Health News Review

Veteran journalist and health policy specialist Trudy Lieberman has begun a new series, “Medicare Uncovered,” on the Columbia Journalism Review website.

The first in the series is on “the pain from ‘skin in the game.’ ”

In it, she writes:

Right before Christmas, when Beltway reporters were absorbed in the fisticuffs on the edge of the fiscal cliff, the National Association of Insurance Commissioners (NAIC), a group of state insurance regulators that drafts model laws, delivered some important news that has yet to surface as much of a story. It should.

The Affordable Care Act tasked the insurance commissioners group with helping to think through the implementation of Obamacare, and the commissioners poked a pretty big hole in one of the ways the health reform law seeks to control medical costs.

Buried deep in the Act is a little-noticed provision—that is, little noticed so far by the press and the public—that would require seniors who have bought two popular Medigap plans (more on those below) to pay a lot more out-of-pocket for them because the plans would be required to pay for a lot less out than they do today. The theory behind the move is that consumers will not use as many medical services if they have to pay more each time.

This is another variation on the “skin-in-the-game” approach to cost control—forcing the patients to carry a higher share of their medical bills so they’ll use fewer services. That’s a popular idea with some policy people and with certain healthcare special interests, since it tends to protect their incomes. Whether patients get what they need is another matter.

Journalists covering Medicare in the coming debates over entitlements will hear that seniors must have more “skin-in-the-game,” to help the government balance its budget. Tennessee Republican Senator Bob Corker has introduced a bill that would do just that. The NAIC’s report is a starting point for asking Corker and others advocating this approach some tough questions about the underlying assumptions behind it.


Brad F posted on January 16, 2013 at 6:40 pm

The post conveyed an assured conviction elimination of Medigap would have negative consequences for beneficiaries. Not clear:

The NAIC, “were unable to find evidence in peer-reviewed studies or managed care practices that would be the basis for nominal cost sharing to encourage the use of appropriate physicians’ services.” Is this so?

Also, can we implement changes to discourage the use of inappropriate services?