But the centerpiece of Ryan’s proposal—tax credits for everyone who needs to purchase individual policies regardless of income—may not go far enough to prevent people from losing coverage while creating new spending that would benefit high-income earners who can already buy their own health insurance.
By some accounts, pregnancy and delivery is the single most expensive group of diagnoses for employers providing insurance coverage. Contraception coverage is in the ACA and it’s a good deal for insurers because contraception prevents unintended pregnancies. But complaints about limited options abound.
Guideline writers are dialing back breast screening recommendations because of concerns about false positives and overdiagnoses. For instance, there’s the debate about at what age screening should start. Meanwhile, advocates and some clinicians are pulling in the opposite direction—for more coverage, especially for 3D mammography.
Perhaps ACOs may be the answer to striking the right balance between utilization and clinical outcomes. But there’s a problem. They are not responsible for the costs of drugs covered by Medicare Part D plans in their total cost of care, but they are responsible for the costs of negative outcomes if medical treatment is inadequate or goes awry.
Doctors maintain that they simply do not have all the tools they need to make value-based care happen, even if they wanted it to happen. Health insurance executives counter that the situation is not that bad. There’s some agreement, however, about quality measures being too complex.
Long-lasting reversible contraceptives (LARCs) are easy to use and effective. One reason the U.S. lags behind other developed countries in LARC use is that memories of the Dalkon Shield still linger from the 1970s, when a design defect in that IUD resulted in infections that led to infertility, ectopic pregnancies, and death.
Women are the unpaid case workers of the American health care system and they don’t trust insurers mainly because insurers aren’t doing enough to earn that trust. Among other things, price transparency and better cooperation between payers and providers might help address this situation.
Sheryl Sandberg has advised women to lean in; Diane Holder, president and CEO of the University of Pittsburgh Medical Center’s (UPMC) health plan, says, “Get out and connect with many people who are different than you.”
Gregg’s Pearl: “If you’re a woman, the best thing you could do was work for a guy with a daughter, and preferably, only daughters, because they have an interest in seeing women do well and open opportunities, ultimately for their own daughters.”