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A Weekly Health Policy Round Up From Health Affairs            

**December 22, 2019**

FOLLOWING THE ACA

Continued Uncertainty As Fifth Circuit Strikes Mandate, Remands On Rest
Of ACA

By Katie Keith (12/19/19)

In a 2-1 decision, the Fifth Circuit partially affirmed a district court
decision that had declared the entire ACA invalid. Read More >>

PHARMACEUTICALS AND MEDICAL TECHNOLOGY

The Case For Letting Biosimilars Compete

By Sameer Awsare, Anthony Barrueta, Amy Gutierrez, and Polly F. Webster
(12/19/19)

There are steps policy makers can take to support others interested in
boosting biosimilar use, which would increase pressure on reference
product manufacturers to compete on price. Read More >>

AFFORDABLE CARE ACT

How The Senate Got To Sixty On Christmas Eve 2009

By Billy Wynne (12/20/19)

Ten years ago, in late December 2009, as northeastern gales began to
collide with arctic temperatures in the midwestern plains, passage of
the Affordable Care Act (ACA) through the U.S. Senate hung in the
balance. Read More >>

CONSIDERING HEALTH SPENDING

Biomedical Innovation: CMS's Next Frontier For Value Transformation

By Kushal T. Kadakia (12/18/19)

Executive order 13890, released in October 2019, provides a policy
window for the Centers for Medicare and Medicaid Services (CMS) to
extend the "value" movement to biomedical innovation. This post
outlines the implications of the executive order, describes a potential
policy agenda for CMS, and identifies the additional bipartisan
legislative support structures needed to accelerate the uptake of
value-based payment models for biomedical innovation.
Read More >>

MEDICARE

Access For 21st Century Cures: Updating Medicare's Approach to
Coverage And Payment

By Mark McClellan, Morgan Romine, Jeff Allen, Tanisha Carino, and Scott
Gottlieb (12/18/19)

Fulfilling the promise of 21st century, innovative care will require
further steps to address issues related to technology access at the
Centers for Medicare and Medicaid Services and throughout the US health
care system. Read More >>

SUBSTANCE ABUSE

For Hospitals, A Blueprint For Fighting The Opioid Epidemic

By Michael Botticelli, Donald M. Berwick, Maia Gottlieb, and Mara
Laderman (12/20/19)

The willingness to work together collaboratively will continue to be
essential as hospitals collectively heed the call and assume a
leadership position in fighting the opioid epidemic. Read More >>

CANCER

Redesigning Oncology Care: A Look at CMS' Proposed Oncology First
Model

By François de Brantes, Nick Bluhm, Alice Gosfield, Michael Kolodziej,
and Valinda Rutledge (12/16/19)

We hope that the Centers for Medicare and Medicaid Services will heed
our recommendations. Patients with cancer and the physicians who care
for them are counting on it. Read More >>

ACCESS TO CARE

Shaping The 2020 National Vaccine Plan

By Angela K. Shen, Richard Hughes IV, Emily Sobel, Alessandra Fix, and
Marissa Shaw (12/16/19)

The development of the 2020 National Vaccine Plan provides an
opportunity to enhance immunization activities at all levels (federal,
state, and local) by ensuring that the guiding framework reflects
contemporary challenges and opportunities for optimizing vaccine
uptake.Read More >>

COSTS AND SPENDING

Assessing The Presidential Proclamation On Visas And Health Insurance

By Leighton Ku (12/17/19)

Uninsured recent immigrants consume minuscule shares of the total
medical resources in the nation. Read More >>

HEALTH PROFESSIONALS

Reflecting Back On Fitz: A Life Well Lived

By Edward Salsberg, Candice Chen, and Patricia Pittman (12/17/19)

Fitzhugh Mullan was a courageous leader who was not afraid of
controversy and advocated for social justice until the last day of his
life. As a teacher, mentor, and role model, he developed the next
generation of leaders and researchers in pursuit of a fairer, more just
health care system and society. He built an infrastructure to advance
social justice and equity within the health care system. Read More >>

