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A Weekly Health Policy Round Up From Health Affairs
December 22, 2019
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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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AHEAD OF PRINTOut-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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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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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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