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The Commonwealth Fund Connection

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




April 29, 2022

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Discrimination’s Impact on Health Care for Older Adults
Racial and ethnic discrimination in the U.S. health care system is taking a toll on older Americans, even preventing some from getting needed care, a Commonwealth Fund study finds. One in four older adults of color surveyed said that health care professionals have treated them unfairly or ignored health concerns because of their race or ethnicity. Among those who reported being discriminated against, more than a quarter said that they did not get the care they needed because of that discrimination.

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How We Get Past Data Barriers to Improve Diversity in Clinical Trial Participation
Racial and ethnic diversity in clinical trial participation is critical to ensuring that newly developed drug therapies and treatments are properly assessed for their safety and efficacy in different patient populations. But a lack of reliable race and ethnicity data in the patient databases used to recruit trial participants stands in the way. In the New England Journal of Medicine, Commonwealth Fund President David Blumenthal, M.D., and Grantmakers In Health president and CEO Cara James explore the factors contributing to this lack of data and suggest potential policy interventions.

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How States Can Use Medicaid Policy to Address Social Drivers of Health
States are increasingly turning to Medicaid to address social drivers of health that contribute significantly to health outcomes, like quality of living conditions and access to nutritious food. Recently, the federal government approved a proposal from California to provide “in lieu of” services — a robust menu of health-related services offered through Medicaid managed care plans. Manatt Health’s Cindy Mann and Dori G. Reyneri take a closer look at California’s new policy and how it could provide a roadmap for other states.

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The Pandemic Won’t End Until We Strengthen Our Safety Net
When a federal judge lifted the national mask mandate on airplanes, trains, and other public transportation, some Americans celebrated. Others dreaded the removal of a relatively simple public health tool at a time when COVID-19 cases are rising across the U.S. On The Dose podcast, Celine Gounder, M.D., talks about why people without privilege — like those who are poor or uninsured and many people of color — will be hit the hardest if we rush to return to normal.

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Steps to Protect and Enhance Recent Gains in Health Coverage
In response to the pandemic, the federal government passed laws and implemented policies to stabilize and expand health care coverage. As a result, the percentage of uninsured Americans decreased. But those temporary measures are set to expire either at the end of the year or when the public health emergency ends. As the Commonwealth Fund’s Sara Collins explains on To the Point, there are several near-term actions Congress could take to help people stay covered while the nation continues to battle COVID-19.

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How ACA Marketplaces Can Keep People Covered When the Health Emergency Ends
The Affordable Care Act’s marketplaces will serve as a critical safety net for up to 16 million people who stand to lose their Medicaid coverage once the federal government declares the end of the COVID-19 public health emergency. But Georgetown University’s Sabrina Corlette and Maanasa Kona find that many people are likely to fall through the cracks, potentially undoing some of the historic coverage gains achieved during the pandemic. They say federal and state-run marketplaces can take steps to help preserve those gains.

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Ending the Mask Mandate on Public Transit: Legal and Ethical Perspectives
Who should be in charge of public health decisions affecting the American people — scientific agencies designated by Congress or unelected federal judges? And how do we balance individual freedom and collective responsibility? Two new commentaries on To the Point take on these questions in light of a federal judge’s recent ruling to end the nationwide mask mandate. Health law expert Timothy S. Jost examines the
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legal rationale for the judge’s decision , while Commonwealth Fund President David Blumenthal, M.D.,
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explores the ethics .

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Is It Time to Reform How Pharmacy Benefit Managers Operate?
Pharmacy benefit managers, or PBMs, have come under scrutiny for their contribution to high prescription drug costs. As their role in the pharmaceutical sector expands, Congress, regulators, and market disrupters have turned their focus to PBM practices. Health policy experts Bobby Clark and Marlene Sneha Puthiyath say that while short-term prospects for change are uncertain, a “clear interest in examining and changing PBM practices” may set the stage for significant reforms that “dramatically alter the way prescription drugs are accessed and paid for in the United States.”

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How Health Care Contributes to Climate Change, and What We Can Do About It
Climate change, a grave threat to population health and the functioning of the health system, is already taking a toll on people’s physical and mental health. Worldwide, the health care sector is responsible for as much as 4.6 percent of total greenhouse gas emissions. Within the United States, it’s responsible for an even larger proportion — 8.5 percent. A new Commonwealth Fund explainer shows how health care systems, which shoulder much of the burden of caring for people affected by climate change, have become significant contributors to the problem.

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Medicare’s Home Health Benefit: Misunderstood and Underused
Medicare’s home health benefit could help many people with long-term, debilitating conditions, and it includes services to improve, maintain, or slow health declines. Home health coverage is available even if services are expected to continue over a long period. But misunderstandings about what is covered, along with changes in Medicare payment and regulations, have greatly restricted use of the benefit. The Center for Medicare Advocacy’s Judith Stein and David Lipschutz discuss what the home health benefit offers, who is eligible, and why services are so underused.

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What Do We Know About Medicare Advantage Plans’ Benefit Design?
As reported in the New York Times, a federal investigation found that
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Medicare Advantage plans often deny beneficiaries needed care. Investigators called for greater oversight of these private insurance plans, which have seen increasing enrollment and now cover some 28 million Americans. Earlier this year, the Fund partnered with Arnold Ventures to publish a series of blog posts taking stock of the Medicare Advantage program, including one that
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examined private plans’ use of prior authorization and other utilization management techniques.





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