Uncertainty On CSR Payments, Mandate Still Weighs On Insurer Exchange Participation And Premiums
On August 9, 2017, the Centers for Medicare and Medicaid Services published its latest 2018 exchange issuer county map. Only 17 counties, all but three in Nevada, remain without insurers currently enlisted to participate in an Affordable Care Act exchange for 2018. They are largely rural counties, including a total of 9,595 current exchange participants, one tenth of 1 percent of total current enrollees.
As of August 9, another 1,409 counties, with 2.5 million current enrollees, about 27 percent of the total, will have only one insurer available on the exchange for next year, although many of these enrollees will have a ch...
Source: Health Affairs Blog - August 10, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage CSRs individual mandate Source Type: blogs
To Speed Access To Compassionate Use, Look Beyond The FDA
In mid-July, the nonpartisan research arm of the federal government, the Government Accountability Office (GAO), released its long-awaited verdict on how the Food and Drug Administration (FDA) is handling compassionate use. As anyone who saw Dallas Buyers Club knows, compassionate use (also known as pre-approval access and expanded access) is when a drug company allows a patient who has no other treatment options to try a drug that is still in development and not FDA approved for use or sale. These patients are generally too sick to participate in a clinical trial—which has inclusion and exclusion criteria to try t...
Source: Health Affairs Blog - August 10, 2017 Category: Health Management Authors: Alison Bateman-House Tags: Drugs and Medical Innovation Population Health Quality Compassionate Use expanded access Food and Drug Administration right-to-try laws Source Type: blogs
Suggestions For A Bipartisan Approach On Health Care
In the wake of Senate Republicans’ failure to roll back key features of the Affordable Care Act (ACA), there is renewed interest in exploring a bipartisan approach. Following their votes that halted action on the Senate repeal legislation, Senators John McCain, Susan Collins, and Lisa Murkowski called for a bipartisan fix for health insurance markets. A coalition of nearly 40 House Republicans and Democrats, dubbed the Problem Solvers Caucus, has advanced a proposal to stabilize individual insurance markets and encourage state experimentation.
Although it is unclear whether such efforts will bring opposing sides together...
Source: Health Affairs Blog - August 10, 2017 Category: Health Management Authors: Joseph Antos and James Capretta Tags: Featured Following the ACA Insurance and Coverage Payment Policy Quality ACA repeal and replace American Health Care Act bipartisanship Source Type: blogs
Substance Use Disorders: A Foundation Sees New Opportunities And Continuing Challenges
Behavioral health conditions (including both mental illness and substance use disorders) are common and serious problems throughout Montana. In 2014, Montana had the highest suicide rate in the United States for all age groups, and it has been among the five states with the highest suicide rate in the nation for more than forty years. Community health assessments from Montana’s fifty-six counties consistently ranked behavioral health as one of the leading community concerns.
The Montana Healthcare Foundation (MHCF) was formed in 2013 and is Montana’s largest health-focused philanthropy. Behavioral health is one of the ...
Source: Health Affairs Blog - August 9, 2017 Category: Health Management Authors: Scott Malloy Tags: Featured GrantWatch Health Professionals Organization and Delivery Behavioral Health Chronic Care Consumers Health Care Delivery Health Philanthropy Health Promotion and Disease PreventionGW Medicaid Mental Health Montana Substan Source Type: blogs
Making The Exchanges More Competitive By Bringing Medicare Into The Fold
With the GOP repeal drive on hold, members of Congress from both parties have declared that they want to shore up the health exchanges. One of the top priorities is increasing competition among insurers. Boosting the number of plans within the exchanges not only would increase options for consumers; it would also reduce the risk an exchange could end up with no plans at all. Perhaps most important, it would likely lead to lower premiums as plans competed to attract enrollees.
Yet in many counties, there’s little chance additional private plans will enter the exchanges. In what is a highly consolidated industry, some of t...
Source: Health Affairs Blog - August 9, 2017 Category: Health Management Authors: Gerard Anderson, Jacob S. Hacker and Paul Starr Tags: Following the ACA Insurance and Coverage Medicare individual market Medicare Advantage Source Type: blogs
Three Ways President Trump Can Make Good On His Promise To Bring Down Drug Prices
A few months ago in Louisville, Kentucky, in one of his many attacks on drug prices, President Donald Trump stated: “The cost of medicine in this country is outrageous. Many times higher than in some countries in Europe and elsewhere. Why? Same pill, same manufacturer, identical, and it’s many times higher in the United States. You know why? Campaign contributions, who knows. But somebody is getting very rich. We’re going to bring it down. We’re going to have a great competitive bidding process. Medicine prices will be coming way down, way, way, way down, and that’s going to happen fast.”
