Medicaid Waivers Should Backstop The Exchanges
During the summer of 2017, there were 82 counties at risk of not being covered for the 2018 policy year. State regulators managed to attract at least one insurer in those counties, but a recent market exit in Virginia leaves more counties at risk. The recent Health Affairs Blog post by Anderson, Hacker, and Starr, which advocates for a persistent Medicare-derived public option that is triggered by insufficient competition on the Affordable Care Act (ACA) exchanges, is an interesting example of harnessing the power of Medicare and repurposing it to compete in the private market. Bare counties and the lack of meaningful cho...
Source: Health Affairs Blog - September 14, 2017 Category: Health Management Authors: David Anderson Tags: Following the ACA Medicaid and CHIP bare counties 1332 waivers Section 1115 Waivers Source Type: blogs
Unpacking The Sanders Medicare-For-All Bill
On September 13, Senator Bernie Sanders (I-VT)—with 16 Democratic cosponsors—released the Medicare-For-All Act of 2017, intended to transition the American health care system to a single-payer system. In addition to the bill text, Senator Sanders released an executive summary, title summary, and white paper on financing options.
The Act would establish the Universal Medicare Program (UMP) and, in doing so, make sweeping changes to the health care system. Once the UMP went into effect (for children, on January 1 of the first calendar year after the bill is enacted and three years later for adults), most benefits...
Source: Health Affairs Blog - September 14, 2017 Category: Health Management Authors: Katie Keith and Timothy Jost Tags: Following the ACA Insurance and Coverage Bernie Sanders single payer Source Type: blogs
Network Adequacy Under The Trump Administration
Network adequacy was one of the many critical issues that the Trump administration confronted when it took over responsibility for administering the Affordable Care Act (ACA). In an effort to provide greater consumer value, insurers in the ACA’s reformed Marketplace have shifted to much narrower provider networks than had existed previously. Many analysts view this as a potentially positive development, but others are concerned that patients will receive inadequate care, especially those individuals with higher-cost conditions. Regulators face the tough task of protecting patients without squelching market innovations th...
Source: Health Affairs Blog - September 14, 2017 Category: Health Management Authors: Mark Hall and Caitlin Brandt Tags: Featured Insurance and Coverage Organization and Delivery Quality narrow provider networks network adequacy quality of care state oversight of health care Trump administration Source Type: blogs
New Graham-Cassidy Bill: A Last GOP Shot At ACA Repeal And Replace Through Reconciliation
On September 13, 2017, senators from opposing parties introduced two bills in the Senate embodying radically different approaches to health care reform. This post will analyze the non-Medicaid provisions of a block-grant bill introduced by Republican senators Lindsay Graham (SC), Bill Cassidy (LA), Ron Johnson (WI), and Dean Heller (NV) late morning. A later post will describe the single-payer bill introduced by independent senator Bernie Sanders (VT) and sixteen Democratic co-sponsors mid-afternoon, while a third post will address the Medicaid provisions of Graham-Cassidy.
With only days left before budget reconciliation ...
Source: Health Affairs Blog - September 13, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP ACA repeal and replace Bill Cassidy block grants Dean Heller Lindsay Graham pre-existing conditions Ron Johnson single payer Source Type: blogs
Investing To Save: Marketing Builds Stable Marketplaces And Saves Money
How to stabilize individual health insurance markets and lower premiums for consumers is rightly one of the hot button issues before policy makers at the state and national levels. Providing ongoing direct funding of the cost-sharing reduction subsidies and creating a national reinsurance program are among the good ideas getting appropriate attention.
What is getting far too little attention, however, is another proven way to increase enrollment, lower premiums, save consumers money, and encourage health plan participation to stabilize the markets: making major investments in marketing and outreach.
Marketing is one of the...
