Senate to begin debate on GOP health care bill; outcome still unpredictable

By the narrowest of votes (51-50), the Senate has voted to begin debate on repealing and replacing the Affordable Care Act. Officially, senators voted to consider the American Health Care Act, the House bill passed in May. “But no one expects that version to become law,” The New York Times reports. The Senate will be limited to 20 hours of debate. It remains unclear whether the GOP has enough votes to ultimately pass replace/repeal legislation. ( The New York Times)

A key voice in the health care vote? The parliamentarian
Friday night, Senate parliamentarian Elizabeth MacDonough challenged key provisions of the current GOP health care legislation--provisions needed to secure conservative votes. She ruled that a super-majority is needed for the temporary defunding of Planned Parenthood, to prohibit use of federal subsidies to buy insurance that includes abortion coverage, and the requirement that people with breaks in coverage wait six months before buying a new plan. ( The New York Times; Kaiser Health News)

Medicaid expansion may not have reduced ED use...

If Maryland is any indication, Medicaid expansion didn’t really help cut emergency department visits. That’s the upshot of research published in the Annals of Emergency Medicine. Researchers analyzed patient visits at EDs across Maryland for an 18-month period before the Medicaid expansion took effect and an 18-month period afterward. They found the number of Marylanders covered increased by more than 20 percent, or 160,000, while the total number of ED visits fell by more than 36,000 during the study period--about a 1 percent change. The study also showed Medicaid-covered visits increased by almost 6 percent, while the number of uninsured patient visits decreased almost 6 percent. ( HealthLeaders Media; Annals of Emergency Medicine)

...But expansion has reduced medical debt among the poor
Medicaid expansion reduced the share of low-income Americans with unpaid medical debt and improved their satisfaction with their own financial situation, according to researchers writing in a Health Affairs Blog post. This evidence is important not only for federal lawmakers debating whether to repeal the ACA, but also for state policymakers in non-expansion states who, if the ACA is retained, will have to decide whether to change course and expand Medicaid. ( Health Affairs Blog)

Being in ACO doesn't improve medication use or adherence
At least where the Medicare Shared Savings Program (MSSP) is concerned, being in an ACO did not improve use of or adherence to medications that improve outcomes for patients with cardiovascular disease or diabetes, according to analysis published in JAMA Cardiology. “Our findings suggest that incentives in the MSSP to improve disease control and lower hospitalization rates and nondrug spending for patients with cardiovascular disease and diabetes have not been associated with meaningful increases in medication use and adherence.” (MedPage Today; JAMA Cardiology)

Want to add seven good years? You know what to do
People who do not smoke, are not obese and consume alcohol in moderation can expect to live seven years longer than average--and those years will be good ones, according to research published in Health Affairs. “In contrast, people with multiple behavioral risk factors not only live shorter lives than those without these factors but also experience an extended time disabled, which underscores the large negative effects of risky health behaviors. Of note, we found obesity to be strongly associated with years lived with a disability,” warn the investigators. (Health Affairs)

KKR buys WebMD: KKR announced plans last week to acquire WebMD for about $2.8 billion. WebMD is the nation’s largest online health information portal, serving consumers and clinicians with public and private sites and publications. ( Modern Healthcare)