Health Politics

McKinsey & Company released a study last week that has caused a kerfuffle here in DC. The study claimed that 30% of employers “will definitely or probably stop offering coverage after 2014” as a result of the implementation of the Affordable Care Act. 

Opponents of the health reform law quickly seized on that number as further proof of President Obama’s anti-business, job killing agenda and bungling of health reform. House Speaker John Boehner’s office posted a blog entitled: “New Report: ObamaCare Will Eliminate Health Coverage, Cost America Jobs,” which breaks down the “troubling” analysis from McKinsey indicating employers ready abandon employee coverage en masse.

On closer inspection, McKinsey’s analysis turns out to be more troubled than troubling. The McKinsey study runs counter to virtually every other non-partisan review of the law’s impact on employer-sponsored insurance, as was pointed out by Time,Business Finance, Politico, the Washington Monthly and others. Even theWall Street Journal acknowledged “previous research has suggested the number of employers who opt to drop coverage altogether in 2014 would be minimal.” That’s not to say that a study countering common wisdom should be discounted out-of-hand, but it does raise enough eyebrows to warrant a closer look – especially when the common wisdom you are countering is your own.

Ironically, the author of an Urban Institute study used by the White House to refute the McKinsey report is none other than McKinsey’s own Bowen Garrett, the chief economist at their Center for U.S. Health System Reform. In his Urban Institute paper, Garrett dismantles “claims that the ACA would cause major declines in [employer-sponsored health insurance],” calling them, “greatly exaggerated.”

Wait, you mean McKinsey published a study claiming 30% of employers will drop employee coverage, in direct contradiction to the expressed position of one of their head health honchos? Mr. Garrett was unavailable to comment.

A closer look at the McKinsey study turns up other inconsistencies. The company has declined to release the methodology or wording of the survey questions – both of which can bias results. McKinsey did acknowledge that the survey “educated respondents about [employer sponsored insurance] implications for their companies and employees before they were asked about post-2014 strategies.” That alone could have influenced respondents’ answers. Without knowing the survey questions, the “educational” script, or the methodology, it’s impossible to know whether or not the design of the survey would itself generate an anti-health reform result. Such a survey is certainly not a sufficient base to support the authors’ prediction of “a radical restructuring of employer-sponsored health benefits.”

What’s most interesting, however, is that McKinsey – institutionally – agrees. Though officials within the company’s press office were unwilling to speak on-the-record, a well-placed source at McKinsey said, “The objective of the survey was to better understand employers' decision making related to employee benefits today and post reform. We were not making a point prediction or forecast about employer behavior after the implementation of health reform.”

The study’s authors appear to have overreached. Their article begins, “the shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower-income workers alike.” That certainly sounds like the type of economic prediction that the McKinsey insider says the study was never intended to be.

This post originally appeared as a guest opinion piece on Kaiser Health News on Tuesday, June 7th, 2011.

House Budget Committee Chairman Paul Ryan, R-Wis., probably did not anticipate the kind of trouble his plan for privatizing Medicare would cause members of his own party. Ever since Democrats scored an upset in a New York state special congressional election that turned on the Republican candidates support for the Ryan plan, GOP presidential hopefuls and lawmakers have been stumbling around the negative reaction the "Path to Prosperity" has drawn from many voters.

Americans have every reason to dislike Ryan's plan. Starting in 2022, it would give Medicare beneficiaries an $8,000 voucher -- the amount currently spent on the average recipient -- to go out and buy health insurance on the private market. Eight thousand dollars won't buy much health insurance in many markets, and seniors who can’t make up the difference would be left with little or no coverage.

However, there is one good thing about Ryan's plan, and it has been completely overlooked. Offering beneficiaries the same voucher, no matter where they live, would expose the egregious amount of money Medicare wastes in many parts of the country.

In Minneapolis, Medicare spent on average about $7,000 per beneficiary in 2007, the most recent Dartmouth Atlas figure available. That's on the low end. Medicare spent about the same amount in Sacramento, Calif., and Salt Lake City, and even less in Salem, Ore. At the high end, Medicare paid out nearly $16,000 per beneficiary in McAllen, Texas. Spending in Miami, Detroit and Boston wasn't far behind.