Source: Health Affairs Blog - September 13, 2017 Category: Health Management Authors: Peter V. Lee Tags: Following the ACA Insurance and Coverage ACA marketing ACA Marketplaces risk mix Source Type: blogs
Census Bureau Finds Health Coverage Stabilization; Oregon 1332 Waiver Open For Comment
On September 12, 2017, the United States Census Bureau released its report on Health Insurance Coverage in the United States for 2016. The report is based on data collected by the Census Bureau’s Current Population Survey Annual Social and Economic Supplement and American Community Survey. The report summarizes the status of the American insured and uninsured population during the last year of the Obama presidency, thus creating a baseline for what follows.
After a sharp drop in the number of the uninsured and expansion of insurance coverage following the full implementation of the Affordable Care Act in 2014, insurance ...
Source: Health Affairs Blog - September 13, 2017 Category: Health Management Authors: Timothy Jost Tags: Featured Following the ACA Insurance and Coverage Medicaid and CHIP Census Bureau Medicaid expansion Oregon Section 1332 waivers Source Type: blogs
School-Based Health Clinics: Critical Access Points For Confronting The Addiction Epidemic
It is undoubtedly a critical time in this country to address the complexities of how to effectively prevent, treat, and help people recover from substance use disorders. As many parts of the country struggle to reduce the impact of the current opioid epidemic and help people rebuild their lives, others are contending with the new reality of cannabis legalization and the possible implications for youth.
Meanwhile, others are calling attention to rising rates of alcohol use, high-risk drinking, and alcohol use disorders, particularly among women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged...
Source: Health Affairs Blog - September 12, 2017 Category: Health Management Authors: Alexa Eggleston Tags: Featured GrantWatch Health Professionals Organization and Delivery Access addiction alcohol abuse Conrad N. Hilton Foundation Health Care Delivery Health Philanthropy Health Promotion and Disease PreventionGW LGBTQ marijuana Ment Source Type: blogs
The Journey Of Geriatric Emergency Medicine: Acceleration, Diffusion, And Collaboration As Keys To Continued Growth
As more and more of us live longer and healthier lives, we are becoming part of one of the largest demographic shifts in US history, as some 10,000 Americans now turn 65 every day. Innovations in health and care have helped make that increased longevity possible, and now a new wave of innovations to our health care system and community-based services must emerge to reflect our country’s changing demographic. One of these innovations is already occurring within emergency departments (EDs), which are increasingly becoming our nation’s “front porch” of health care for older adults. One out of every two older adults ma...
Source: Health Affairs Blog - September 12, 2017 Category: Health Management Authors: Kelly Ko, Adriane Lesser, Kevin Biese, Ula Hwang and Christopher Carpenter Tags: Diffusion of Innovation Population Health Emergency departments Geriatric Emergency Department Collaborative geriatric emergency medicine older adults seniors Source Type: blogs
A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money
Brand and generic prescription drugs dispensed by retail pharmacies cost nearly $400 billion and accounted for more than 10 percent of health care spending in 2016. Despite totaling more than $100 billion, reimbursement for generic drugs has received relatively little policy attention. The combination of a complex distribution system and limited information about actual prices artificially inflates what patients and insurers pay retail pharmacies for generic drugs. A recent study by the Washington State Office of the Insurance Commissioner confirms that retail pharmacies profit more when dispensing generic versus brand dru...
Source: Health Affairs Blog - September 12, 2017 Category: Health Management Authors: Steven Lieberman, Margaret Darling and Paul B. Ginsburg Tags: Costs and Spending Drugs and Medical Innovation Payment Policy generic drug ingredient costs generic drugs Prescription Drugs Source Type: blogs
Let ’s Adapt Health Care Quality Measures To Meet The Needs Of Transgender People
Editor’s Note: This month’s issue of Health Affairs also features a personal essay by a transgender doctor about meeting the health care needs of transgender patients.
As transgender people become increasingly visible, so have the challenges they face in our health care system. In response, the Association of American Medical Colleges (AAMC) recommends better educating providers on how to competently care for transgender patients, and the Institute of Medicine (now the National Academy of Medicine) recommends collecting gender identity information in electronic medical records and conducting more research around trans...
