HCAO News

Why in Heaven's Name Aren't Teeth Considered Part of Our Health?

It is estimated that 108 million Americans have no dental insurance.

AlterNet, April 26, 2016
by Susan Sered / The Conversation

When we talk about the successes and shortcomings of the Affordable Care Act, and health care in the U.S. in general, little attention is given to dental care. While the ACA defines dental coverage as an essential benefit for those under 18, insurers aren’t required to offer dental coverage for adults. Medicare, the nation’s largest insurer, doesn’t cover routine dental work. And coverage for adults through Medicaid varies from state to state.

It is estimated that 108 million Americans have no dental insurance, and that one in four nonelderly Americans has untreated tooth decay.

Oral health isn’t just about nice teeth. As the surgeon general noted in a 2000 report, oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.

The absence of comprehensive dental care exacts a toll on millions of Americans in terms of poor health, pain and the social stigma associated with bad teeth.

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Is U.S. Drug Pricing Debate Leaving Europe Feeling Good?

The Wall Street Journal, Money Beat, April 22, 2016
by Helen Thomas

Are the transatlantic tables turning in pharmaceuticals?

Switzerland’s Novartis said this week that it was seeing faster uptake of its heart failure drug Entresto in Europe than in the U.S. The potential blockbuster, which Novartis believes could generate $5 billion in annual peak sales, has been struggling: it sold just $17 million in the first quarter with Novartis guiding to $200 million for the year, well below consensus forecasts.

With heightened focus on the burden of high U.S. drug prices, Novartis said it was getting a better reception in Europe’s single-payer system than in the U.S. for its value-for-money pitch for Entresto, which helps to reduce rates of hospitalization. That would be a real turn-around: for years, pharma companies have benefited from high prices for innovative drugs in the U.S., while struggling in Europe.

The shift may be less dramatic than it seems. Novartis later conceded that Entresto is priced at €5.50 a pill in Europe, about half the list price in the U.S. Of course, no one pays the list price. But Novartis also suggested that its pricing of the drug, which got a nod of approval from the Institute for Clinical and Economic Review, meant more limited discounts on offer to payers than seen elsewhere.

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Analysis of Claims Data Finds Workers' Out-of-Pocket Health Costs Growing Faster Than Costs Paid by Insurers

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The Lund Report, April 13, 2016
by Amy Jeter

For workers covered by their employer's health plans, out-of-pocket costs including deductibles and coinsurance have been increasing significantly faster than costs paid by insurers, reflecting a decade-long trend toward slightly less generous coverage, a new Kaiser Family Foundation analysis finds.

Between 2004 and 2014, covered workers' average out-of-pocket costs grew 77 percent, outpacing health plans’ average payment per enrollee, which rose by 58 percent. Overall, workers' out-of-pocket costs rose from an average of $422 in 2004 to $747 in 2014, while average payments by health plans rose from $2,748 to $4,354. As a result, the average generosity of health plans declined slightly, covering 85.3 percent of covered medical expenses in 2014, compared with 86.7 percent in 2004.

Trends varied for different types of patient cost-sharing. Workers’ payments toward deductibles rose 256 percent (from an average of $99 to $353), and their payments towards coinsurance increased 107 percent (from an average of $117 to $242). Average payments for copays decreased by 26 percent, from $206 to $152.

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