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Kaiser Health News reported on enrollment in the health insurance exchanges established by the Affordable Care Act as roughly matching last year's enrollment. The numbers are not final since a few states have not yet closed enrollment. However, that the enrollment nearly matches last year's is surprising given that the White House halved the window for sign-up while slashing the marketing budget by 90%.

Interestingly, the current White House administration, a vocal critic of the Affordable Care Act, apparently "framed the outcome as the result of her agency's efficient use of government funding and as a sign of how staffers had created a strong, well-run website."

The comparable level enrollment suggests that there is strong demand for the insurance policies, and that the insurance marketplaces might be more robust than anticipated.

California Healthline reported that specialty drugs have been posing a challenge to CalPERS, a pension system for retired California public employees. While accounting for only 1% of prescriptions, specialty drugs accounted for roughly 30% of the pension system's total pharmaceutical spending.

Apparently, CalPERS has fairly successfully encouraged the use of generics, which now account for roughly 85% of their prescriptions. Last year saw headlines of how some specialty drugs (which generally do not have generic alternatives) cost more than $100,000 for a regimen.

These findings are likely representative of what many health insurance plans are experiencing. Left unchecked, increased reliance on specialty drugs will result in higher premiums. Perhaps a continuing trend in this area will force a discussion of what benefits should be covered by basic health plans.

In another sign of how health care in America is changing, members of a collaborative charged with improving health outcomes have recommended that providers offer some sort of warranty on their services. The cited example suggests that patients should not be financially liable for their care if they experience certain avoidable complications. The article draws a comparison with certain professions where if workers in those industries fail to maintain basic standards, the customer expects not to pay.

This recommendation follows in the same vein as what Geisinger Health System has already pioneered. Likewise, Medicare has started to reduce payments if providers have poor outcomes. As patients are expected to pay more and more out-of-pocket, it would not be hard to imagine their becoming savvier in their shopping for certain operations and preferring guarantees such as this one.