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I read 7 Republican Obamacare replacement plans. Here’s what I learned: Sarah Kliff, Vox

Posted by on November 17, 2016

Summary: “If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare,” writes Sarah Kliff over at Vox. “But Obamacare repeal would leave an estimated 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly clear that Republicans can’t just repeal Obamacare — they need to replace it with something.
It turns out Republicans have a lot of choices: There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years. I’ve spent the past week reading them, and what I’ve learned is this:

  • Yes, Republicans have replacement plans. It is true that the party has not coalesced around one plan — but there are real policy proposals coming from Republican legislators and conservative think tanks. There is a base that the party can work from in crafting a replacement plan.
  • There is significant variation in what the plans propose. On one end of the spectrum, you see plans from President-elect Donald Trump and Sen. Ted Cruz that would repeal Obamacare and replace it with virtually nothing. On the other end of the spectrum, there are plans from conservative think tanks that go as far as to keep the Affordable Care Act marketplaces and continue to give low-income Americans the most generous insurance subsidies.
  • If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s.
  • Economic analyses estimate that these plans reduce the number of Americans with insurance coverage. The actual amount varies significantly, from 3 million to 21 million, depending on which option Republicans pick. They will near certainly provide more coverage than Americans had before Obamacare, but also less than what exists currently under the health law.” Sarah Kliff, “I read 7 Republican Obamacare replacement plans. Here’s what I learned,”

What’s next for the ACA? A roundup of early predictions

Posted by on November 17, 2016

Summary: No one really knows what will happen when Donald Trump takes office, in light of his pledge to repeal the Affordable Care Act. Nothing is as simple as it sounds ever in life; also, Trump will have to contend with the fact that many parts of the A.C.A. were wildly popular with insurance companies, hospitals and other providers, big drug companies and a host of other health care market players who profited from it. Also, it’s wise to recall that health spending has been an engine of the economy; health stocks have boomed, by and large, and health sector jobs have risen consistently for a number of years. So, what will happen? Prognostications abound. Here are some, selected from post-election writings by people who have reason to make wise predictions about the future. But we won’t really know until the new president and congress take their seats in January. So: Fasten your seatbelts.

Read more…


Our pledge to you in the wake of the election

Posted by on November 16, 2016

Summary: Now that we have some distance from Donald Trump’s election victory on Tuesday, we can look to what’s ahead and where we fit in. Trump has been quoted as saying that he will repeal the entire Affordable Care Act, and also that he would repeal only parts of it. Not much is certain at this point.

It’s worth remembering that the insurance companies, the drug companies and hospitals benefited greatly from the A.C.A. So did a vast number of intermediaries. Taxpayer dollars have subsidized insurance for millions of people, who then went out and bought health care. Health stocks boomed, and health sector employment did too. Also, there are certain things a president cannot do without the approval of Congress. And once any attempt at repeal comes to the fore, we can expect armies of lobbyists protecting the interests of their clients.

Despite this uncertainty, we can be sure of a few things. Many people will lose their health insurance in some not especially predictable fashion. The uncertainty will mean that more marketplace actors will be seeking to protect or enlarge their piece of the pie, so we should all keep our hands on our wallets. There will be a lot of anxiety, and a lot of attempts to spin public opinion, so we should all remain as calm and as fact-based and logical as possible.

One other thing is certain: Our work here at ClearHealthCosts is more important now than ever.

We will continue to give you reliable, unbiased, trustworthy information, and to relieve your anxieties in any way possible. For example, if you need a procedure, check out our blog and our price lists to see the variations in pricing, and make the best decisions you can for your health and your pocketbook. If your medication prices skyrocket, use our prescription shopping resources. Got a question? Then go to the blog and search for your topic; chances are, we’ve covered it. Or email me! I’m 

And remember this: For routine procedures and for many medications, the cash market is just not that scary. We would never recommend that anyone go without insurance, but we hear a lot from people saying they were insured but they paid less in cash than they would have using their insurance. I’ve written about this and so have others: The Los Angeles Times, the Wall Street Journal.

Also: Your generosity has brought us to over a third of our goal in our crowdfunding campaign on iFundWomen. We need more help, so please: call out to your networks and ask them to support us. Send them this note, with our link to our iFundWomen page. Together we are strong. 

We are here to help you through the next few months and years with as much knowledge as we can supply, and we are grateful for the support and trust you have placed in us. And now, back to work.

Jeanne and the ClearHealthCosts team


Abortion cost searches: How do people use our data?

Posted by on November 9, 2016
Seen at Trafalgar Square.

Garry Knight, Creative Commons attribution license.

Summary: We’re often asked how people use our data. One of our most visited posts is this one on “how much does an abortion cost?” This is information that’s hard to find, and we see that a lot of our visitors are typing this into their search bar — or some variant of this wording — particularly on Saturday and Sunday mornings, on smartphones and other mobile devices like iPads and similar tablets. Click here to support our project on iFundWomen to improve our mobile experience.

A lot of the visitors are from college campuses. Here’s a partial census from three days in early November of the networks that sent us people seeking abortion pricing, collected from our web analytics:

Arizona Tri University Network, Austin College, Bard College, Binghamton State University, Boston University, Bryn Mawr College, California State University at Sacramento, California State University, Central Methodist University, Colgate University, Dartmouth College, Drew University, East-West University, ECPI Colleges in Virginia Beach, Emory University, Fordham University.

Iowa State University, Kennesaw State University, Loyola Marymount University, Madonna University, Montana State University, Montclair State University, New York University, Northern Arizona University, Oregon State University, Penn State, Richard Stockton College of New Jersey, Rowan University, Rutgers University, Sonoma State University, St. John’s University –New York, State University of New York at Oswego, State University of New York at Stony Brook, SUNY College at Cortland, SUNY Stony Brook.

