are soaring and copays are increasing is the increased cost of drugs, Heather Bresch is basically blaming herself and her company but pretending otherwise. So far it doesn’t seem to be working. You’ll notice that the prices in the Guardian article are the price Mylan charges the middlemen, so those increases are all on Mylan. Here’s hoping they lose lots of money over their greed.

Conservatives and women

Via here, we get this:

The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.

But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain “in the absence of war, natural disaster, or severe economic upheaval”.

From 2000 to the end of 2010, Texas’s estimated maternal mortality rate hovered between 17.7 and 18.6 per 100,000 births. But after 2010, that rate had leaped to 33 deaths per 100,000, and in 2014 it was 35.8. Between 2010 and 2014, more than 600 women died for reasons related to their pregnancies.

No other state saw a comparable increase.

In the wake of the report, reproductive health advocates are blaming the increase on Republican-led budget cuts that decimated the ranks of Texas’s reproductive healthcare clinics. In 2011, just as the spike began, the Texas state legislature cut $73.6m from the state’s family planning budget of $111.5m. The two-thirds cut forced more than 80 family planning clinics to shut down across the state. The remaining clinics managed to provide services – such as low-cost or free birth control, cancer screenings and well-woman exams – to only half as many women as before.

The report is here and its interpretation is much more circumspect:

The Texas data are puzzling in that they show a modest increase in maternal mortality from 2000 to 2010 (slope 0.12) followed by a doubling within a 2year period in the reported maternal mortality rate. In 2006, Texas revised its death certificate, including the addition of the U.S. standard pregnancy question, and also implemented an electronic death certificate. However, the 2006 changes did not appreciably affect the maternal mortality trend after adjustment, and the doubling in the rate occurred in 2011–2012. Texas cause-of-death data, like with data for most states, are coded at the National Center for Health Statistics, and this doubling in the rate was not found for other states. Communications with vital statistics personnel in Texas and at the National Center for Health Statistics did not identify any data processing or coding changes that would account for this rapid increase. There were some changes in the  provision of women’s health services in Texas from 2011 to 2015, including the closing of several women’s health clinics. Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a 2-year period in a state with almost 400,000 annual births seems unlikely. A future study will examine Texas data by race–ethnicity and detailed causes of death to better understand this unusual finding.

The study is actually much more scathing in regards to something much more basic:

It is an international embarrassment that the United States, since 2007, has not been able to provide a national maternal mortality rate to international data repositories such as those run by the Organization for Economic Cooperation and Development.22 This inability reflects the chronic underfunding over the past two decades of state and national vital statistics systems. Indeed, it was primarily a lack of funds that led to delays (of more than a decade in many states) in the adoption of the 2003 revised birth and death certificates. This delay created the complex data comparability problem addressed in this study. The lack of publication of U.S. maternal mortality data since 2007 has also meant that these data have received a lesser degree of scrutiny and quality control when compared with published vital statistics measures such as infant mortality. For example, had the National Center for Health Statistics and the Texas vital statistics office both been publishing annual maternal mortality rates, the unusual findings from Texas for 2011–2014 would certainly have been investigated much sooner and in greater detail. Accurate measurement of maternal mortality is an essential first step in prevention efforts, because it can identify at-risk populations and measure the progress of prevention programs.

The study notes the same thing as the WHO does here, the US is one of the few countries in the world where the mortality rate for pregnant women is going up and it has one of the highest in the developed world (for example it is double that of Canada). That’s pathetic.

 

Government works, part two

Republicans keep saying that Obamacare has been a disaster. Let’s see what a recent study says:

A study published Monday in JAMA Internal Medicine offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.

Their survey found people in Arkansas and Kentucky were nearly 5 percent more likely than their peers in Texas to say they were in excellent health in 2015. And that difference was bigger than it had been the year before.

The survey also asked about other subjects. It found that people in the expansion states were more likely to have a doctor and to have a place to go for care. They said they were more likely to have their chronic disease treated, and that they were more likely to have received screening for high cholesterol or high blood sugar, markers for heart disease and diabetes.

On financial measures, the study was in line with some previous studies, finding that people in Kentucky and Arkansas were less likely to postpone care or avoid taking prescribed drugs because of the cost, and that they were less likely to be struggling with a medical bill.

Gee, a government program has made people healthier. That’s going to end civilization as we know it.

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