Therapeutic Alternatives Key to Medicare Drug Price Negotiations
With its newfound authority to negotiate prices for high-cost prescription drugs, the Centers for Medicare and Medicaid Services (CMS) recently selected the first 10 drugs to focus on and began collecting information to inform initial offer prices. On To the Point, Kate Meyer and Jeremy Sharp of Waxman Strategies say that by analyzing data on therapeutic alternatives, CMS can establish a novel framework for systematically comparing drugs based on their value to patients — and ultimately help lower prices that are misaligned with clinical value.
The Financial Struggles Older Medicare Enrollees Face
A recent Commonwealth Fund study revealed the financial toll that health care expenses take on many older Americans enrolled in Medicare. Using data from the Fund’s most recent Biennial Health Insurance Survey, researchers found that nearly one in five older adults with Medicare are underinsured, based on their reported health care costs, and more than one in five struggle to pay their Medicare premiums. Older adults in Medicare Advantage and traditional Medicare reported problems with premiums, health care expenses, medical debt, and bills at similar rates.
Scorecard: Large Gaps in Long-Term Care Across States
Long-term care for older adults and people with disabilities is profoundly inadequate, according to a new scorecard from AARP that evaluates long-term services and supports in the United States across five dimensions. The researchers found major deficiencies in every state, especially those related to support for family caregivers, the long-term care workforce, equity in nursing homes, and emergency preparedness. The Commonwealth Fund is a cosponsor of the scorecard.
Using Brokers to Reverse Racism in Insurance Industry
Health insurance brokers play a key role in getting Americans covered, but they often aren’t representative of the communities they serve. Some state health insurance marketplaces are working to address these racial disparities, say Georgetown University’s Jalisa Clark and Christine H. Monahan. Connecticut, for example, has created a “broker academy” to recruit from historically underserved communities and train people to become life and health insurance brokers. Other states are engaging brokers to improve outreach into communities of color.
With so many young people experiencing behavioral health challenges, school-based health services have never been more important to getting kids the care they need. Congress has increased funding for schools to build their capacity to meet children’s behavioral health needs, and now there’s legislation pending to strengthen the pipeline of behavioral health professionals. Experts at Impact Health Policy Partners say policymakers have an opportunity to leverage federal resources and Medicaid flexibilities to increase access to treatment in America’s schools.
Continuous Medicaid Eligibility for Children and Adults
As pandemic-era continuous eligibility requirements for Medicaid unwind, millions of children and adults face potential disruptions in their health coverage and access to care. Recognizing the importance of uninterrupted coverage, a 2022 federal law required 12-month continuous eligibility for children by 2024. The Urban Institute’s Matthew Buettgens estimates that if all states made children continuously eligible for 12 months in 2024, the number of uninsured children would decline by 34,000 per month, with federal and state spending increasing by only 0.1 percent. And if Congress adopted similar policies for adults — and all state Medicaid programs made adults continuously eligible for 12 months in 2024 — Buettgens says there would be 267,000 fewer uninsured a month. Households and employers, meanwhile, would each save about $1 billion a year in health spending.
Tanzania Tripled HPV Vaccination in Three Years
In the East African country of Tanzania, 60 percent of women and girls over age 15 had been fully immunized against the human papillomavirus (HPV) by 2022, even though the vaccine wasn’t widely introduced until 2018. To achieve that success, Tanzanian officials first had to develop a crisis communication plan to counter rumors that the vaccine caused infertility, primarily by having physicians speak directly with concerned parents about the vaccine’s efficacy and safety. As the Commonwealth Fund’s Evan Gumas writes in International Insights, the United States is also battling misinformation in its campaign against HPV, alongside decreasing awareness about the virus and the vaccine. He believes the Tanzanian approach has a lot to offer state and local officials in the U.S., particularly in rural and low-income communities.
Community health centers provide comprehensive, quality care to more than 30 million Americans, regardless of their ability to pay. But federal funding has been on the decline since the COVID-19 pandemic. A study from the African American Research Collaborative demonstrates how inconsistent federal funding from year to year is preventing health centers from retaining a reliable workforce and meeting increased patient demand. The authors recommend three key policy changes to alleviate the financial challenges these safety-net providers face.
Improving Birthing Services for Underserved People
New licensing requirements in states like Alabama are impeding the development and spread of birthing centers designed to serve Black patients and rural communities, a New York Times investigation found. Nearly half of rural U.S. counties lack access to obstetric care, which is contributing to rising maternal death rates. Commonwealth Fund researchers recently reported on efforts to improve outcomes for people in underresourced areas.
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