Source: Health Affairs Blog - September 11, 2017 Category: Health Management Authors: Landon Hughes and Heather Pearson Tags: Featured Health Equity Population Health Quality Alternative Payment Models equality LGBT health quality measures transgender health Source Type: blogs
The Case For Confronting Long-Term Opioid Use As A Hospital-Acquired Condition
The first principle of medicine is to “do no harm.” Over the past two decades, the medical community has attempted to honor this principle by treating patient pain with opioid prescriptions. Unfortunately, these good intentions have driven an epidemic of opioid addiction and drug overdoses, now the leading cause of accidental death in the United States.
Inpatient overprescription of opioids such as morphine, oxycodone, and hydrocodone happens in a variety of ways—doctors prescribe too many doses, too large a dose, or allow patients to continue opioid treatment for too long. And many times, doctors could avoid opi...
Source: Health Affairs Blog - September 8, 2017 Category: Health Management Authors: Michael Schlosser, Ravi Chari and Jonathan Perlin Tags: Featured Health Professionals Hospitals Population Health hospital-acquired condition opioid epidemic overprescribing opioids pain management Source Type: blogs
A Safer Way To Legalize Marijuana
Eight US states, the District of Columbia, and the country of Uruguay have recently legalized the recreational use of marijuana, with Canada and more US states poised to do the same. The new laws include limits on youth access, operation of motor vehicles when using, and high-volume purchases or possession. However, none of the laws consider which kinds of marijuana products should and should not be legally sold.
While we take no position on the overall desirability of marijuana legalization, we propose here that policy makers in favor of it consider only permitting the sale of tetrahydrocannabinol (THC) extracts intended ...
Source: Health Affairs Blog - September 8, 2017 Category: Health Management Authors: Rebecca Haffajee, Alex C. Liber and Kenneth E. Warner Tags: Featured Public Health drug policy legalization of marijuana Source Type: blogs
Governors Testify In Second Day Of HELP Hearings
At the beginning of the second day of the bipartisan Senate Health, Education, Labor, and Pensions (HELP) Committee hearings on short term market stabilization, committee chair Lamar Alexander (R-TN) summarized what he thinks is needed to achieve stabilization. His list began with funding of the cost-sharing reduction program. He also acknowledged widespread support for short-term reinsurance funding, although he suggested that states should have a role in providing it. In other news, on September 5, a federal trial court judge denied motions to dismiss in a case claiming discrimination in violation of section 1557 of the ...
Source: Health Affairs Blog - September 7, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Source Type: blogs
Can States Substantially Reduce Medicaid Spending Through Delivery System and Financing Reform?
To achieve federal Medicaid savings and make federal expenditures more predictable, the American Health Care Act (AHCA) and the Better Care Reconciliation Act of 2017 included a Medicaid block grant and per capita caps. In these proposals, if Medicaid program costs exceed the funding limits set by the cap, states will have to increase state spending or reduce spending to stay within the budget ceiling.
This approach is not new. Presidents Ronald Reagan and George W. Bush proposed Medicaid block grants, and Congress passed a Medicaid block grant, which was vetoed by President Bill Clinton and did not become law.
Although bl...
Source: Health Affairs Blog - September 7, 2017 Category: Health Management Authors: Joshua M. Wiener, Melissa Romaire and MaryBeth Musumeci Tags: Costs and Spending Long-term Services and Supports Medicaid and CHIP Payment Policy Medicaid block grants per capita caps RTI International Source Type: blogs
Why Medicaid Is The Platform Best Suited For Addressing Both Health Care And Social Needs
The debate about if and how to amend, repeal, or replace the Affordable Care Act has drawn attention to the central role that the Medicaid program plays in providing coverage and access to health care for millions of Americans. This central role positions Medicaid as an ideal platform on which to build an integrated system that simultaneously addresses health care and social needs.
Evidence has been building that social determinants of health have a bigger impact even than health care services on people’s health, functioning, and quality of life. But the United States, while arguably developing some of the world’s most...
Source: Health Affairs Blog - September 7, 2017 Category: Health Management Authors: Katharine Witgert Tags: Health Equity Medicaid and CHIP Population Health Public Health Social Determinants of Health Source Type: blogs
