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Practice Rounds: Increasing Federal Subsidies for ACA


The presidential candidates have diametrically opposed positions on healthcare and Congress may be the culprit for out-of-control drug costs.

Welcome to Practice Rounds, our new weekly column exploring what's being covered in the larger world of healthcare.

Where Clinton and Trump Stand on Healthcare

The presidential election is only five weeks away, yet little has been said about healthcare policy in the U.S. When it comes to the much-maligned Affordable Care Act (ACA), Clinton has said she supports maintaining the law and building on key provisions; Trump is in favor of scrapping the law altogether and replacing it with programs that rely on free-market principals. Several key issues with the ACA have presented themselves during the campaign, reports Kaiser Family Foundation, falling into these buckets: affordability of premiums and cost sharing; marketplace enrollment; and health plan choice and competition. On affordability, Clinton says she would increase federal subsidies so that enrollees would pay no more than 8.5 percent of their income for health insurance. Trump says he will fully repeal the ACA and also eliminate the individual mandate, replacing them with tax deductions to help purchase individual health insurance.

Congress Culpable for High Drug Costs

Both lawmakers and the public have expressed outrage over seriously inflated drug prices like Mylan's life-saving Epi-Pen. However, the government may be responsible for setting up an environment where there is little regulation over drug prices, reports NBC News. When passing legislation designed to increase patient access to prescription medications, Congress failed to enact control mechanisms to limit price increases, instead relying on market forces. The drug benefit program Medicare Part D, enacted in 2003, does not allow the government to negotiate with suppliers for the best price. And by protecting patients from catastrophic drug costs, the law inadvertently enabled manufacturers to pass high-dollar costs for new specialty drugs on to the tax payer.

Good News for Patients with Type 1 Diabetes

The Food and Drug Administration has approved a new insulin delivery system for patients with Type 1 diabetes. Currently, patients either self-inject insulin throughout the day or use an insulin pump. The new device, Medtronic's MiniMed 670G, is a hybrid closed-loop system comprising both an insulin pump and a continuous glucose monitor (CGM). Both products are currently on the market separately, but the new device allows each component to talk to the other -permitting much more accurate glucose control. The device can recognize when a patient's blood sugar is dropping and act to correct the imbalance. That ability is why it is has been christened "the first artificial pancreas," according to NPR.

Guns N' Physician Offices

The AMA, the AAP, and the ACP all believe that physicians should be allowed to ask patients about gun ownership. Not as a way to promote a "gun-control platform," but simply as part of the family and social history used to investigate whether patients are exposed to unsafe environments. However, should this conversation about guns extend to a patient's right to carry a weapon into the physician's office? In Medical Economics, Washington, D.C.-based physician Ashesh D. Patel says he is not adverse to gun ownership, but does not allow patients to bring a weapon into the practice - unless they are law-enforcement personnel. He believes that "private doctors' offices, hospitals, and other healthcare facilities should be allowed to ban guns" as a safe haven for staff and patients.

Quote of the Week:

6 Ways to End a Doctor-Patient Relationship

"Patients see us at their worst and sickest and should be given some consideration in this regard. We should only terminate those relationships that have become truly toxic or dysfunctional. And we must do it in the proper way so to avoid accusations of abandonment."

Linda Girgis, MD, family physician

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