Spending And Payment

Building on the federal government’s estimates of state-level health expenditures, which only run through 2014, Emily Johnson and coauthors estimate state spending through 2019.

Between 2013 and 2019, after adjusting for inflation, "annualized per person spending growth for each state ranged from 1.0 percent in Washington, D.C., to 4.2 percent in South Dakota."

Enrollment by patients with end-stage renal disease in Medicare Advantage
(MA) plans is likely to grow rapidly because of recent federal policy changes.

Eugene Lin and coauthors find that the largest MA plans pay about one-quarter more than Medicare fee-for-service rates for dialysis, with the highest markups paid to large dialysis chains.

Victor Van de Wiele and coauthors review drug patents approved in 2019 and 2020 and find that "numerous patents covered aspects of the drug beyond its chemical compound."

They conclude that "patent reform, rather than changes to nonpatent exclusivities, is the key to ensuring timely generic entry."

State Medicaid programs have expanded access to home and community based services through waivers.

Meghan Skira and coauthors find that between 1999 and 2017, waivers covered a wider range of services, including an increase in coverage for services that support self-direction. Section 1915(c) waiver spending increased across all service categories during this period.

Looking at data from five years after the launch of the Medicare Shared Savings Program, José Figueroa and coauthors find that accountable care organization participation among Medicare beneficiaries "was associated with small savings among those with [serious mental illness], including schizophrenia and related psychotic disorders, bipolar disorder, and major depressive disorder."

After Virginia expanded Medicaid in 2019, newly enrolled members had decreased financial concern about nonmedical needs, such as housing and food, and decreased concern about medical costs and medical debts, according to Hannah Shadowen and coauthors.

There were larger reductions in concerns for non-Hispanic Black and African American enrollees relative to White enrollees, and larger reductions for members in rural than nonrural areas.

Workforce

In March 2020 New Jersey enacted the COVID-19 Temporary Emergency Reciprocity Licensure Program, allowing out-of-state licensed practitioners to continue providing telehealth or in-person services to New Jersey patients.

Analyzing survey responses from more than 10,000 temporary licensees, Ann Nguyen and coauthors find that participating practitioners "originated from every state in the US, provided both COVID-19 and non-COVID-19-related care, [and] served a combination of new and existing patients."

In related Perspectives, Brendan Carr and Nicholas Gavin note that New
Jersey’s temporary licensure program reveals a need to consider surge capacity, to have a broadened understanding of access, and to maintain local care priorities.

Bianca Frogner argues that states should move toward uniform licensure requirements to ensure continuity of care and make temporary licensure programs permanent.

Humayun Chaudhry says that policy makers need to understand the individual and combined effects of pandemic-era policy and translate this understanding into sustained pandemic preparedness efforts.

Global Health Policy

Using survey data from fifty-six low- and middle-income countries during 2006–18, Simiao Chen and coauthors find that only 20.3 percent of respondents report that they are covered by health insurance.

"Only seven [countries] achieved health insurance coverage greater than
50 percent," they report. Sub-Saharan Africa has the lowest proportion covered, at 7.7 percent.

Barak Richman and coauthors conducted a cross-national analysis of billing
and insurance–related health care costs at six provider locations in five
nations.

"Billing costs range from a low of $6 in Canada for a nonsurgical inpatient
bill to a high of $215 in the US for an inpatient surgical bill," they find.

Although countries with lower costs have different health systems, "they each contain national structures that standardize how payers compensate providers."

Determinants Of Health

Using data from the period 2011–19, Yanlei Ma and coauthors conclude that implementation of statewide paid sick leave mandates is associated with a 5.6 percent reduction in state emergency department visit rates, with the largest reduction among Medicaid patients.

Charlotte Probst and coauthors examine changes in US life expectancy between 2000 and 2018 that are attributable to alcohol.

They find that "deaths from liver disease and cirrhosis, suicides, and motor vehicle accidents were…more concentrated among men and women without college degrees than among those with a college degree or more."

This month, Health Affairs is continuing to grow its portfolio of virtual programming, beginning with a Policy Spotlight event on August 3 with FDA Commissioner Robert Califf.

The event is open to all, and you won't want to miss this one-on-one discussion. Register today to reserve your seat.

We're also hosting a Professional Development event for Health Affairs Insiders on August 11. Join Health Affairs Design Director Julia Vivalo, who will share tips and strategies for translating data results into eye-catching exhibits to underscore your policy conclusions.

As a reminder, access to our virtual Lunch and Learn, Professional Development, and Journal Club events will be limited to Health Affairs Insider and Unlimited members only.

To become an Insider and attend all virtual events, visit our membership page.

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.

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