Dear John,

The November issue of Health Affairs examines various forms of health insurance—employer-sponsored, Medicare, and Medicaid—along with articles on drug development and more.

It includes an article by A. Jay Holmgren and coauthors that uses a novel method to demonstrate that physicians’ time documenting notes in the electronic health record crowds out time spent viewing patient records.

The article is part of our Practice Of Medicine series, supported by the Physicians Foundation.

H E A L T H   I N S U R A N C E

Gary Claxton and coauthors report the results of the 26th annual KFF Employer Health Benefits Survey, fielded in the first half of 2024.

Among their many findings are that annual family premiums overall average $25,572, and half of covered workers in firms with fewer than 200 employees face an individual annual deductible of $2,000 or more.

Benedic Ippolito and coauthors examine the expected out-of-pocket costs Medicare enrollees incur if they use a typical set of health care services.

Enrollees in traditional Medicare, on average, face costs almost one-quarter higher than enrollees in Medicare Advantage (MA) plans.

For enrollees in poor health, out-of-pocket costs are about $200 per month higher in traditional Medicare than in MA preferred provider organization plans.

Veterans can be eligible for health benefits from both the Veterans Health Administration (VHA) and Medicare.

Yanlei Ma and coauthors identify almost 300 MA plans with veterans making up more than 20 percent of their enrollees in 2022.

The authors find that “although less than four percent of the general MA enrollee population did not use any Medicare services in 2020, the rate rose to almost 10 percent for VHA enrollees in MA plans and to 21 percent among VHA enrollees in high-veteran MA plans.”

Sumedha Gupta and coauthors assess the effects of resumption of Medicaid eligibility determinations at the end of the COVID-19 public health emergency.

Using data from the Census Bureau’s Household Pulse Survey, the authors find a decline in self-reported Medicaid coverage starting in April 2023 but no statistically significant increase in reports of being uninsured.

According to survey data from six states, Maria Steenland and Jamie Daw find that the proportion of people with health insurance exceeds 90 percent during pregnancy among noncitizen residents who either have temporary status or are without documentation.

But the proportion is only 50 percent before pregnancy and 53 percent one year postpartum, which is far below the share of people with insurance during the perinatal period among citizens and permanent residents.

In an effort to expand access to opioid medication treatment, the federal government invited Medicaid waivers from states that enabled the states to lift the prohibition on using Medicaid funds for residential substance use disorder treatment as long as states provided a full continuum of opioid use disorder (OUD) care and adhered to quality standards.

Stephan Lindner and coauthors analyze Medicaid data for seventeen states that received waivers and find no overall improvement in treatment, although there were positive results for people with severe OUD treatment needs.

Almost seventy million adults in the US lacked dental coverage in 2023.

Hawazin Elani and coauthors examine the availability of dental coverage in the Affordable Care Act Marketplaces.

They find that two-thirds of US adults live in a county with more than five choices of a Marketplace dental plan—either a stand-alone plan or as part of comprehensive insurance coverage—with counties in rural areas and dentist shortage areas more likely to have fewer insurance options.

P H A R M A C E U T I C A L S

The Inflation Reduction Act’s Medicare drug price negotiations operate under a shorter timeline for small-molecule drugs than for biologics.

Katherine Clifford and coauthors examine approved drugs during the period 1999–2018. 

They find similar incremental health benefits associated with small-molecule drugs and biologics but substantially lower incremental costs for small-molecule drugs, suggesting that “policy makers should consider creating parity in terms of time to Medicare price negotiation” for the two types of drugs.

In an Analysis, Janice Jhang and Troyen Brennan note that “close study of the evidence, current market dynamics, and recent regulatory changes suggests that biosimilars have made important gains in the marketplace after overcoming patent hurdles and that swift change is still feasible.”

Anna Larson and coauthors examine delays between recommendations by the federal Advisory Committee on Immunization Practices and states’ adoption of school-entry immunization requirements.

The average delay is almost five years for the tetanus, diphtheria, and acellular pertussis vaccine—the shortest delay among the three vaccines studied, which had a range in delays of from less than a year to fifteen years.

According to the authors, this “is reflective of the varied nature of state legislative and regulatory processes.”

NIH’s Approach To Funding Biomedical Research Exacerbates Inequality And Health Disparities

A. Susana Ramírez

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Join Health Affairs this Thursday, November 7 for a virtual event highlighting how states have promoted Medicare and Medicaid integration even in the absence of full financial integration and how federal policy can better care for people who are dually eligible.

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Join Health Affairs November 20 for a virtual event examining how the loss of public health emergency funds challenges the financial viability of nursing homes.