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Health policy research, commentary, and analysis.

January 4, 2022

www.healthaffairs.org/toc/hlthaff/41/1?utm_medium=email&utm_source=email&utm_campaign=letter+from+the+editor&utm_content=toc

John,

Today, we released the January issue of
Health
Affairs
.

In this newsletter, I wanted to share and highlight some of the major
findings from this month's research articles.

This month's journal covers topics ranging from health coverage and
Medicaid to nurses and more.

Read The Full Issue

As a new year begins, this issue of the journal reflects the varied
roles that Health Affairs plays in health policy. It includes the
federal government's annual national health expenditures report, by
Micah Hartman and colleagues, revealing a nearly 10 percent increase in
health spending in 2020

due almost entirely to growing federal expenditures associated with the
COVID-19 pandemic.

It also includes the latest in our series of Policy Insights, with
Robert Berenson and Robert Murray making the case that price regulation
can serve to increase competition in health care

in the domains that matter most to patients.

And as we went to press, the wildly successful Health Affairs Blog has
became Health Affairs Forefron
t
,
which will continue to publish the most timely and influential thought
at the forefront of health policy.

Read Health Affairs Forefront

Coverage

George Wehby links birth certificate data to standardized test scores

for children in Iowa and provides strong evidence that the Affordable
Care Act (ACA) insurance expansions led to improvements in reading
scores, particularly among children in households of mothers with a high
school education or less, in the third and fourth years after Iowa's
expansion.

Toward the end of the open enrollment period in California's ACA
Marketplace, Covered California, tens of thousands of people begin but
do not complete the process. Rebecca Myerson and coauthors report
results from a randomized tria
l

showing that personalized telephone calls from service center
representatives to discuss consumers' options increase enrollment for
lower-income households, with particularly large increases seen among
adults older than age fifty.

Read The Full Issue

Medicaid

Wehby and coauthors analyze national survey data and find that Medicaid
expansion in states where significant adult dental benefits

were included saw a narrowing of racial and ethnic disparities in dental
care use in low-income adults.

Dimitris Karletsos and Charles Stoecker examine changes in the
geographic proximity of Medicaid enrollees to providers in the wake of
Louisiana's 2016 Medicaid expansion
.
They find that distance traveled by Medicaid beneficiaries decreased
across all eight types of services examined, with the greatest declines
seen in general practice and primary care.

In their systematic review of the literature, Meghan Bellerose and
coauthors find that the ACA Medicaid expansion increased preconception
and postpartum Medicaid coverage and reduced insurance churn, but there
is limited evidence of increased perinatal care use or improved infant
birth outcomes
.

Sarah Gordon and coauthors analyze data from Colorado, which in July
2021 extended postpartum Medicaid coverage for twelve months
.
They find that the extension is likely to improve the stability of
health insurance coverage in the postpartum year.

Read The Full Issue

Nurses

Peter Buerhaus and coauthors examine health care employment during the
COVID-19 pandemic and find unprecedented declines in the early months,
most intensely in physician offices, outpatient care centers, and home
health care
.
Although employment in most sectors gradually returned toward
prepandemic levels over the course of 2020, "total employment in nursing
homes remained 13.2 percent lower [fifteen months into the pandemic]
than it had been in February 2020."

With an aim to increase the nurse supply, the ACA Graduate Nurse
Education Demonstration provided federal funding to offset the clinical
training costs of advanced practice nurses from 2012 to 2018. Joshua
Porat-Dahlerbruch and coauthors report

that the program was "associated with a significant average increase of
twenty-eight [nurse practitioner (NP)] graduates and eighty-nine NP
enrollees per school of nursing throughout the demonstration period."

Medicare

Matthew Trombley and coauthors report net savings of $381.5 million from
$144.9 million of program costs over three years of the Accountable Care
Organization (ACO) Investment Model (AIM). Yet they find that "nearly
two-thirds of AIM ACOs exited the Medicare Shared Savings Program when
faced with the requirement to assume downside financial risk
,
starting in year four of participation."

Aaron Schwartz and coauthors characterize coverage denials in Aetna's
Medicare Advantage (MA) plans and find that during 2014-19, service
denial rates increased by 15 percent, and spending denial rates
increased by 60 percent
.
Overall they report $416 million in denied spending resulting from
Medicare or MA plan coverage criteria, with 0.81 denials and $60 of
denied spending per beneficiary annually.

In 2016 CMS introduced Current Procedural Terminology codes that allow
billing for advance care planning in fee-for-service Medicare, but their
use remains low. Based on 272 interviews with key staff from eleven
health systems, Keren Ladin and coauthors identify barriers

- ranging from concerns about patient ethics to workflow burden -
that reflect the challenges associated with using the codes.

Read The Full Issue

Get the most out of your subscription today by checking out the current
and past issues
.

Attend these Events

Join Health Affairs for a free virtual event
!
In addition to the new journal edition, we produce a variety of events
that relate to our research and bring health policy professionals up to
speed on the latest in health policy research.

On January 5, you are invited to join Health Affairs Editor-in-Chief
Alan Weil for a Lunch and Learn discussion

of the findings from the 2020 national health expenditures report from
CMS

with economists Sherry Glied and Craig Garthwaite.

On January 11, Charles Stoecker and Dimitris Karletsos discuss their
research

for the article "Louisiana Medicaid Expansion Associated With Reduced
Travel For Care Among Minorities And Rural Residents
"
during a Journal Club.

On January 20, Robert Berenson, Institute Fellow at the Urban Institute,
and Robert Murray, President of Global Health Payment, will discuss
their
paper
,
"How Price Regulation Is Needed To Advance Market Competition
."

Visit The Full Events Schedule

Listen to these Podcasts

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Alongside the issue release, we invite authors from the issue to speak
with Editor-in-Chief Alan Weil on our A Health Podyssey podcast, which
features interviews with leading and up-and-coming researchers in health
services and health policy.

On today's episode, Matthew Trombley joins the program to discuss how
the ACO Investment Model worked to form ACOs in rural areas but why many
AIM ACO participants exited the program once being exposed to downside
financial risk
.

Don't miss recent episodes where Jennifer Attonito discusses lessons
learned from the COVID-19 vaccine rollout in Florida

and Esther Friedman explains home care and nursing home workforce
changes
.

See All Podcasts

Read The Full January Issue

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mailto:[email protected]

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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