Thurston & Lovey, Subsidized

Courtesy of HotAir, we have this story about the North Star State's health insurance exchange, as well as its Medicaid program:

"When a millionaire on Medicaid calls you and says, ‘I’m going to spend the winter in Florida. Can you help me find a doctor,’ it’s like, what?”

Of course, this is hardly exclusive to Minnesota; the rules for calculating subsidy and Medicaid eligibility all rely on solely income. And if you're a millionaire, well, then, you have access to some rpetty sharp accounting folks who can help you make darned sure that your MAGI is within acceptable range for either a subsidy or Medicaid.

There is, though, this little question:

"If they have $500,000 or $1 million in net worth, should these people qualify for subsidies?"

To which I would reply: Talk to the Hand, Judge Learned Hand.

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Vaping in the News

We haven't posted on vaping in a while; last time we looked it was in relation to how The ObamaTax treated it for rating purposes (Spoiler Alert:Smoking/Vaping bad, Meth use fine). It's important to distinguish between vaping e-liquid with nicotine extract vs completely nicotine-free. Although artificial nicotine is available, there's really no way for the consumer or an underwriter to know whether or not any nicotine present in the e-liquid is artificial or tobacco-extracted.

There's another vaping-related controversy: is it a gateway to cigarette use, or a path away from tobacco? This has been a long-running battle, with both sides claiming (perhaps justifiably) that the science was in their favor.

Recent new evidence has come to light, though, which seems to bolster one side's position:

"Latest Data from England Refute Argument that E-Cigarettes Do Not Help Smokers Quit"

In a recent study, English researchers found that the success rate for folks trying to kick the tobacco habit has increased "dramatically" in recent years. They set about trying to determine what, exactly, is driving this positive new trend, and proposed the hypothesis that "a shift in methods used for quitting is propelling this change." And what would that method shift entail? Well:

"Starting in 2011 and coinciding precisely with the increased quit rate was a dramatic shift away from the use of nicotine replacement therapy (NRT) in quit attempts and towards the use of electronic cigarettes."

So, not so much the patch as the e-cig? There's apparently some decent enough info to back that up, but they hinge on the fact that "[p]rior to 2011, virtually no smokers in England were using e-cigarettes to try to quit smoking, while approximately 30% were using NRT." That makes sense, but it's also important to remember that *correlation ≠ causation."

So, promising to be sure, but still a ways from being dispositive.

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Rx News: 70/30 is the new 80/20

It's a truism that (for example) 20% of one's customers create 80% of one's problems; the ratio is applicable to many other situations, as well.

But one area where it's apparently not is specialty meds:

"3 percent of the total pharmacy prescriptions are considered specialty, but they cost 30 percent of a plan’s overall pharmacy expense."

I should point out that this isn't exactly groundbreaking news; as we reported almost 6 years ago, "[a]ccording to UHC, "specialty medications" (e.g. injectibles) are used by less than 1% of its insureds, but represent an astonishing 20% of its pharma claims." And of course, med's are a major driver of health insurance costs, which is why we're seeing so many of them being moved to higher (and more expensive to the insured) tiers.

As pointed out in the article linked above, pharma costs increased 13% in 2014, driven in large part by "a 30.9 percent increase in spending on specialty pharmaceuticals." And it's only going to become worse as the population ages, generating demand for more and more meds to combat chronic conditions like arthritis and Alzheimers.

Happy days, indeed.

[Hat Tip: Allison Bell]

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Monday LinkFest

■ First up, some potential good news in the war on cancer, specifically the early detection there of:

"Scientists are developing a 10-minute cancer test which can be taken at home with just a drop of saliva"

Just as with pregnancy tests, this simple and inexpensive (about $20) tech is unobtrusive and doesn't require even a pinprick of blood; best of all, it's (supposedly) 100% accurate.

It's about to enter clinical trials this year, and they're hoping for FDA approval by 2018.

■ The Zika virus is the newest crisis-du-jour, and with good reason: it's already led to numerous birth defects, and is thus far unstoppable. Add to that the fact that certain areas - particularly in the Caribbean - seem more infested than others, and the folks who sell travel insurance plans are having to really step up their game. FoIB Holly R passed along this news:

"InsureMyTrip, a travel insurance comparison site, reported a 20% surge in calls last week from travelers worried about the virus." The number one question they're getting is whether folks traveling to Zika hotspots can, out of an abundance of concern, cancel their trips and receive a refund.

The short answer: probably not. The longer answer: it depends. On what, you may ask? On whether or not you purchased the upgraded plan that includes an "any cause" bailout provision. Something to consider if you'r e planning that mid-winter cruise...

■ We've long been proponents of Concierge-model health care. As FoIB Jeff M tips us:

"North Raleigh physician is state's first embracing hybrid medical model ... under which patients pay an annual retainer fee and in return receive longer consultations during their office visits, along with Belcea’s promise to track patients’ medical conditions more closely and follow up as he or they see a need to do so."

As The ObamaTax continues its stranglehold on how healthcare is financed (and hence delivered), I would expect to see many more physicians adopt this type of practice (or it's cousin, Direct Primary Care).

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(Un)Sustainability: 1,000 Words

Phrasing!

Ummm:

[Source]

[Hat Tip: Ʀєfùsєηíκ]

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Late Breaking: Money, Money Health Wonk Review

Steve Anderson hosts this week's break-out edition of the Health Wonk Review. It's about money, for sure, bit it's also about egregious wealth creation (well, okay, that's money) and wasteful legislation, patient-centered care and connectivity.

In fact, it's just a great collection of thought-provoking insights - kudos to Steve!

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