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IN THE JOURNAL

AHEAD OF PRINT

Out-Of-Network Billing And Negotiated Payments For Hospital-Based
Physicians

By Zack Cooper, Hao Nguyen, Nathan Shekita, and Fiona Scott Morton

Most recently, attention on out-of-network billing has been focused on
patients receiving large, unexpected physician bills. However, the
impact of out-of-network billing on total health care spending is also
significant, according to Zack Cooper and coauthors from Yale
University. Analyzing data from a large commercial insurer, the authors
found that at in-network hospitals, 11.8 percent of anesthesiology care,
12.3 percent of care involving a pathologist, 5.6 percent of claims for
radiologists, and 11.3 percent of cases involving an assistant surgeon
were billed out of network. Read More >>

RURAL HEALTH

When Rural Hospitals Close, The Physician Workforce Goes

By Hayley Drew Germack, Ryan Kandrack, and Grant R. Martsolf

Growing numbers of rural hospital closures raise serious concerns about
access to care. Hayley Drew Germack and coauthors find that in
1997-2016, in the four years leading up to a rural hospital closure,
there was an average 6.9 percent annual loss in general surgeons in that
county. Over the six-plus years following a closure, there was an
average 10.5 percent annual loss in physicians overall, including an
average 8.2 percent annual loss in primary care physicians. Read More >>

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Access, Quality, And Financial Performance Of Rural Hospitals Following
Health System Affiliation

By Claire E. O'Hanlon, Ashley M. Kranz, Maria DeYoreo, Ammarah Mahmud,
Cheryl L. Damberg, and Justin Timbie

One potential response to impending hospital closure is to become part
of a larger hospital system. Claire O'Hanlon and coauthors compare the
attributes of the 306 rural hospitals that created such affiliations in
2009-17 with those of rural hospitals that did not. Read More >>

Rural Residents With Mental Health Needs Have Fewer Care Visits Than
Urban Counterparts

By James B. Kirby, Samuel H. Zuvekas, Amanda E. Borsky, and Quyen
Ngo-Metzger

James Kirby and coauthors report that "among people likely to need
mental health treatment, rural residents typically received fewer mental
health services than urban residents did in 2010-15, even after mental
and physical health and a variety of sociodemographic factors were
controlled for." Read More >>

Enhancing Staffing In Rural Community Health Centers Can Help Improve
Behavioral Health Care

By Xinxin Han and Leighton Ku

Xinxin Han and Leighton Ku find that, despite an overall disadvantage in
provider levels in rural areas, behavioral health staffing levels grew
more rapidly in rural health centers than in urban centers in 2013-17,
with most care provided by licensed clinical social workers and other
licensed mental health providers. Read More >>

Rural-Urban Differences In Individual-Market Health Plan Affordability
After Subsidy Payment Cuts

By David Anderson, Jean M. Abraham, and Coleman Drake

Rural Marketplace enrollees eligible for Advance Premium Tax Credits saw
their premiums decrease $126 from 2017 to 2019 following the termination
of cost-sharing reduction (CSR) subsidies in 2017, while those in urban
markets saw theirs decrease $95. David Anderson of the Duke-Margolis
Center for Health Policy and coauthors examined how insurers and states
reacted to CSR cuts and the impact on urban and rural enrollees. Read
More >>

Effect Of Population Size On Rural Health Insurance Premiums In The
Federal Employees Health Benefits Program

By Abigail R. Barker

In the study of health insurance access and affordability in rural
areas, a recurring issue is to understand the challenges that programs
based upon the competitive market model, such as the Affordable Care
Act's Marketplaces, may experience in less populated areas. This
article analyzes data for 2013-16 from the Federal Employees Health
Benefits Program, focusing on premium and enrollment data for
"state-specific" plans-which offer insurance policies and set
premiums at the regional level. Read More >>

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NARRATIVE MATTERS: BEHAVIORAL HEALTH CARE

When People You Love Are The Unintended Consequences Of Opioid Policy

By Mary Beth Foglia

After the release of federal guidelines to curb opioid misuse, a patient
is unable to obtain effective pain treatment and dies from
complications. Read More >>

Read the December 2019 Table of Contents

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