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At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.

An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.

Missouri approves Medicaid expansion

by jerry on August 09, 2020

About a month after Oklahoma voters approved of Medicaid expansion, Kaiser Health News reports that residents of Missouri also voted to approve Medicaid expansion. While the federal government would pay for 90% of the cost of expansion (at least initially), it appears that opponents are concerned about the 10% of the cost that the state is liable for, and how that might grow over time. Part of the opposing rhetoric was reported to tap into fears that Medicaid expansion would attract illegal immigrants.

About a month after Oklahoma voters approved of Medicaid expansion, Kaiser Health News reports that residents of Missouri also voted to approve Medicaid expansion. While the federal government would pay for 90% of the cost of expansion (at least initially), it appears that opponents are concerned about the 10% of the cost that the state is liable for, and how that might grow over time. Part of the opposing rhetoric was reported to tap into fears that Medicaid expansion would attract illegal immigrants.

An interesting comment from a health policy expert was that people support giving low-income families access to Medicaid coverage, although a number of people may oppose similar measures when labeled as Medicaid expansion or Affordable Care Act. Another interesting detail that was reported is that voters in the three counties with the highest uninsured rates in the state rejected the expansion.

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Difficulty in forecasting insurance premiums

by jerry on August 02, 2020

Kaiser Health News reported on insurance premiums, explaining why premiums might not be dropping even though insurance companies may be experiencing greater profits than before the pandemic. While many might have thought that insurance costs would risen this year because of the pandemic, it turns out that many people delayed medical care, so insurers have had to pay out less in medical costs. Based off of that, one might expect that premiums for the next year might fall. The article points out, though, that medical costs could surge next year if people who were delaying medical care choose to be treated then. If health insurance companies price their premiums too high, they can give money back; however, if health insurance companies price their premiums too low, they cannot easily ask for the difference and can only adjust premiums upwards for the following year.

Kaiser Health News reported on insurance premiums, explaining why premiums might not be dropping even though insurance companies may be experiencing greater profits than before the pandemic. While many might have thought that insurance costs would risen this year because of the pandemic, it turns out that many people delayed medical care, so insurers have had to pay out less in medical costs. Based off of that, one might expect that premiums for the next year might fall. The article points out, though, that medical costs could surge next year if people who were delaying medical care choose to be treated then. If health insurance companies price their premiums too high, they can give money back; however, if health insurance companies price their premiums too low, they cannot easily ask for the difference and can only adjust premiums upwards for the following year.

The Affordable Care Act stipulates that insurance companies must spend a certain percentage of their premiums on medical costs. Profits above a certain margin are supposed to be redistributed back to the plan members as a rebate.

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Executive orders to manage drug prices

by jerry on July 26, 2020

NPR reported that the president signed executive orders to manage drug prices, a sore point for many for several years. Apparently, the most notable executive order was one requiring Medicare to pay the same prices on drugs received in hospitals as other countries pay. However, it is unclear whether that executive order will take effect, given that the president seems to be using it as a threat to convince pharmaceutical companies to come up with a more palatable alternative.

NPR reported that the president signed executive orders to manage drug prices, a sore point for many for several years. Apparently, the most notable executive order was one requiring Medicare to pay the same prices on drugs received in hospitals as other countries pay. However, it is unclear whether that executive order will take effect, given that the president seems to be using it as a threat to convince pharmaceutical companies to come up with a more palatable alternative.

Another of the executive orders allow certain prescription drugs to be imported from Canada. The impact of that executive order will depend greatly on how broad the list of drugs that can be imported will be, and whether Canada welcomes exporting such drugs.

