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A Weekly Health Policy Round Up From Health Affairs            

**February 23, 2020**

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THIS WEEK ON THE BLOG

FOLLOWING THE ACA

Texas At The Supreme Court: The Latest

By Katie Keith (2/21/20)

In a 2-1 decision, the Fifth Circuit Court of Appeals partially affirmed
the district court, agreeing that the mandate is now unconstitutional
but remanding the case back to the district court on the issue of
severability. A coalition of Democratic attorneys general and governors,
led by California, and the US House of Representatives appealed the
Fifth Circuit's decision to the Supreme Court. Read More >>

CONSIDERING HEALTH SPENDING

How Administrative Spending Contributes To Excess US Health Spending

By Laura Tollen, Elizabeth Keating, and Alan Weil (2/20/20)

In 2018, Health Affairs launched the Council on Health Care Spending and
Value, a nonpartisan, expert working group that will, over the course of
three years, develop recommendations about how the US could take a more
deliberate approach to moderating health care spending growth while
maximizing value. This post, the first in a series providing a view into
the council's discussions, recaps its inquiry into administrative
spending.
Read More >>

MEDICARE

Medicare For All: What History Can Teach Us About Its Chances

By John E. McDonough (2/21/20)

If Democrats can advance further toward near-universal coverage without
the life-or-death struggles of passing Medicare for All, they just might
achieve meaningful and historic progress even as they preserve political
capital to make progress on other urgent policy needs. Read More >>

Five Reasons Medicare For All (Or Anything Like It) Won't Pass In 2021

By Billy Wynne (2/21/20)

There is a tremendous amount of headway Democrats can make in furthering
the party's goal of achieving quality, affordable coverage for all in
2021 if we can put our ideological preferences on the back burner. Read
More >>

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SUBSTANCE ABUSE

Enhancing Rates Of Opioid Overdose Education And Naloxone Distribution
In Emergency Departments

By Kristen Huntley, Emily B. Einstein, Mary Ellen Palowitch, Anita
Thomas, Terri L. Postma, Shari M. Ling, and Wilson M. Compton (2/21/20)

Emergency departments offer critical opportunities for addressing the
opioid crisis because they are on the front lines of health care and are
an underutilized point of contact with people at risk of opioid
overdose. Read More >>

BEHAVIORAL HEALTH CARE

The Primary Care First Model Is Flawed: CMS Can Fix It With Stronger
Support For Behavioral Health Integration

By Joshua Barrett, Brigitta Spaeth-Rublee, and Harold Pincus (2/18/20)

Offering support to smaller, less advanced primary care practices,
including direct incentives, and eliminating disincentives for
behavioral health integration will enable more primary care practices to
deliver high-quality, integrated care. Read More >>

MEDICAID

Medicaid Enrollment Programs Offer Hope To Formerly Incarcerated
Individuals And Savings For States

By Abaki Beck (2/20/20)

Given the initial findings on usage of Medicaid services, reduced
recidivism, and state savings, it seems advantageous for all states to
expand Medicaid to our formerly incarcerated community members. Read
More >>

Inside The D.C. Circuit's Opinion In Gresham v Azar

By Alexander Somodevilla and Sara Rosenbaum (2/20/20)

In a unanimous opinion written by Judge David Sentelle, a three-judge
court affirmed a lower court ruling that set aside the approval of
Arkansas's Medicaid work experiment by the Secretary of Health and
Human Services. Read More >>

PRIMARY CARE

To Strengthen The Primary Care First Model For The Most Frail, Look To
The Independence At Home Demonstration

By Bruce Leff, Peter Boling, George Taler, and Bruce Kinosian (2/18/20)

Congress and the Centers for Medicare and Medicaid Services can seize
this moment to couple an effective and patient-centered, home-based
primary care model for highly complex patients with Primary Care First,
and serve the breadth of frail patients in our society.
Read More >>

PAYMENT

Population-Based Payments May Help Ensure Access To Life-Saving
Antibiotics For Medicare Beneficiaries

By Monika Schneider, Nicholas R. Harrison, and Mark B. McClellan
(2/18/20)

As the "lifetime" payer for the segment of the US population most
susceptible to death and complications from antimicrobial resistance,
and as the largest health care payer, the Centers for Medicare and
Medicaid Services is in a unique position to take the lead in advancing
broad-based payment reforms to address antimicrobial resistance. Read
More >>

CHRONIC CARE

Chronic Condition Self-Service: An Idea Whose Time Has Come?

