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The Commonwealth Fund Connection

A roundup of recent Fund publications, charts, multimedia, and other timely content.




October 29, 2021

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A Key Pathway to Timely Generic Drug Competition Is Under Threat
“Skinny labeling” helps speed up drug competition by allowing generic manufacturers to seek approval for treatment of diseases or patient populations that are no longer under patent protection. In this way, generics can enter the market before all of a brand-name drug’s patents expire. But Bryan Walsh, a health care researcher at Harvard Medical School, reports that a recent court opinion upholding a challenge to skinny labeling may result in patients paying higher brand-name-drug prices for longer.

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What Role Could Domestic Reference Pricing Play in Medicare Drug Price Negotiations?
Although Medicare Part D is the federal government’s largest prescription drug program, it pays nearly triple what Medicaid pays for certain drugs and nearly double what the VA and the Defense Department pay. One explanation: those other programs use domestic pricing benchmarks, while Medicare doesn’t. In a new explainer, we discuss what’s known as domestic reference pricing and how Medicare could potentially use it when negotiating prices with pharmaceutical companies — a prospect that Congress is currently debating.

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Sara Collins: Ease the Cost Burden of Employer Health Insurance
“The cost burden of commercial insurance is an enduring problem in U.S. health care that is undermining America’s overall economic well-being,” said Commonwealth Fund health economist Sara Collins during her recent invited testimony before the Senate Finance Committee. At a hearing focused on the current and future role of federal health insurance programs, Collins spoke on trends in employer plan enrollment, the share of firms offering health benefits, workers’ insurance and health care costs, and policy options for improving employer coverage.

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New Podcast: Online Therapy Works. Will It Stick Around?
When the COVID-19 pandemic hit last March, mental health care, which was typically delivered in face-to-face sessions, rapidly moved online. But as we glance — with cautious optimism — toward a return to “normal,” will telehealth be the dominant mode of delivering mental health services? On the latest episode of The Dose podcast, Latoya Thomas and Solome Tibebu talk about the future of virtual mental health care, particularly for underserved groups.

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What Employers Need to Know About Vaccine Mandates and Incentives
Private employers may — and, in some situations, must — require their workers to be vaccinated against COVID-19. However, the ACA and certain federal laws prohibiting religious and disability discrimination limit employers’ ability to do so. Health law expert Timothy S. Jost delves into the complex web of legal requirements regarding vaccine mandates and incentives. In imposing any requirement, “employers must be mindful of federal laws prohibiting discrimination, regulating health plans, and protecting privacy,” he writes.

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Do State Experiments Restricting Medicaid Retroactive Eligibility Limit Access to Care?
People in need of Medicaid coverage can become eligible up to three months before they formally apply. So-called retroactive eligibility can help those who need care immediately. George Washington University’s Sara Rosenbaum writes that since the 1990s, states have experimented with restricting retroactive eligibility. While the federal government is required to evaluate the impact of these state demonstrations, it hasn’t done so, she says, and state waivers continue to be approved. Rosenbaum believes the Biden administration can take steps to ensure future demonstrations strengthen Medicaid coverage, not undermine it.

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New Strategies and Practices for Confronting Racism in Health Care
Leaders from several U.S. health systems have named racism as a public health threat and promised to identify and reverse racist policies and practices in their institutions. In a new feature article, the Commonwealth Fund’s Martha Hostetter and Sarah Klein describe the actions eight academic medical centers are taking to reduce health disparities, create more equitable workplaces, and invest in communities of color.

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Modernizing Racial and Ethnic Data Collection in Federal Health Programs
The path to health equity starts with collecting, reporting, and using complete, accurate, and reliable data on race and ethnicity. But as the COVID-19 pandemic has shown, the U.S. does a poor job of this. Researchers from Grantmakers in Health and the National Committee for Quality Assurance have outlined an agenda for modernizing racial and ethnic data collection in federal health programs. Two of the biggest barriers, they say, are the lack of a sufficient federal standard and misconceptions and fear over how the data will be used.

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Reducing Racial Disparities in Cancer Treatment
Many Black patients don’t get timely or adequate cancer care. Earlier this week, the
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Washington Post
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reported on ACCURE, the first clinical trial specifically developed to reduce racial disparities in cancer treatment. Results indicated that prior differences that had existed between Black and white patients’ survival rates were eliminated. In the new issue of Transforming Care, “
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Reducing Racial Disparities in Health Care by Confronting Racism ,” we report on the trial and its roots in a participatory research project that sought to understand Black people’s experiences in the health care system, build patient trust, and train nurse navigators to reduce barriers to care.



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Addressing Maternal Health Needs Before, During, and After Childbirth: We Need to Do Better
Every year, as many as 60,000 U.S. women experience serious illnesses or complications during pregnancy and delivery. The numbers are rising, even though many cases could be prevented with timely care. In Severe Maternal Morbidity in the United States: A Primer, Boston University’s Eugene Declercq and the Commonwealth Fund’s Laurie Zephyrin, M.D., detail the scope and severity of the maternal morbidity crisis and show why addressing it is critical to advancing equity in maternal health. The primer is the latest in our series of publications investigating the causes of poor maternal outcomes and identifying potential solutions.

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Legal Challenges to S.B. 8, the Texas Abortion Ban
Next week, the U.S. Supreme Court will hear two challenges to S.B. 8 — the Texas law that prohibits abortion after a fetal heartbeat is detected and penalizes anyone who helps a person seeking an abortion, including health care providers and family or friends. On To the Point, health law experts Timothy S. Jost, Katie Keith, and Sara Rosenbaum discuss the status of these cases. Given the questions about S.B. 8’s enforcement scheme, which relies on private individuals, they say the lawsuits “will likely be resolved on procedural grounds.” In December, the Supreme Court will hear a separate challenge to a Mississippi law that would ban nearly all abortions after 15 weeks.

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To Expand Coverage Options, Lower Barriers Between Individual and Small-Group Markets
The ACA helped lower health insurance premiums in both the individual and small-group markets. Now some experts are wondering whether we need to allow consumers access to both markets to help ensure they have affordable coverage options. In a new Commonwealth Fund issue brief, Mark Hall and Michael McCue show how providing consumers with opportunities to cross over into either market could be beneficial.

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How Can We Better Meet the Needs of Older Adults with Disabilities in Their Homes?
Millions of older Americans with disabilities live at home, and most of the assistance they receive for daily tasks like bathing and dressing comes from family members, friends, and other unpaid caregivers. Findings from Johns Hopkins University researchers show that older adults with dementia, those needing substantial daily assistance, and those living in poverty are more likely to suffer adverse consequences when no one is available to care for them. In their Commonwealth Fund issue brief, the authors suggest two policy strategies: government financing for assistive services for older adults with disabilities, and national paid family leave for family caregivers.

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