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This Week in Health Care Reform - June 19th, 2015

Concern mounts that skyrocketing prices are putting drugs increasingly out of reach; a new survey lays the foundation for broader comfort with telehealth; tensions mount ahead of the much-anticipated Supreme Court decision; and, a small percentage of beneficiaries are found to account for a large portion of overall spending in Medicare.


Week in Review

Skyrocketing Worries: Advances in the ways in which we’re able to diagnose, treat, and, in some instances, cure illness have put our health care system on the precipice of a new age for medicine.  But, what good are these advances if no one can afford them?  That’s the question that seems to be on everyone’s mind these days as new treatments make their way to market.  And, nowhere is that worry more prevailing than when it comes to prescription drugs.  With so many of these drugs now priced so high, there’s legitimate concern that they’re increasingly out of reach for many patients.  In fact, with 40 percent of the country projected to have their health care coverage through government-sponsored programs (Medicare, Medicaid, or the exchanges) by 2017, accounting for nearly 60 percent of all prescriptions, stakeholders across the spectrum are getting understandably nervous.  A quick scan of the horizon doesn’t offer much hope either.  A new class of cholesterol drugs is expected to hit the market soon, and while that in and of itself might not be front-page news, the estimated $23.3 billion in new costs they’re expected to add to our system should stop the presses.  For their part, pharmaceutical executives continue to turn a deaf ear to the hue-and-cry being raised over the issue, offering up the same tired talking points (while quietly brushing aside any information that might undermine their position).  But, a new survey threatens to shake up the debate, casting the industry in an even harsher light.  In its latest Health Tracking Poll, the Kaiser Family Foundation found that a large majority of people not only thinks that prescription drug costs are unreasonable, but place the blame squarely on the drug companies for setting their prices too high, as well.  Unfortunately, it doesn’t look like it’s going to get much better any time soon, with worldwide spending on cancer drugs, alone, expected to hit $100 billion next year.  And, taken a step further, global prescription drug sales are forecasted to reach $987 billion by the end of this decade.  As the world continues to come to grips with this harsh new reality, it’s clear that we find ourselves teetering on the brink, a diagnosis without an easy prescription.  

Unaware, but Interested:
Despite steady gains in adoption rates and utilization across the health care industry, telehealth continues to find itself fighting an uphill battle.  Whether it’s infrastructure issues or combatting ingrained bias against its widespread application, digital technology and its capability to transform health care delivery still have to fight and scrap for every inch of progress.  A new survey only serves to highlight this disconnect, but also offers hope for telehealth advocates.  Compiled by :DentalPlans, the study found that approximately two-thirds of the 6,800 respondents polled were unfamiliar with telehealth.  However, upon having it described to them, 59 percent said they’d be willing to give it a try.

With the calendar running out on the Supreme Court’s current term, the wary (and weary) eyes of supporters, opponents, and the merely curious, anxiously watch the Court to see how the Justices will ultimately rule in the King v. Burwell case.  Given what’s at stake in the immediate aftermath of the ruling, it should come as no surprise that tensions are running high.  GOP leaders, already struggling to get their rank-and-file to coalesce around a plan, now face additional pressure from the growing field of candidates with their eyes on next year’s Presidential campaign.  For its part, the Administration, having already acknowledged the lack of an ‘easy fix’ in the wake of the Court’s decision, nonetheless remains adamantly opposed to any Republican plan that would seek to extend the subsidies while also undoing some of the health care law’s key provisions. 

Medicare Drivers:
About two-thirds of Medicare beneficiaries have multiple chronic conditions, according to a new analysis by USA Today.  Perhaps of greater concern, though, is that 15 percent of those beneficiaries, some 4 million people, have at least six chronic conditions and account for more than 41 percent of Medicare’s overall $324 billion in spending.  Driving these costs is the steady influx of Baby Boomers to the program, many of whom bring with them more health conditions than the previous generation of Medicare beneficiaries, while also living longer, leading some experts to caution that neither our health care system nor these seniors are prepared for the financial and emotional crisis that lies ahead.

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Looking Ahead

Whatever the Supreme Court decides in the case challenging the subsidies granted through the federal exchange, many states find themselves unprepared for the fallout, despite having been urged to map their way to a solution.  Meanwhile, there’s growing concern that the government is also without a viable backup plan – a glaring omission that others stand ready to correct

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