Susquehanna University, Syracuse University, Temple University, Tennessee Technological University, Texas A & M University, Texas State University –San Marcos, Texas State University, the University of California at Santa Cruz, Towson State University, Tulane University, University of Alabama, University of California — Riverside, University of California — San Diego, University of California at Berkeley, University of California at Davis, University of Central Florida, University of Connecticut, University of Dayton, University of Florida, University of Georgia, University of Hawaii, University of Houston.

University of Massachusetts, University of Michigan, University of New Haven, University of New Mexico University of Notre Dame, University of Pennsylvania, University of South Carolina, University of Tampa, University of Texas at Austin, Villanova University, Virginia Commonwealth University, Virginia Polytechnic Institute, Washburn University, Washington State University, Wellesley College. Wofford College.


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A doctor’s view on payments: Cherry-picking and lemon-dropping

Posted by on November 7, 2016


Guest post summary: “The dirty little secret of current medical payment changes is doctors and hospitals now have a financial incentive to not provide care for some patients, those who put the providers at higher risk of financial penalties. We call this phenomenon cherry-picking and lemon dropping,” writes Mary O’Connor, M.D., Yale School of Medicine and Yale-New Haven Hospital, in a guest post.


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A Medicare practice wastes money and infuriates doctors: KevinMD

Posted by on November 6, 2016

Summary: “In the last decade, the federal government has undertaken considerable steps to control the way doctors care for their patients,” Andrew Lam writes over at KevinMD, in a doctor’s eye view of quality measurements. “Its goal is to improve healthcare quality and lower costs, but the very regulation tasked with achieving this has created a paperwork nightmare that actually does the opposite: it impedes care and increases costs. I’m referring to the Physician Quality Reporting System, or PQRS, which originated with the Tax Relief and Health Care Act of 2006. I doubt you’ve heard of it, but your doctor surely has, and chances are he or she considers it an expensive and burdensome bureaucratic reporting exercise that does practically nothing to increase quality. Here’s how it works. A doctor examines a patient and submits a bill to Medicare. To be fully paid, the doctor must also document that certain tasks were performed. If this is not done correctly, he is penalized with a reduction in payment. While this sounds reasonable, let me explain why it’s an awful way to measure a doctor’s “quality.” For one thing, many of the clinical tasks we’re bound to report are extremely basic. Like reviewing a patient’s medications. Or checking blood pressure. And here’s one example from my field of ophthalmology: I have to confirm I examined the macula of a patient with macular degeneration — which is about as elementary as asking a cardiologist to confirm he listened to the heart. Even the most uninformed doctor would perform these tasks. Medicare is spending tax dollars to scrutinize measures that set the bar so low that the exercise is meaningless.” Andrew Lam, “The costly Medicare boondoggle that’s wasting tax dollars and infuriating doctors,”


We’re live: Our iFundWomen crowdfunding campaign launched

Posted by on November 2, 2016

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Summary: We’re thrilled to announce our crowdfunding campaign over on the new iFundWomen website. We’re raising money to make our website better for people who come to us on smartphones and tablets, like iPads. Why? We get 60 percent of our traffic on mobile, up from 40 percent when we built the site, and we need to be better for our mobile users. You can read all about it here on our iFundWomen page, where you’ll also find the movie shown here. Please contribute! Your support is deeply appreciated, and it will take us to the next level. Also — please look at the other 16 powerful women-founded companies that are part of this beta class with us.

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Shamed for overcharging, hospitals raised their prices, again: The Washington Post

Posted by on November 1, 2016

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Summary: “A year ago, a study about U.S. hospitals marking up prices by 1,000 percent generated headlines and outrage around the country,” Lena Sun writes at The Washington Post. “Twenty of those priciest hospitals are in Florida, and researchers at the University of Miami wanted to find out whether the negative publicity put pressure on the community hospitals to lower their charges. Hospitals are allowed to change their prices at any time, but many are growing more sensitive about their reputations. What the researchers found, however, was that naming and shaming did not work. The researchers looked at the 20 hospitals’ total charges in the quarter of a year before the publicity and compared them to charges in the same quarter following the publicity. There was no evidence that the negative publicity resulted in any reduction in charges. Instead, the authors found that overall charges were significantly higher after the publicity than in previous quarters.” Lena Sun, “Despite being shamed for overcharging patients, hospitals raised their prices, again,” The Washington Post.


What’s the most popular drug in your state: Viagra, Truvada, Chantix?

Posted by on October 31, 2016

Summary: What’s the prescription drug that’s most searched for on Google in your state? Look here: a fascinating tale of who’s looking to kick smoking with Chantix (Montana, North Dakota, Iowa) or have an erection  with Viagra (California) or lower blood pressure with Exforge (Texas, Louisiana, South Carolina. Utah: Nuvaring contraceptives. And New York? Truvada, the anti-HIV medication. The big winner: Suboxone, to help addicts. Full story is here.


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How much will that cost/did that cost? Part 1 of a series on billing

Posted by on October 30, 2016


SUMMARY: How much will that cost? Why did that cost so much? People are getting used to asking this in the health care marketplace. Many of us grew up with the $10 co-pay, but that’s rapidly becoming a thing of the past. With rising deductibles, more out-of-network providers, more uninsured people and more out-of-pocket spending, it’s increasingly a question we want to ask – and before the medical procedure, not after, when the “gotcha” bill upsets us. Here’s a handy guide to asking: Before, during and after. How much will that cost? Why did that cost so much? Click  for Part I.



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