Ideally, health reform involves righting wrongs in the system.

By Clifton Leaf and Sy Mukherjee
March 8, 2017

Good morning. Much has been said and written about the GOP’s replacement bills for Obamacare, including this great roundup of reactions from Sy. Alas, I was closing the magazine and couldn’t weigh in. But this morning, I woke up with a swirl of questions in my head about the Republican plan—the two House bills introduced into the Ways and Means and the Energy and Commerce Committees on March 6—and what comes next. But here’s just one:

What problems do the replacement bills solve? This is the very good question that Peter Suderman asked in a blog post for Reason magazine, which often offers thoughtful analysis from a conservative point of view. Republican leaders have railed against Obamacare since its inception, contending that the mandate to buy insurance was un-American and that it created a new entitlement program with potentially runaway costs.

But their “fix” doesn’t fix any of that. The legislation swaps out an Obamacare penalty (that goes to taxpayers) for failing to buy insurance with a new hefty penalty (that goes to insurance companies) for those who lapse in coverage. As for the big, sweeping infrastructure (the exchanges), it largely keeps that as well. The so-called “entitlement” remains intact, too—with the tax credits of the old system rejiggered, but still there; and the Medicaid payments changed, but still there. (At least a few commentators have suggested that the Republican plan incentivizes states that have yet to accept the Medicaid expansion to rush into the federal program before the window shuts.) As Suderman sums up: “So Republicans would be replacing one set of insurance subsidies with another set of insurance subsidies, while killing the individual mandate but leaving many of the law’s insurance regulations intact.” Yup.

It’s no wonder conservatives in Congress and the commentariat have voiced their full-throated rejection of the plan, calling it “Obamacare Lite,” “Obamacare 2.0,” and my favorite: “RINOcare” (for “Republican-in-name-only”).

My question really isn’t about what it fixes or doesn’t fix about Obamacare, but rather about what it solves in our healthcare system in general. Does it address soaring costs? (Not that I can see.) Does it encourage innovation, new models of collaboration, data sharing? (Hmm.) Does it shift the focus to the prevention of disease rather than fight the costly rear-guard battle that we fight now? (No, it seems to do just the opposite.)

Obamacare, for all its flaws, at least temporarily shored up a rickety system of private, employer-based, and public insurance providers by essentially guaranteeing insurers a market with millions of newly enrolled citizens. I think that was one of its big mistakes, frankly—but that’s for a different column. The program has also helped 20 million Americans get insurance, many for the first time. So one could fairly say that the Affordable Care Act “solved” something.

The Republican plan, by virtually all early readings, is likely to cause many to lose their insurance. It will encourage private companies to stop covering employees (the new legislation cancels provisions in Obamacare that prevent that), and it isn’t likely to shore up anything.

So my question again: What does it solve?

Clifton Leaf
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

Amazon Alexa can now answer health-related questions using WedMD. “Alexa, ask WebMD how to treat a cough.” That’s right – Amazon has updated its digital assistant so that it can now read through the mountains of medical information on WebMD and answer users’ medical questions. The feature will be available across Alexa-enabled platforms including the Echo, Echo Dot, and Amazon Fire TV. This isn’t Alexa’s first foray into health care triage and symptom analysis, either. Digital health firm HealthTap’s “Dr. AI” – which offers significantly more detailed services – is also compatible with the tech. (Fortune)

Study rains on the virtual doctor visit parade. There’s considerable, and unmet, demand for telemedicine services in the U.S. But a new study published in the journal Health Affairs suggests a digital doctor visit may not be all that cost-effective or reduce health care spending. The ironic reason? Making it easier to access a doctor also leads to a higher demand for services even when there’s not much need for a consultation. In fact, just 12% of telemedicine visits actually replace a costlier in-person visit – the other 88% is all just new demand, according to the study. (Kaiser Health News)


INDICATIONS

Cost watchdog says Sanofi’s Lemtrada is the only fairly priced multiple sclerosis drug. The Institute for Clinical and Economic Review (ICER), the cost watchdog gadfly of the biopharma industry, is out with a new report finding that the vast majority of multiple sclerosis medications on the market aren’t cost-effective. In fact, the sole treatment that ICER considers a “good value” compared with supportive care is Sanofi’s Lemtrada. Treatments from Biogen, Novartis, Teva, and others were all considered too expensive to provide reasonable value. (FiercePharma)

GV leads $51.7 million Series C for company developing new antibiotics. GV (formerly Google Ventures) has led a $51.7 million Series C funding round for Spero Therapeutics, a company striving to make sorely-needed new antibiotics. Other investors in the round include RA Capital Management and Rock Springs Capital, according to a press release. “The financing provides us the necessary resources to execute our aggressive strategy to address this growing threat of multidrug-resistant bacteria, and we are proud to have earned the confidence of such well-respected partners in our efforts,” said Spero CEO Ankit Mahadevia in a statement. Last month, the World Health Organization (WHO) released its first-ever list ranking the most dangerous drug-resistant bacteria.

Novo may finally be trying to branch beyond its diabetes focus. Danish drug giant and diabetes specialist Novo Nordisk is reportedly in talks to snatch up the U.S. biotech Global Blood Therapeutics Inc., which is creating therapies for serious blood disorders, sources tell Reuters. The details are still sparse, but many analysts have noted that Novo should consider branching out much further from its diabetes and insulin treatment focus. (Reuters)


THE BIG PICTURE

Pretty much the entire medical industry is united against the GOP’s Obamacare replacement. To pile on to Cliff’s observations and queries above, almost every single major medical group has now come out in opposition to the GOP’s American Health Care Act. The list now includes the American Medical Association (AMA), the AARP, the American Hospital Association (AHA), the American Academy of Pediatrics (AAP), the American Psychiatric Association (APA), and the Federation of American Hospitals, among others. All of these groups list concerns ranging from the bill’s likely effect of slashing insurance coverage and making it more difficult for poorer and older Americans to afford out-of-pocket medical costs to its dismantling of public health and preventative medicine funding. The lone trade giant that has yet to speak? America’s Health Insurance Plans (AHIP). (Fortune)

IUD procedures are continuing to climb under Trump. President Donald Trump’s election led to a flurry of requests for IUD procedures amid concerns that the president and a GOP-controlled Congress would slash funding for Planned Parenthood and other women’s health initiatives (and, in fact, the new Republican Obamacare replacement plan does de-fund Planned Parenthood). That trend doesn’t appear to be slowing down. A new analysis  by athenaInsight finds that IUD-related visits spiked 21% between October 2016 and January 2017 compared with the same time period one year ago, and that overall IUD procedures soared 30% in January 2017 compared with January 2016.


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