The Republican majority has passed a bill out of the House of Representatives to repeal the Patient Protection and Affordable Care Act signed into law last year by President Obama. Though the vote itself is symbolic, the hostility to the law is very real.

Here are the three most important things to understand about the “repeal” effort.

This article is cross-posted at newamericamedia.org.

The Republican majority has passed a bill out of the House of Representatives to repeal the Patient Protection and Affordable Care Act signed into law last year by President Obama. Though the vote itself is symbolic, the hostility to the law is very real.

Here are the three most important things to understand about the “repeal” effort.

The repeal ain’t gonna happen...yet. The full-scale repeal bill is extraordinarily unlikely even to come up for a vote in the U.S. Senate as Democrats maintain a majority there.  However, this may no longer be the case after the elections in 2012. If the Republicans gain a majority in the Senate and win the presidency, all bets are off. The major provisions of the bill aren’t implemented until 2014, so there would still be plenty of time for the Republicans to “repeal and replace” much of federal healthcare reform. Between now and then, they will hold a series of oversight hearings and advance small initiatives designed to defund and otherwise handicap the process of implementing the bill.

With Republicans vowing to dismantle the health law and courts wrestling with its constitutionality, some health policy experts are pondering a possible "Plan B" in case the individual mandate – the requirement that everyone get health insurance starting in 2014 – is weakened or struck down.

Six months ago, when I was researching an article on health reform implementation in the states, I had to choose three states to focus on -- red, blue, and broke (California). I also did a separate little story on Connecticut's path to a public option.

Red was Georgia -- we know health reform has an uphill battle there (although it's gotten more uphill since last spring).

California is turning out pretty much as I expected; Republican Schwarzenegger and the Democratic legislature have passed a framework for an exchange, Jerry Brown will replace Schwarzenegger, the legislature is still Democratic -- and the state is still broke but moving ahead in an admirably determined fashion.

Senate Republicans eager for a face-to-face with the new CMS Administrator Don Berwick got their wish. Dr. Berwick appeared today before the Senate Finance Committee for a hearing on the future of Medicare and Medicaid. Democrats focused their questions on how Dr. Berwick and the Affordable Care Act could improve the American health care system, while Republicans focused on Berwick’s nomination (he took office as a recess appointment, without formal Senate confirmation) and the length of the hearing. (The hearing was cut short by a vote on food safety legislation on the Senate floor, which irked many committee members -- Senator Hatch called the time available “pathetic”).

Berwick opened his testimony by recalling his father’s long career as a general practitioner, and what he had learned from it -- Berwick’s vision of health care is responsive, embedded in a community and connected to it, and focused on the needs of patients and families. The health care world today is full of new and wonderful technologies, Berwick said, and is much more complicated -- compared to what his father could do in his day, our current health system can work miracles ... when everything goes right.

We'll be live tweeting today's Senate Finance Committee hearing, Strengthening Medicare and Medicaid: Taking Steps to Modernize America’s Health Care System. The guest of honor this morning is Dr. Don Berwick, the administrator of the CMS. Follow along live starting at 10am, hashtag #SFC #hcr, over at NewHealthDialog on Twitter.

The Alliance for Health Reform held a session on the political future of the Affordable Care Act today, and here are some highlights (slightly delayed after my netbook went into a deep dark and mysterious hibernation from which it just awoke). All three speakers predicted a three-pronged attack by House Republicans.

Legislative (repeal or repeal and replace or some variant). Appropriations to try to "defund" reform. Neither are likely to succeed. And, third, oversight hearings, repeatedly grilling top Obama administration health officials, which is also a way of fighting what one of the speakers reminded us was the real battle to preserve the benefits of health care -- the battle for the hearts and minds before the next election.

Heather Kelley over at INQRI Blog hosts the latest edition of the Health Wonk Review, "Health Wonk Review Wishes You a Happy Veteran's Day," and commemorates all who serve our country for their sacrifice and commitment. She also thanks health care bloggers for their dedication to improving the health of our nation and links to the best blog submissions, which cover the mid-term elections, health care costs and the Initiative on the Future of Nursing report. Check it out!