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A Weekly Health Policy Round Up From Health Affairs            

**December 15, 2019**

FOLLOWING THE ACA

2020 Enrollment Lags Slightly As More Keep 2019 Coverage; New Direct
Enrollment Guidance

By Katie Keith

****Overall, more than a million consumers are new consumers while about
2.8 million actively renewed their coverage from last year. New
enrollment is down by 4 percent and renewals are down by 7 percent
relative to last year. Read More >>

Justices Appear Sympathetic To Insurers In Risk Corridor Payment Oral
Arguments

By Katie Keith (12/12/19)

This post discusses the history of the risk corridors litigation, the
arguments made by the parties and amici, the oral argument, and
potential outcomes. A decision, which will have implications beyond the
risk corridors program, is expected by summer 2020. Read More >>

New Data On Health Spending, White Paper On Risk Adjustment Data
Validation

By Katie Keith (12/9/19)

The Centers for Medicare and Medicaid Services (CMS) Office of the
Actuary released new data showing that national spending reached a total
of $3.6 trillion in 2018, or $11,172 per person. CMS released a new
white paper on risk adjustment data validation (RADV) with the goal of
soliciting feedback for future RADV policy. Stakeholders can comment on
the white paper until January 6, 2020. Read More >>

PHARMACEUTICALS AND MEDICAL TECHNOLOGY

Prescription Drug Legislation In Congress: An Update

By Rachel Sachs (12/11/19)

Over the past week, there have been developments in both houses of
Congress on drug pricing legislation. In this post, I summarize the
developments, explaining what each package would and would not do for
different aspects of the drug pricing issue. Then, I situate these
Congressional developments within the context of the White House and
executive branch's efforts to advance regulatory reforms in this area.
Read More >>

Drug Makers Cry Wolf Yet Again

By Henry A. Waxman (12/10/19)

I urge members of Congress to ignore pharmaceutical company
fear-mongering and instead focus on the facts and Americans' health
care needs, just as Congress did thirty-five years ago when it passed
the Hatch-Waxman Act. Read More >>

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HEALTH INFORMATION TECHNOLOGY

Rethinking Patient Data Privacy In The Era Of Digital Health

By Lisa Bari and Daniel P. O'Neill (12/12/19)

As federal and state lawmakers look to revamp privacy rules, this post
outlines a proposal to adapt and extend the familiar HIPAA framework,
and some of the fiduciary principles embedded in that framework, for a
new era of digital-first health care. Read More >>

MEDICAID

Medicaid Recipient Awareness Of Work Requirements: Importance And
Challenges

By Jessica Greene (12/11/19)

In this post, I discuss how low enrollee awareness has long plagued not
just work requirements but other Medicaid "consumer-driven"
policies. Read More >>

HEALTH CARE SPENDING

Health Conundrum: How State Budgets Can Find The Balance Between Social
Versus Medical Services

By Shannon Brownlee, Vikas Saini, and Benjamin F. Miller

Can the United States bring down overall health care costs by spending
more on social determinants of health? The authors say that strategy
remains unproven. However, states are the principal spenders on social
services. Few studies have directly examined the tradeoffs that states
and local governments are making between social services and health
care. The authors discuss results of a Lown Institute report-funded by
Well Being Trust-on California spending. Read More >>

MEDICARE

Medicare For All Would Improve Hospital Financing

By Christopher Cai and James Kahn (12/9/19)

Two current bills, H.R.1384 and S.1129, would implement a single-payer,
Medicare for All reform. Under these bills, needed hospitals,
particularly rural and safety net, could thrive, and unnecessary
hospitals would close. Read More >>

PUBLIC HEALTH

The FDA's Opaque Approach To Breast Density Communications

By Bridget C. E. Dooling (12/13/19)

The new wording could confuse and spook women, pushing some away from
seeking life-saving health care or toward extra testing that they
don't really need. Read More >>

HEALTH AFFAIRS EVENTS-PAST EVENT:  RURAL HEALTH

The December 2019 issue of Health Affairs explores various dimensions of
health and health care in rural America-health needs of people living
in rural areas, inequities, financing of care-and identify policies
and practices that can improve the health and well-being of rural
Americans. Get caught up with the Rural Health event:  slides

(click on Download Event), video
, and
podcast
.

Access the December PRINT

or ONLINE

issue.

