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A Weekly Health Policy Round Up From Health Affairs            

**September 20, 2020**

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FAST TRACK AHEAD OF PRINT

COVID-19

The Risk Of Severe COVID-19 Within Households Of School Employees
And School-Age Children

By Thomas M. Selden, Terceira A. Berdahl, and Zhengyi Fang

Thomas Selden and coauthors analyzed data from the Medical Expenditure
Panel Survey for 2014-17 to examine how often persons with underlying
health issues that place them at increased risk for severe COVID-19 were
connected to elementary or secondary schools, either as employees or by
living in households with school employees or school-age children.
Read More >>

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IN THE JOURNAL

EYE ON HEALTH REFORM

A Hot Summer Brings More ACA Litigation

By Katie Keith

One week after the 2020 election, all eyes will be on the US Supreme
Court as the justices hear the oral arguments for California v. Texas,
the case testing the constitutionality of the Affordable Care Act. Katie
Keith has covered the many twists and turns this case has taken for the
past two-plus years after Congress's zeroing out of the individual
mandate in the Tax Cuts and Jobs Act of 2017. Read More >>

AFFORDABLE CARE ACT

Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy
Design

By Karina C. Manz, Teresa M. Waters, and Cameron M. Kaplan

Karina Manz and coauthors examined individual premiums based on age,
tobacco use, and geographic premium rating area for all health plans
available through the federal health insurance Marketplace to describe
trends over time in premium prices and affordability for tobacco users
compared with nonusers. Read more >>

MEDICARE

Target Prices Influence Hospital Participation And Shared Savings In
Medicare Bundled Payment Program

By Nicholas L. Berlin, Baris Gulseren, Ushapoorna Nuliyalu, and Andrew
M. Ryan

Medicare's Bundled Payment for Care Improvement initiative sets target
prices for hospitals for selected services and provides financial
rewards to hospitals that deliver those services at a lower cost.
Nicholas Berlin and coauthors analyze hospital performance. Read More >>

The Beneficial Effects Of Medicare Advantage Special Needs Plans For
Patients With End-Stage Renal Disease

By Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H.
Jain, Jennifer Kowalski, and Amol S. Navathe

Brian Powers and coauthors analyzed data related to patients with
end-stage renal disease who moved from fee-for-service Medicare into a
Medicare Advantage Special Needs Plan. Read More >>

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THE PRACTICE OF MEDICINE

Adjustment For Social Risk Factors Does Not Meaningfully Affect
Performance On Medicare's MIPS Clinician Cost Measures

By Alexander T. Sandhu, Jay Bhattacharya, Joyce Lam, Sam Bounds, Binglie
Luo, Daniel Moran, Aimée-Sandrine Uwilingiyimana, Derek Fenson, Nirmal
Choradia, Rose Do, Laurie Feinberg, Thomas MaCurdy, and Sriniketh
Nagavarapu

Alexander Sandhu and coauthors investigate the portion of Medicare's
Merit-based Incentive-based Payment System (MIPS) that evaluates
clinicians based on the risk-adjusted cost of each care episode. The
authors readjust the current model from focusing solely on clinical
conditions into different approaches to incorporate social risk.Read
More >>

Clinicians With High Socially At-Risk Caseloads Received Reduced
Merit-Based Incentive Payment System Scores

By Kenton J. Johnston, Jason M. Hockenberry, Rishi K. Wadhera, and Karen
E. Joynt Maddox

Analyzing data from 2019, Kenton J. Johnston and coauthors find that
there is an important link between clinicians, social risk, and MIPS
scores. Read More >>

High Rates Of Partial Participation In The First Year Of The Merit-Based
Incentive Payment System

By Nate C. Apathy and Jordan Everson

Nate Apathy and Jordan Everson focus on evaluations of clinicians from
the first year of MIPS in 2017. Clinicians were evaluated across three
categories but participation was not consistent. Read More >>

These papers appear in an ongoing Health Affairs article series, The
Practice of Medicine
,
which is supported by The Physicians Foundation.

