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A Weekly Health Policy Round Up From Health Affairs            

**September 22, 2019**

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HEALTH AFFAIRS EVENTS

AGING AND HEALTH:  IMPROVING CARE FOR OLDER ADULTS

THIS TUESDAY! September 24, 2019
10:00 am - 12:00 pm Eastern
National Press Club - 529 14th Street NW, Washington, DC
Registration Open

Join Health Affairs and The John A. Hartford Foundation for a robust
policy conversation featuring authors from the journal's Aging &
Health series, as well as other experts in the field, to discuss topics
including:

* Moving Serious Illness Care from Hospital to Home

* Disparities in Home- and Community-Based Care

* Impact of Caregiving on Spouses and Need for Support

In addition to Terry Fulmer, President of The John A. Hartford
Foundation, confirmed speakers include:

* Timothy G. Ferris, CEO, Massachusetts General Physicians Organization

* Ann Hwang, Director, Center for Consumer Engagement in Health
Innovation, Community Catalyst

* Tamara Konetzka, Professor of Health Services Research, Department of
Public Health Sciences and Department of Medicine, The University of
Chicago Biological Sciences, on "A National Examination Of Long-term
Care Setting, Outcomes, And Disparities Among Elderly Dual-Eligibles"
(July 2019)

* Bruce Leff, Professor of Medicine and Director, Center for
Transformative Geriatric Research, Division of Geriatric Medicine, Johns
Hopkins University School of Medicine

* Katherine A. Ornstein, Associate Professor of Geriatrics and
Palliative Medicine, and Research Director, Institute for Care
Innovations at Home, Icahn School of Medicine at Mount Sinai, on
"Spousal Caregivers Are Caregiving Alone In The Last Years Of Life"
(June 2019)

* Brad Stuart, Chief Medical Officer, Coalition to Transform Advanced
Care, on "A Large-Scale Advanced Illness Intervention Informs
Medicare's New Serious Illness Payment Model" (June 2019)

* Jennifer Wolff, Eugene and Mildred Lipitz Professor and Director of
the Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins
School of Public Health

Getevent-specific emails
delivered directly to your inbox.

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THIS WEEK ON THE BLOG

FOLLOWING THE ACA

Section 1557 Litigation: Latest Developments

By Katie Keith (9/18/19)

Judge O'Connor set a hearing on the motion to intervene for September
16 in Fort Worth, Texas. From here, he is expected to rule on the motion
to intervene and potentially on the request for summary judgment. Read
More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Understanding The House Democrats' Drug Pricing Package

By Rachel Sachs (9/19/19)

In this post, I first summarize key provisions from the Democrats'
proposal, explaining how it aims to lower prescription drug prices.
Then, I situate this package from the Speaker within the broader set of
drug pricing reforms being considered by the federal government.
Finally, I present a key objection the package is likely to face from
the Republican caucus and consider questions that remain for the
substance of the package. Read More >>

PUBLIC HEALTH

How FDA Can Act On E-Cigarettes And Protect The Public Health

By Andrew B. Meshnick, Brian J. Miller, and Boris Lushniak (9/17/19)

Through banning flavors in both retail and online settings, increasing
advertising oversight, regulating nicotine concentration, and
encouraging further evidence-based research, the Food and Drug
Administration can tip the balance of the e-cigarette marketplace to
ensure that these products not only live up to their potential, but
protect the public health.
Read More >>

ACCESS TO CARE

High Rates Of Perinatal Insurance Churn Persist After The ACA

By Jamie R. Daw, Katy B. Kozhimannil, and Lindsay K. Admon (9/16/19)

Strategies to improve continuity of coverage must be considered as part
of clinical and policy solutions for improving maternal health outcomes
in the US. Read More >>

Road To Universal Coverage: Addressing The Premium Affordability Gap

By Jen Mishory and Katie Keith (9/18/19)

Current proposals to expand access to coverage-such as state or
federal public options, Medicaid or Medicare buy-in proposals, and
single-payer plans-reflect a range of strategies to make premiums more
affordable. This post discusses the impact that these different
approaches would have on premium affordability for low- and
middle-income families and individuals. Read More >>

MATERNAL AND CHILD HEALTH

Caught In The Crossfire Of The Trump Administration's New SNAP
Proposal: 500,000 Children

By Swapna Reddy, Gregory Sprout, Maureen McCoy, Sarah Martinelli, and
Jessica Lehmann (9/18/19)

The Trump administration's new proposal would restrict flexibility for
states to grant eligibility for the Supplemental Nutrition Assistance
Program (SNAP) through criteria that differ from federal standards. This
measure would, by extension, have widespread eligibility implications
for the National School Lunch Program (NSLP). Read More >>

PAYMENT

Data: Silver Loading Is Boosting Insurance Coverage

By Aviva Aron-Dine (9/17/19)

The enrollment gains from silver loading suggest that premium tax credit
(PTC) increases could significantly increase Marketplace enrollment and
reduce uninsured rates, particularly among the already PTC-eligible
consumers who make up the majority of the Marketplace-eligible
uninsured. Read More >>

QUALITY OF CARE

Moving More Electrons To Optimize New Adult Composite Immunization
Measures

By Angela K. Shen and Elizabeth Sobczyk (9/20/19)

Composite measures go beyond vaccine-specific measures and provide a
systems-wide view of preventive care performance. Having new measures
that better reflect improved health outcomes, the processes that lead to
them, and systems of care delivery epitomize the next generation of
measures. Read More >>