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Lawsuit to overturn ACA continues

by jerry on July 19, 2020

The current White House administration recently reiterated support for a lawsuit that seeks to overturn the Affordable Care Act (ACA). Although Congress did not vote to overturn the ACA outright, it did vote to eliminate the penalty for individuals who do not have health insurance (the penalty is known as the individual mandate). Earlier, there was a separate suit alleging that Congress lacked constitutional authority to pass the ACA. In that case, the Supreme Court ruled that the individual mandate was in fact a tax (although not so named), and that Congress indeed had constitutional authority to levy taxes. Hence, this current suit argues that since the individual mandate was repealed, the ACA is no longer a tax, and therefore the current form of the ACA is unconstitutional. If the ACA is found to be unconstitutional, health insurance companies could start denying coverage to patients who have pre-existing conditions. Kaiser Health News offered an analysis on whether pre-existing conditions can list COVID-19 as a reason for denial.

The current White House administration recently reiterated support for a lawsuit that seeks to overturn the Affordable Care Act (ACA). Although Congress did not vote to overturn the ACA outright, it did vote to eliminate the penalty for individuals who do not have health insurance (the penalty is known as the individual mandate). Earlier, there was a separate suit alleging that Congress lacked constitutional authority to pass the ACA. In that case, the Supreme Court ruled that the individual mandate was in fact a tax (although not so named), and that Congress indeed had constitutional authority to levy taxes. Hence, this current suit argues that since the individual mandate was repealed, the ACA is no longer a tax, and therefore the current form of the ACA is unconstitutional. If the ACA is found to be unconstitutional, health insurance companies could start denying coverage to patients who have pre-existing conditions. Kaiser Health News offered an analysis on whether pre-existing conditions can list COVID-19 as a reason for denial.

While the ACA was deeply unpopular with certain segments of the US population at the time of passage, parts of the bill have grown in popularity since then. For example, people have appreciated being able to sign up for insurance despite any conditions they might have had before. Likewise, Medicaid has expanded, despite several states' initial resistance. While the current White House administration would consider the overturning of the ACA as a victory, the current pandemic could render such a decision deeply unpopular since many people who are vulnerable might then be unable to secure health insurance coverage. By the time that the Supreme Court decides on this case, the political landscape could have changed enough such that victory for the plaintiffs could be very costly politically.

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Patients may start to pay more out-of-pocket for medications

by jerry on July 12, 2020

Kaiser Health News reported on a federal rule going into effect in 2021 that reduces the helpfulness of drug coupons from manufacturers. Even the background on this issue is complex: the pharmaceutical industry has evolved into a state where drug manufacturers charge high prices, but then offer large coupons to help individual patients offset the cost. The rationale for this arrangement is not entirely straightforward, but it is believed that it has a lot to do with the incentives of pharmacy benefit managers who act as purchasing intermediaries and some to do with helping the pharmaceutical industry be perceived more favorably by the public. The policy question that the federal rule addresses is: in terms of deductibles and copayments, which price of the drugs should be used: before the coupons are applied or the amount that patients actually paid?

Kaiser Health News reported on a federal rule going into effect in 2021 that reduces the helpfulness of drug coupons from manufacturers. Even the background on this issue is complex: the pharmaceutical industry has evolved into a state where drug manufacturers charge high prices, but then offer large coupons to help individual patients offset the cost. The rationale for this arrangement is not entirely straightforward, but it is believed that it has a lot to do with the incentives of pharmacy benefit managers who act as purchasing intermediaries and some to do with helping the pharmaceutical industry be perceived more favorably by the public. The policy question that the federal rule addresses is: in terms of deductibles and copayments, which price of the drugs should be used: before the coupons are applied or the amount that patients actually paid?

Counting the price of the drugs before the coupons helps the patients in that they very quickly meet their deductibles (and perhaps some out-of-pocket maximums), and insurance would more quickly start to pay. However, the idea behind insurance plan health design is that having patients shoulder more of their own healthcare costs will make them savvier consumers who will seek out better value (e.g. more earnestly explore alternatives), saving the overall system more money. To allow patients to skip the pain of deductibles and copayments would essentially short-circuit the principles behind many plan designs. Complicating this is that patients will be transitioning from the status quo, which allows them to apply the pre-coupon dollar figure (more favorable to them) to potentially a less favorable arrangement if their payers so choose. Also complicating this change is that drug prices have been rising very quickly in the past decade.

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