Preview

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 >>

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.

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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.

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.

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.

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