By Anupam Goel and Shantanu Nundy (2/19/20)

Chronic care self-service would not be a replacement for primary care.
As these programs expand to address more complex combinations of
concordant and discordant chronic conditions, integration with primary
care will be critical. Read More >>

HEALTH AFFAIRS BRANDED POST

The Value Of Medicare Advantage: Health Coverage As Unique As You

By Allyson Y. Schwartz and Gary A. Puckrein (2/19/20)

Supported by the Better Medicare Alliance

A 2015 report from the US Census Bureau found that Americans speak 350
different languages in the home. This rich multiculturalism extends to
older Americans as well.
Read More >>

IN THE JOURNAL

AHEAD OF PRINT

The Past, Present, And Possible Future Of Public Opinion On The ACA

By Mollyann Brodie, Elizabeth C. Hamel, Ashley Kirzinger, and Drew E.
Altman

When the Affordable Care Act (ACA) became law in 2010, public opinion of
it was narrowly divided and deeply partisan. Mollyann Brodie and
coauthors analyzed data from 102 nationally representative public
opinion polls that were conducted between April 2010 and November 2019
as part of the ongoing Kaiser Family Foundation Health Tracking Poll.
They found that while the ACA is now more popular than ever, opinions
remain divided, and partisan divisions have gotten larger rather than
smaller over time. Read More >>

THE PRACTICE OF MEDICINE

Clinician-Directed Performance Improvement: Moving Beyond Externally
Mandated Metrics

By Lara Goitein

Lara Goitein describes the Clinician-Directed Performance Improvement
program at Christus St. Vincent Regional Medical Center and its impact
on quality, costs, and the engagement and morale of clinicians. Read
More >>

Differences In Starting Pay For Male And Female Physicians Persist;
Explanations For The Gender Gap Remain Elusive

By Anthony T. Lo Sasso, David Armstrong, Gaetano Forte, and Susan E.
Gerber

Anthony Lo Sasso and coauthors examined survey data for graduating
medical residents and fellows in New York State for the years
1999-2017. They found that during this period, the average starting
compensation was $235,044 for men and $198,426 for women, with a larger
gap in more recent years than in earlier years. Approximately 60 percent
of the gap in starting salary could be explained primarily by
differences in specialty and hours spent in patient care.
Read More >>

ThePractice Of Medicine
series is
supported by the Physicians Foundation.

NARRATIVE MATTERS: PATIENT-CENTERED CARE

There's No Algorithm For Empathy

By Hannah B. Wild

When physicians rely on a behavioral "recipe" to convey empathy, patient
care can suffer. Read More >>

Listen to the podcast here.

GLOBAL HEALTH POLICY

Copayment Incentive Increased Medication Use And Reduced Spending Among
Indigenous Australians After 2010

By Amal N. Trivedi and Margaret Kelaher

In 2010 the Australian government reduced or eliminated medication
copayments for indigenous people with chronic disease or risk factors
for chronic disease. In this quasi-experimental study Amal Trivedi and
Margaret Kelaher found that the copayment reductions were associated
with a 39 percent relative increase in the use of medications and a 61
percent reduction in out-of-pocket spending. Read More >>

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Health Spending: Moving From Theory to Action
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Aging and Health:  Improving Care for Older Adults
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About Health Affairs

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at the intersection of health,
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, and Health Affairs Sunday
Update .  

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