Cultural Competence Is Key To Meeting Patients' Needs: One Perspective
From New York City

By Hewett Chiu (9/19/19)

Cultural competence is essential to providing high-quality care and is a
bedrock for meeting the needs of an increasingly diverse patient
population. Throughout his career, this author has set out to change the
health care system at the community level to better meet the needs of
patients facing language or cultural barriers to care. Key to helping
him on this path was his participation in the United Health Foundation's
Diverse Scholars Initiative. Read More >>

PATIENT-CENTERED CARE

Accelerating The Shift Toward Person-Generated Real-World Evidence

By Tanisha Carino and Mark McClellan (9/19/19)

Gaps in evidence from traditional clinical trials, coupled with progress
in the availability and use of standardized electronic data, has led to
increasing interest in real-world data (RWD)-recently defined by the
FDA as "data relating to patient health status and/or the delivery of
health care routinely collected from a variety of sources." Read More >>

MEDICAID

What Some Researchers Get Wrong About Medicaid's Income Eligibility
Requirements

By Tricia Brooks (9/19/19)

The bottom line is this-the National Bureau of Economic Research
working paper used as the basis for the recent Wall Street Journal
commentary is relying on unadjusted self-reported survey data as a proxy
for actual Medicaid income eligibility and enrollment. Read More >>

IN THE JOURNAL

EYE ON HEALTH REFORM

Texas Arguments Lead Heavy ACA Action

By Katie Keith

Katie Keith reviews the unusual chronology of Texas v. United States,
which in July was discussed at a hearing before a three-judge panel of
the Fifth Circuit Court of Appeals. With the US Department of Justice
now supporting the decision of the lower court to invalidate the
constitutionality of the Affordable Care Act (ACA), Keith details issues
of standing (for Democratic attorneys general and the US House of
Representatives) that could be key to the Appeals Court's ruling. Read
More >>

PAYMENT

Marketwide Price Transparency Suggests Significant Opportunities For
Value-Based Purchasing

By Anna D. Sinaiko, Pragya Kakani, and Meredith B. Rosenthal

Anna Sinaiko and coauthors analyze variation in paid claims across
payers and providers in Massachusetts. Overall, "prices paid for
outpatient services delivered at acute hospitals were 76 percent higher
than prices paid for the same services received in other settings, but
there was considerable variation across service categories."Read More
>>

CULTURE OF HEALTH

Experiment To Decrease Neighborhood Poverty Had Limited Effects On
Emergency Department Use

By Craig E. Pollack, Shawn Du, Amanda L. Blackford, and Bradley Herring

Isolating the effects of neighborhood characteristics on health is
challenging. Leveraging the large Moving to Opportunity for Fair Housing
Demonstration Program, developed by the US Department of Housing and
Urban Development, Craig Pollack and coauthors focus on the emergency
department (ED). They do not find "strong evidence that receipt of a
housing voucher or exposure to low-poverty neighborhoods was
significantly associated with reductions in long-term ED use among
adults or children." Read More >>

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HOSPITALS

Emergency Department Closures And Openings: Spillover Effects On Patient
Outcomes In Bystander Hospitals

By Renee Y. Hsia and Yu-Chu Shen

Renee Hsia and Yu-Chu Shen analyze how health outcomes for heart attack
patients change when an emergency department opens or closes. They find
that an ED closure requiring patients to travel an additional thirty
minutes to a hospital already operating at or near capacity is
associated with lower rates of timely treatment, higher rates of
readmission, and an 8 percent increase in the likelihood of dying within
one year. Read More >>

THE PRACTICE OF MEDICINE

US Physicians' Reactions To ACA Implementation, 2012-17

By Lindsay Riordan, Rahma Warsame, Sarah Jenkins, Kandace Lackore, Joel
E. Pacyna, Ryan M. Antiel, Timothy Beebe, Mark Liebow, Bjorg
Thorsteinsdottir, Matthew Wynia, Susan Dorr Goold, Matthew DeCamp,
Marion Danis, and Jon Tilburt

There have been few analyses of physicians' views of the ACA, and none
examining changes over time. To fill this gap, Lindsay Riordan and
coauthors compared responses to their 2012 and 2017 surveys of US
physicians' perceptions and approval of the ACA.
Read More >>

The Practice Of Medicine
series is
supported by The Physicians Foundation.

GLOBAL HEALTH POLICY

In Low- And Middle-Income Countries, Is Delivery In High-Quality
Obstetric Facilities Geographically Feasible?

By Anna D. Gage, Fei Carnes, Jeff Blossom, Jalemba Aluvaala, Archana
Amatya, Kishori Mahat, Address Malata, Sanam Roder-DeWan, Nana
Twum-Danso, Talhiya Yahya, and Margaret E. Kruk

Anna Gage and coauthors modeled the geographic feasibility of service
delivery redesign that shifted deliveries from primary care clinics to
hospitals in Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. Under
the authors' hospital-only redesign, between 72.9 percent (Tanzania)
and 98.3 percent (Haiti) of pregnant women would need to travel two
hours or less, an increase in average travel time from seven minutes
(Kenya) to forty-six minutes (Tanzania). While the authors acknowledge
the challenges of implementing these changes, they note that because
primary care facilities are not able to consistently provide lifesaving
care, it is time to consider a hospital-only approach. Read More >>

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About Health Affairs

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