�鶹Ů��

California lawmakers have been trying for more than a decade to protect hospital patients from being hit with huge bills from doctors who aren’t part of their health insurer’s network. They have another opportunity to do so this year, and they should seize it. ... AB 72, would require out-of-network doctors to obtain a patient’s permission at least a day before providing non-emergency treatment at an in-network hospital or clinic. If the patient doesn’t voluntarily agree to be treated by a specific out-of-network doctor and pay the extra charges, he or she couldn’t be billed for more than an in-network provider would have cost — even if out-of-network doctors are brought in. Any participating out-of-network doctor, meanwhile, would have to accept the average amount paid to in-network doctors or go to arbitration with the insurer. (7/12)

Congress is about to pass a bill meant to deal with the nation’s opioid epidemic. It contains some good ideas. It will also be far less effective at saving lives than it should be. The Senate is expected to vote soon on the measure, approved by the House on Friday by an overwhelming 407-to-5 majority. It would authorize addiction treatment and prevention programs to stem what has become a scourge and a disgrace — more than 28,600 overdose deaths in 2014. But it contains not a penny to support those initiatives. (7/12)

The federal health reform known as the Affordable Care Act has dramatically reduced the number of Americans without insurance. In California, the rate of adults under age 65 without coverage has fallen from 23.7 percent to 11.1 percent since the law took effect. But as many of the newly insured have discovered, there’s a big problem lurking behind those numbers: Even with insurance coverage, it can still be very difficult for consumers to find a doctor. (Daniel Weintraub, 7/11)

In an era when bipartisanship is rare, the U.S. House of Representatives has taken a step toward providing more care and treatment of severely mentally ill people. The U.S. Senate, including California Democrats Dianne Feinstein and Barbara Boxer, should take a cue from the House and approve HR 2646, the Helping Families in Mental Health Crisis Act. The bill, introduced after the slaughter at Sandy Hook Elementary School in 2012, passed the House by a vote of 422-2 – not a typo. (7/11)

It’s understandable why most Massachusetts legislators weren’t talking publicly last week about one particular amendment they cut from the state budget before sending it to Governor Charlie Baker. Opposing a measure titled “Preventing patient abuse in nursing homes” probably wouldn’t sit well with constituents, especially older ones, who tend to vote in droves. The proposal, which called for drastically increasing the limit on fines that can be levied against nursing homes for health and safety violations, seemed to have broad support on Beacon Hill. Until it didn’t. (7/11)

President Obama’s Special Communication reports substantially slower increases in health care spending during the first 5 years of the ACA (2010-2014). One question is whether this slowing occurred because of the ACA, or because of other factors unrelated to the ACA .... The slowing of health care spending began in 2006, before both the ACA was passed and the onset of the 2008 recession. A previous study suggested that the specific cost-saving components of the ACA during this period could not have accounted for this moderation in growth. ... So if not the ACA, why was inflation-adjusted Medicare spending declining on a per-capita basis during 2010-2014? ... the early enthusiasm for many then-new technologies developed in the 1990s and 2000s ebbed beginning in 2006, leading to a general “exnovation” or scaling back of many common and expensive treatments such as coronary artery bypass graft surgery, carotid endarterectomy, coronary artery stenting, and inpatient back surgery. (Jonathan Skinner and Amitabh Chandra, 7/11)

First, perhaps the most significant surprise since 2010 is the substantial deceleration in health care costs. The conventional wisdom at the time the ACA was enacted was that despite its ostensible dual mandate, the act largely addressed the coverage problem while doing almost nothing to address cost trends. ... So why has this happened? For employer-sponsored insurance, the evidence points strongly to the economic downturn as the primary impetus. ... For Medicare, by contrast, the evidence shows little if any business cycle effect. The Medicare trend thus provides the most suggestive structural evidence of “bending the cost curve.” (Peter R. Orszag, 7/11)

The president is also unduly sanguine about the future of health care costs. Financing of Medicare has benefited from a slowdown in the increase in health costs. But this trend preceded enactment of the ACA, and many analysts are uncertain about the cause and continuation of the slowdown in the growth of health care costs, attributing much of the moderation to the Great Recession. The president could be correct that the ACA will slow the growth of per capita health spending, but the CBO and others expect spending to increase more rapidly in the future. (Stuart M. Butler, 7/11)