5 Things We’re Watching – Washington, November 2013

We take a holistic, generalist’s view on health care and health policy.  So we are watching how disparate, seemingly unrelated things may impact the evolving conversation in health care, through both quantitative and qualitative means.

So, we’re watching what we think are some important data points out this month:  JAMA studies, HCA innovation plans, and election results, to name a few.

DJ Wilson - Host, State of Reform 

1. JAMA: ‘65% of healthcare costs from aged 65 or younger’

Last week, JAMA released perhaps the most important study I’ve read on health costs in years.  It overturns some mainstream notions about costs in America.

84% of costs in American health care today come from chronic conditions from the entire population, not just the elderly.  In fact, 65% of all costs in American health care today come from chronic conditions from people under the age of 65.

Personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%.  Price is 91% of the increase in costs, not utilization or service intensity.

2. Governor Jay Inslee to give lunch keynote

This morning, we posted the draft Topical Agenda for our January 8th State of Reform Health Policy Conference.   Honestly, I think it might be our most important, most timely event we’ve ever done.

We are really excited about the agenda, about the input from our Convening Panel, and about the outreach many of you have done to engage us in the conversation.  We try to create a policy agnostic, non-partisan forum where all credible voices and perspectives can learn, listen, and engage.  And, we think this year may be as important as ever that we hit that mark.

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3. Oregon’s exchange website still not up

Cover Oregon, the exchange in that state, has yet to “go live” over 50 days from launch.  The state-led effort, which won accolades earlier this year, is now being called “worse than healthcare.gov” – an unkind label if there ever was one.

Rocky King, the exchange CEO did a good job of lowering expectations (Item 1) this summer, but the implications to innovation in the market there are real and starting to be felt.  He goes on the “hot seat” today before the Oregon Legislature to answer questions after being put “on notice” by his own board just a few days ago.

4. 133-page draft “innovation” plan from the HCA

The HCA released a long awaited draft state health care innovation plan a few weeks ago, and the buzz we’re hearing doesn’t portend well for the state.

We’ve heard a few private comments on the plan which probably aren’t what the HCA wants to hear.  “I followed this process closely, and attended a number of meetings, but I don’t know where much of this came from.”  “This is a lot of new complexity with no new money, and no clear outcome benefits.”  “It’s not good for us to be seen as negative with the HCA, but we’ll work to kill it in the Legislature.”

That strikes me as a problem for the SHCIP’s future.  However, if CMS comes through with $100m in funding, that may change a few things…

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5. A political ‘fork in the road’

Are Washington State politics – and by extension health policy – about to become polarized?

On the one hand, the left seems about to get worked up over how extremely leftward they should move.  There is a Socialist on the Seattle City Council now calling on Boeing workers to take over Boeing factories.  There is a state party chair race on where the victor will have to ‘out-liberal’ the others.  And, they just lost an important state Senate seat held by a moderate physician, no less.  Will this push Democrats significantly leftward on policy?

On the other hand, Republicans nationally used opposition to Obamacare to make strong gains in recent elections, and are looking now to 2014.  Even where they lost, opposition to the ACA narrowed the gap.  Will Republicans follow national trends, or stay constructively engaged on health policy?