A new RAND Corporation study concludes that eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges. The study comes as the U.S. Supreme Court prepares to hear arguments in March regarding the constitutionality of the individual mandate, a key provision of 2010's Affordable Care Act. According to estimates created using a microsimulation model created by the RAND Comprehensive Assessment of Reform Efforts (COMPARE) program, the number of Americans predicted to get coverage in 2016 under the Affordable Care Act would drop from 27 million to 15 million if the individual mandate were eliminated. Despite that drop, the study estimates that eliminating the individual mandate would increase an individual's cost of buying insurance through the individual exchanges by just 2.
Researchers from Mount Sinai School of Medicine have found that laws permitting children to stay on their parents' health insurance through age 26 result in improved access to health care compared to states without those laws. This analysis indicates the potential positive impact of a key provision of the Patient Protection and Affordable Care Act of 2010 (ACA). The study appears in the March issue of the journal Pediatrics, the official journal of the American Academy of Pediatrics. The ACA requires private insurance companies to support children on their parents' policies through age 26. The Mount Sinai research team analyzed the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System survey and compared the period before the state laws were enacted (2002 to 2004) to the period after the state laws went into effect (2008 to 2009).
How can insurers justify spending hundreds of thousands of dollars per patient per year on "orphan drugs" - extremely expensive medications for rare conditions that are mostly chronic and life-threatening - when this money could provide greater overall health benefit if spread out among many other patients? Those spending decisions reflect the "rule of rescue, " the value that our society places on saving lives in immediate danger at any expense. But the broad application of the rule of rescue will be increasingly difficult to support as "personalized medicine" produces more drugs genetically targeted to relatively small groups of patients, concludes an article in the Hastings Center Report. For example, rather than a new blockbuster drug that treats millions with hypertension, new targeted therapies will treat only those few thousand with a particular genetic makeup.
The financial burden Americans face paying out-of-pocket costs for prescription drugs has declined, although prescription costs remain a significant challenge for people with lower incomes and those with public insurance, according to a new RAND Corporation study. Despite the improvement, more than 8 million nonelderly Americans lived in families with high drug-cost burden in 2008 and one in four devoted more than half of their total out-of-pocket medical spending to prescription drugs, according to findings published in the February edition of the journal Health Affairs. "Our findings are evidence of the success of strategies already in place to help lower the cost of medications for consumers, even during a period when medication use was increasing, " said Dr. Walid Gellad, the study's lead author and a researcher at RAND, a nonprofit research organization.
There are ways in which patients who leave the hospital against medical advice wind up paying for that decision. Being saddled with the full cost of their hospital stay, however, is not one of them. Insurance companies know this. Patients who walk out may know this. But many physicians, according to a study published in the Journal of General Internal Medicine, do not. A survey of general internal medicine doctors at the University of Chicago Medicine found that two-thirds of residents and almost half of attending physicians believe that when a patient leaves the hospital against medical advice, insurance companies will not pay for the patient's hospitalization, leaving the patient liable for the full hospital bill. "We have all heard this, and many physicians may have passed it on to their students, even to patients threatening to leave on their own, " said study author Vineet Arora, MD, associate professor of medicine at the University of Chicago Medicine.