First post of 2017

 Happy New Year!  The 115th Congress goes to work tomorrow. This gives Congress a two and half week long head start on the executive branch before the clock starts to run on the Trump Administration’s first 100 days.

On Saturday afternoon, at the 11th hour, a federal judge from the Northern District of Texas ruled  that the government “Defendants are hereby ENJOINED from enforcing the [HHS PHSA 1557] Rule’s prohibition against discrimination on the basis of gender identity or termination of pregnancy.” A copy of the preliminary injunction decision is available here.  The FEHBlog was pleased for the plaintiffs but he erroneously thought that the lawsuit also encompassed other onerous provisions of the rule, such as the document translation requirements.

An injunction against provisions of the rule not found in the statute, such as the document translation requirements, would have nullified those requirements. The issue of whether PHSA Section 1557 reaches the two issues that the court addressed can be fought out in private litigation, even if the government cannot enforce the rule. So the decision is a half loaf, which of course is better than none.

Healthcare Dive had an useful report on the optimism and challenges for putting value in value-based care.

The FEHBlog also ran across two interesting studies:

  • UPI reported on “A new [Journal of the American Medical Association] study of health care costs found that just 20 conditions make up more than half of all spending on health care in the United States. The study, which covered 155 conditions, showed the most expensive health condition was diabetes, which totaled $101 billion between diagnoses and treatment costs, and spending increased 36 times faster than the cost of heart disease.” Heart disease was ranked number 2 in the study.  Back and neck pain ranked third.  “Aside from the top three conditions, hypertension and injuries from falls made up 18 percent of all personal health spending and totaled $437 billion in 2013. Other conditions among the top 20 included musculoskeletal disorders, such as tendinitis, carpal tunnel syndrome and rheumatoid arthritis.”
  • Physicians’ Briefing reports that 

[JAMA Pediatrics] researchers observed an increase in health care spending on children from 1996 to 2013, from $149.6 billion to $233.5 billion. The largest health condition leading to health care spending for children was inpatient well-newborn care in 2013. The second and third largest conditions were attention-deficit/hyperactivity disorder and well-dental care. In 2013, infants younger than 1 year had the greatest spending per child at $11,741. There was an increase in health care spending per child from $1,915 in 1996 to $2,777 in 2013. In absolute terms, the greatest area of growth in spending was ambulatory care among all types of care; among all conditions, the greatest areas of growth were in inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma.

The FEHBlog presumes that it’s no coincidence that the federal government’s State Children’s Health Insurance Program law was enacted in August 1997.  Not a knock on health care spending for children; just an observation.