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A Weekly Health Policy Round Up From Health Affairs            

**December 8, 2019**

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IN THE JOURNAL

NEW ISSUE:
RURAL HEALTH

Much attention is focused these days on the relatively poor health
outcomes and heightened rate of socioeconomic disadvantage of rural
America. The December issue of Health Affairs explores many dimensions
of health and health care for the one out of five Americans who live in
what the US Census Bureau defines as a rural area.

The December issue of Health Affairs was supported by the Robert Wood
Johnson Foundation, The Colorado Health Foundation, the Episcopal Health
Foundation, the Kate B. Reynolds Charitable Trust, Con Alma Health
Foundation, Empire Health Foundation, The John A. Hartford Foundation,
the California Health Care Foundation, and St. David's Foundation.

Read the December 2019 table of contents
and listen to a
two-minute introduction of the issue from Editor-in-Chief Alan Weil.

Structural Urbanism Contributes To Poorer Health Outcomes For Rural
America

By Janice Probst, Jan Marie Eberth, and Elizabeth Crouch

In this overview paper, Janice Probst and colleagues point out that
rural mortality rates only started falling behind urban rates in the
mid-1980s. The authors introduce the concept of "structural
urbanism"-a bias in financing health care services tied to individuals
that favors densely populated areas and fails to account for the fixed
costs associated with delivering services to those living more remotely.
Read More >>

What Is Rural? Challenges And Implications Of Definitions That
Inadequately Encompass Rural People And Places

By Kevin J. Bennett, Tyrone F. Borders, George M. Holmes, Katy Backes
Kozhimannil, and Erika Ziller

Kevin Bennett and coauthors review how various government agencies
define rural and point out the consequences of using definitions that
may be inappropriate for a particular purpose. Read More >>

Recovery Residences Combat Addiction In Rural Communities

By Brian Rinker

Many communities far from treatment centers and large health systems are
expanding access to local sober-living homes. Read More >>

AHEAD OF PRINT

National Health Care Spending In 2018: Growth Driven By Accelerations In
Medicare And Private Insurance Spending

By Micah Hartman, Anne B. Martin, Joseph Benson, Aaron Catlin, and
The National Health Expenditure Accounts Team

This new analysis from the Office of the Actuary at the Centers for
Medicare and Medicaid Services estimates that in 2018 health care
spending in the United States grew at a rate of 4.6 percent to $3.6
trillion, or $11,172 per person. The 4.6 percent growth rate in 2018 was
faster than that of 4.2 percent in 2017 but was equal to the rate in
2016. The 0.4-percentage-point acceleration in overall growth in 2018
was driven by faster growth in private health insurance spending and
Medicare. For the second year in a row, the number of uninsured people
increased by 1.0 million, reaching 30.7 million in 2018. Read More >>

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THIS WEEK ON THE BLOG

FOLLOWING THE ACA

****

ACA Round-Up: Enrollment Lags, IRS Reporting Requirements, And QHP
Compliance Report

By Katie Keith (12/5/19)

With less than two weeks left until the December 15 deadline, enrollment
through HealthCare.gov is lagging by about 10 percent relative to last
year. This update also covers the release of new issuer-level enrollment
data for prior years, nonenforcement of penalties connected with certain
IRS reporting requirements, and a report on improved insurer compliance
with 2019 notices. Read More >>

CONSIDERING HEALTH SPENDING

There's Nothing Wrong With US Health Care That Less Money Couldn't
Fix
By Bruce Pyenson, and Marjorie Schulman (12/6/19)

Changes along these lines, which involve more than simple defunding
approaches, would help to stabilize current health care spending while
giving politicians time to work out more emotionally and politically
charged issues. Read More >>

MEDICARE

Moving To A Market-Driven Medicare Program

By Brian J. Miller and Gail R. Wilensky (12/5/19)

With more than half a century of price setting in Medicare
fee-for-service, we have failed to control health care expenditure
growth. Now is the time to try something different.
Read More >>

PATIENTS AND CONSUMERS

The Lurking Danger In The "Business Case" For Patient Safety

By Michael L. Millenson (12/2/19)

Hospital boards and leaders have a duty to their community to make
replicating the "zero preventable harm" exemplars' achievements a
measurable, accountable, and urgent goal. Read More >>

ACCESS TO CARE

Beyond The Firewall: Pathways To Affordable Health Coverage For
Low-Income Workers

By Tara Straw (12/3/19)

Compared to middle- and upper-income employees, low-income workers are
often offered less robust coverage, get less employer help with their
premiums, and must pay a greater share of their income toward health
care costs. Read More >>

VIOLENCE AND HEALTH

The Critical Role Of Philanthropy In Researching Solutions To Gun
Violence

By Nina E. Vinik (12/5/19)

The Joyce Foundation looks back at 25 years of funding gun violence
research. Grantees have included universities, hospitals, and think
tanks. Early research supported by Joyce helped define gun violence as a
public health discipline. And, because lack of data was a barrier to
understanding gun violence, this foundation and others funded
development of a comprehensive data set on all violent deaths in the US.
There is more we need to learn, though, says this author. Read More >>

PRIMARY CARE

Leveraging Virtual Networks To Improve Dermatologic Access And Care

By Karen E. Edison (12/4/19)

Initiatives such as Project ECHO help us maximize the physician
expertise we do have-making expert care available to more patients,
and improving cost-effectiveness in the health care system-and they
make a difference.
Read More >>

ELSEWHERE@HEALTH AFFAIRS

Fitzhugh Mullan: A Health Affairs Reading List

(12/4/19)

The Health Affairs community was deeply saddened to learn that Fitzhugh
Mullan- pediatrician, activist, researcher, educator, editor-passed
away on November 29, 2019, at the age of 77. He will be so dearly
missed. Over more than 30 years, Mullan authored dozens of articles that
were published by Health Affairs, including research, commentaries, and
interviews. Read More >>

MEDICAID

Inside Tennessee's Final 1115 Medicaid Block Grant Proposal

By Sara Rosenbaum, Alexander Somodevilla, Morgan Handley, and Rebecca
Morris (12/6/19)

The state's proposal, if approved, would become "Amendment 42" to
TennCare since its establishment nearly 30 years ago, although the term
"amendment" would hardly seem to describe such a total and sweeping
departure from the normal Medicaid coverage and payment principles that
govern all state Medicaid programs, including TennCare.
Read More >>

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HEALTH AFFAIRS EVENTS-2019 Commonwealth Fund International Health
Policy Survey

This Week! December 11 at 9:00 am - 12:00 pm Eastern
Conrad Hotel - 950 New York Ave NW, Washington DC
Register To Attend

Join us for a special event to be convened by Health Affairs and The
Commonwealth Fund marking the publication of the 2019 Commonwealth Fund
International Health Policy Survey of Primary Care Physicians in 11
Countries. Senior government officials, delivery system experts, and
leading policy thinkers from around the world will gather for a high
level discussion of strategies to promote high-quality primary care,
with special attention to the integration of health and social care.

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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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