Getevent-specific emails

delivered directly to your inbox.

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IN THE JOURNAL

AHEAD OF PRINT

Primary Care Physicians' Role in Coordinating Medical And
Health-Related Social Needs In Eleven Countries

By Michelle M. Doty, Roosa Tikkanen, Arnav Shah, and Eric C. Schneider

A survey of primary care physicians in eleven countries shows that the
United States is an outlier in lacking extended access to primary care
via home visits and after-hours appointments. Michelle Doty and
colleagues found that 37 percent of US physicians reported that they or
a health care professional in their practice made home visits frequently
or occasionally, compared to 70 percent or more in all of the other
countries. Read More >>

THE PRACTICE OF MEDICINE

The Decline In Rural Medical Students: A Growing Gap In Geographic
Diversity Threatens The Rural Physician Workforce

By Scott A. Shipman, Andrea Wendling, Karen C. Jones, Iris Kovar-Gough,
Janis M. Orlowski, and Julie Phillips

Medical students from rural backgrounds are more likely to practice in
rural areas than those from urban backgrounds are. Scott Shipman and
coauthors find that in the years 2002-17 the number of medical school
applicants from a rural background declined by 18 percent and the number
of matriculants declined by 28 percent, while urban applicants increased
by 59 percent and matriculants by 35 percent.Read More >>

The Practice Of Medicine series
is supported
by The Physicians Foundation.

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RURAL HEALTH

Lack Of Access To Specialists Associated With Mortality And Preventable
Hospitalizations Of Rural Medicare Beneficiaries

By Kenton J. Johnston, Hefei Wen, and Karen E. Joynt Maddox

What are the consequences of access barriers in rural areas? Kenton
Johnston and coauthors find that rural Medicare beneficiaries with
chronic conditions experience a 40 percent higher preventable
hospitalization rate and a 23 percent higher mortality rate, compared to
urban residents. Read More >>

Higher US Rural Mortality Rates Linked To Socioeconomic Status,
Physician Shortages, And Lack Of Health Insurance

By Gordon Gong, Scott G. Phillips, Catherine Hudson, Debra Curti, and
Billy U. Philips

Gordon Gong and coauthors identify socioeconomic status, physician
shortages, and lack of health insurance as the primary reasons rural
residents have higher mortality rates than urban residents do in almost
every state in the country. Read More >>

Rural Counties With Majority Black Or Indigenous Populations Suffer The
Highest Rates Of Premature Death In The US

By Carrie E. Henning-Smith, Ashley M. Hernandez, Rachel R. Hardeman,
Marizen R. Ramirez, and Katy Backes Kozhimannil

Despite well-documented health disparities by rurality and
race/ethnicity, research investigating racial/ethnic health differences
among US rural residents is limited. Carrie Henning-Smith and coauthors
used county-level data to measure and compare premature death rates in
rural counties by each county's majority racial/ethnic group. Read
More >>

Healthy People 2020: Rural Areas Lag In Achieving Targets For Major
Causes Of Death

By Sirin Yaemsiri, Johanna M. Alfier, Ernest Moy, Lauren M. Rossen,
Brigham Bastian, Jane Bolin, Alva O. Ferdinand, Timothy Callaghan, and
Melonie Heron

Rural America faces numerous public health challenges, including reduced
access to health services, poor nutrition, uncontrolled diabetes, mental
and substance use disorders, heart disease, and stroke. Sirin Yaemsiri
and coauthors evaluated rural and urban progress toward national targets
for rates of the seven major causes of death tracked by Healthy People
2020, an initiative led by the Department of Health and Human Services
that provides a national framework for setting and tracking public
health priorities. Read More >>

In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse
Practitioners And Physician Assistants

By Michael L. Barnett, Dennis Lee, and Richard G. Frank

Michael Barnett and coauthors examine the effects of the 2017
Comprehensive Addiction and Recovery Act on the expansion of clinicians
able to prescribe buprenorphine, a key medication for treating opioid
use disorder. Read More >>

LEADING TO HEALTH

Bringing Palliative Care To Underserved Rural Communities

By Charlotte Huff

With home visits and modern technology, palliative medicine physicians
in Alabama are overcoming long-held resistance. Read More >>

This article appears in Health Affairs' series on Leading to Health
.

Read the December 2019 Table of Contents

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About Health Affairs

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