The Daily Rise: Wednesday, July 27

Media Check: AP Error on Drug Spending

Did the Associated Press ignore important figures in calculating the driving force behind rising health care spending?

Dr. Bob Goldberg fact checks AP’s claims that “the rapid rise in spending for pricey drugs threatens to make the popular prescription benefit financially unsustainable.” He points to several factors that contradict their conclusions. Among the points he raises in a post at

  • CBO Analysis of Drug Costs: A 2013 CBO analysis found that Part D drug costs between 2007-2010 “increased by just 1.8 percent per year per beneficiary, growing more slowly than total per capita drug costs.” From 2010-2013 per capita costs increased by 1.6 percent.
  • Improved Adherence: “Improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare.”
  • Reduced Hospitalizations: Another study found that part D spending reduced hospitalizations generally by 4.1 percent.
  • Shorter Hospital Stays: Among beneficiaries with limited or no prior drug coverage Part D reduced the number of overnight hospital stays by about 12%, and among beneficiaries with generous prior drug coverage Part D reduced the number of hospital nights by about 21%.

Yes, we need to address the rising cost of health care. In order to do that, we must accurately review all of the factors contributing to health care costs — rather than look for the convenient headlines.

Health Insurance Tips for Baby Boomers

Until health care costs are brought under control, patients should take steps to properly prepare.

Maurie Backman of the Motley Fool offers three helpful health insurance tips for Baby Boomers. Tip #1: Coverage under Medicare isn’t totally free

“All in all, Medicare enrollees spend thousands of dollars each year to cover their health-related needs,” Backman reminds patients. “According to the Kaiser Family Foundation, in 2010, Medicare beneficiaries spent an average of $4,745 on out-of-pocket healthcare expenses.”

For other health insurance tips, check out the entire piece at The Motley Fool.

Quote of the Day: CMS Concerns

“With programs like this we do have the potential to create a new tension that didn’t exist before – the same physician who is caring for me is also concerned about the cost of my care. Might he be altering what’s best for me because of the cost constraints?”

Dr. Robert Siegel, director of oncology at Bon Secours St. Francis Health System, one of nearly 200 providers nationwide participating in the Center for Medicare and Medicaid Services pilot project.

We are all for models to bring costs down — if patient care is not sacrificed. It remains to be seen whether that’s possible here. As cancer care continues to become more individualized, it’s unclear how much savings there would really be from CMS’s pilot project.

Affordable Care Act: Legal Uncertainty

Back in 2012, the U.S. Supreme Court upheld the constitutionality of the individual mandate. That doesn’t mean the Affordable Care Act is clear of legal challenges.

Morning Consult examines the remaining legal challenges to the Affordable Care Act — which could deal a devastating blow to the landmark health care law. By far, the biggest of the cases, House v. Burwell, challenges the cost-sharing reduction subsidies provided to insurers.

“The market’s adjusting, and I’m hoping it’s going to stabilize, but if the House succeeds in House v. Burwell, if they succeed ultimately, it’s going to be a huge kick in the gut for health insurers in the individual market,” Tim Jost, an emeritus law professor at Washington and Lee University, told Morning Consult.

An analysis by the left-wing Urban Institute claims that silver plan premiums would increase $1,040 per person in 2016, if the House prevails in its legal challenge.

“Even if insurers are allowed sufficient time to modify premiums, they may leave the marketplaces in response to the continued litigation and associated policy changes, the lack of predictability such changes create, and the costs such changes impose on insurers,” the Urban Institute says.

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