GLOBAL HEALTH POLICY

Restrictions On US Global Health Assistance Reduce Key Health Services
In Supported Countries

By Jennifer Sherwood, Matthea Roemer, Brian Honermann, Austin Jones,
Greg Millett, and Michele R. Decker

The 2017 expanded Mexico City Policy prohibits non-US-based
nongovernmental organizations from receiving US global health assistance
if they either perform or refer for abortion services. Jennifer Sherwood
and coauthors study the effects of the expanded policy on implementing
partners of US-funded HIV programming by the President's Emergency
Plan for AIDS Relief (PEPFAR).Read More >>

THIS WEEK ON THE BLOG

COVID-19

Long-Term Care Facilities Must Prioritize Immigrant Workers' Needs To
Contain COVID-19

By Caroline Lee, Archana Podury, Jasmine Kaduthodil, and Leigh Graham
(9/18/20)

After detailing the heightened risks to immigrant workers from the
pandemic, we propose systems-level changes including comprehensive
COVID-19 protections, long-term improvements to working standards, and
organizing for immigrant workers' rights.
Read More >>

Promoting Equitable Access To COVID-19 Vaccines-The Role Of Medicaid

By Jacob Wallace, Jason L. Schwartz, and Walter A. Orenstein (9/15/20)

Targeted, strategic investments in Medicaid at this unprecedented moment
can help reverse current declines in vaccination rates and provide
financial resources to Medicaid programs and providers in preparation
for a COVID-19 vaccination campaign. Read More >>

FOLLOWING THE ACA
New GAO Report On Deceptive Coverage Marketing; Extended GA Waiver
Comment Period

By Katie Keith (9/16/20)

On September 16, the US Government Accountability Office released a new
report revealing troubling marketing practices by sales representatives
selling products that do not have to comply with the Affordable Care
Act's consumer protections. Read More >>

CDC 2019 Coverage Numbers Show Increase In Uninsurance Rate, With
Caveats

By Katie Keith (9/14/20)

Although the CDC cautions against making direct comparisons between 2019
and prior years due to methodological changes, the uninsured rate for
2019 is up from 2018 both overall (10.3 percent versus 9.4 percent) and
among non-elderly adults (14.7 percent versus 13.3 percent). Read More
>>

QUALITY OF CARE

To Design Equitable Value-Based Payment Systems, We Must Adjust For
Social Risk

By Philip M. Alberti, Christie Teigland, and David R. Nerenz (9/17/20)

Using social risk adjustment in value-based payment programs would not
mask poor quality of care nor would it disincentivize quality
improvement. The absence of such adjustment does nothing to address
racial inequities in health and health care; if anything, it makes the
problems worse. Read More >>

ETHICS

Ethical Considerations In The Use Of AI Mortality Predictions In The
Care Of People With Serious Illness

By Charlotta Lindvall, Christine K. Cassel, Steven Z. Pantilat, and
Matthew DeCamp (9/16/20)

Having prognostic information in hand could spur patients, families, and
health care professionals to have advanced care planning discussions and
avoid nonbeneficial or unwanted interventions. Yet the rapid
dissemination of mortality algorithms by electronic health record
software raises serious ethical concerns. Read More >>

DETERMINANTS OF HEALTH

The Role Of Racial Justice In Building A Culture Of Health

By Alonzo Plough and Gail Christopher (9/16/20)

A culture of racial injustice and a culture of health cannot coexist.
Alonzo Plough and Gail Christopher share highlights from the Robert Wood
Johnson Foundation's 2020 Sharing Knowledge forum, which focused on
racial injustice and health. Read More >>

MEDICARE

Sharing Drug Rebates With Medicare Part D Patients: Why And How

By Steven M. Lieberman, Paul B. Ginsburg, and Erin Trish (9/14/20)

The growth in rebates has affected Medicare Part D patients. The
challenges in the Medicare program regarding rebates differ from the
challenges in commercial insurance, where some major steps have already
been taken. Legislation should require that an approximation of the
rebate amount for a drug is credited to patients. Read More >>

2019 Medicare Shared Savings Program ACO Performance: Lower Costs And
Promising Results Under 'Pathways To Success'

By Seema Verma (9/14/20)

Centers for Medicare and Medicaid Services Administrator Seema Verma
takes readers through the latest results for accountable care
organizations in the Medicare Shared Savings Program and describes how
she and the administration view those results.Read More >>

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About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

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