So far it has been all...
Source: Health Affairs Blog - August 9, 2017 Category: Health Management Authors: Alfred Engelberg Tags: Costs and Spending Drugs and Medical Innovation Medicaid and CHIP Medicare competitive pricing prescription drug prices price gouging Source Type: blogs
Contaminated Childhood: The Chronic Lead Poisoning of Low-Income Children and Communities of Color in the United States
The water crisis in Flint, Michigan, revealed systemic government malfeasance that exposed an entire city population to lead-contaminated water. It also alerted the nation to the fact that lead poisoning remains endemic and threatens the livelihood of children across the country. The problem extends beyond Flint—a recent report identified more than 2,600 areas in the United States that have lead poisoning rates at least double those recorded during the peak of the Flint crisis.
According to the American Healthy Homes Survey, conducted by the Department of Housing and Urban Development (HUD), more 23 million homes in ...
Source: Health Affairs Blog - August 8, 2017 Category: Health Management Authors: Emily A. Benfer Tags: Featured Health Equity Population Health Public Health civil rights Lead poisoning racial inequity Social Determinants of Health social justice Source Type: blogs
The FDA Must Continue To Regulate E-Cigarettes To Protect Children
Last year, after nearly a decade of inaction, the Food and Drug Administration (FDA) made significant advancements in the regulation of e-cigarettes. Through its “deeming regulation,” the agency required that manufacturers provide information for the assessment of public health risks of new tobacco products, defined as products introduced to the market after February 15, 2007 (referred to as the “grandfather date”). However, on July 28, 2017, the FDA announced that the office would delay the enforcement of the deeming regulation by several years, which would prohibit the FDA from exercising its appropriate authorit...
Source: Health Affairs Blog - August 8, 2017 Category: Health Management Authors: Brian P. Jenssen, Maria Rahmandar, Rachel Boykan, Susan C. Walley, Bryan Mih, Sophie J. Balk, Jyothi N. Marbin, Alice L. Caldwell, John E. Moore and Judith Groner Tags: Featured Population Health Public Health deeming regulations e-cigarettes secondhand smoke Source Type: blogs
Insurers Score Another Risk Corridor Win; New Guidance On Consumer Assister Training
On August 4, 2017, judgment was awarded for another insurer in a risk corridor case in the Court of Federal Claims, this time for Molina for $52.4 million. Molina’s win means that insurers have now prevailed on the merits in two of the 26 risk corridor cases pending in the Court of Claims while the government has prevailed in three.
Judge Thomas Wheeler, who ruled in favor of Molina, was also the author of the Moda decision, the only other risk corridor decision to date in favor of an insurer. Not surprisingly, he followed his earlier decision.
Judge Wheeler held that the Affordable Care Act requires the government to ma...
Source: Health Affairs Blog - August 7, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Navigators risk corridor payments Source Type: blogs
Health Affairs ’ August Issue: Consumerism, Competition, Drug Approval, And More
The August issue of Health Affairs, a variety issue, includes a number of papers focusing on the role of consumers and competition in achieving a more efficient and higher quality health care system. Other issue studies address global health, Medicare savings, and the health gains of an FDA expedited review.
Life expectancy and infant mortality in Appalachia versus the rest of the country: disparities widen
Appalachia has long been recognized as a socially and economically disadvantaged part of the United States. Gopal Singh from the Health Resources and Services Administration (HRSA) and coauthors compared disparities in ...
Source: Health Affairs Blog - August 7, 2017 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Source Type: blogs
More Than 1 Million Young Caregivers Live In the United States, But Policies Supporting Them Are Still ‘Emerging’
Being a family caregiver today is a demanding responsibility. If caregiving is stressful for the “typical” caregiver—a 49-year-old woman—think how much more is at stake when the caregiver is a child or teenager. Yet more than a million youngsters ages 8–18 take on challenging tasks to help a parent, grandparent, sibling, or other relative. While that number is undoubtedly an underestimate, it does not even include an emerging subgroup—children whose parents are struggling with opioid addiction.
If we have limited information about the young people taking care of those with diabetes, cancer, and ...
Source: Health Affairs Blog - August 7, 2017 Category: Health Management Authors: Carol Levine Tags: Featured Population Health Public Health Quality Agnes Leu child caregivers family caregivers National Alliance for Caregiving Saul Becker United Hospital Fund Source Type: blogs
Supporting The Individual Health Insurance Market
The status of the market for individual health insurance has attracted considerable scrutiny recently. Premiums are high and rising, and insurers are exiting the market. Some believe that this is evidence of a death spiral in the market, reflective of inherent problems with the Affordable Care Act (ACA). Yet, other recent reports suggest a turn toward insurer profitability and market stability. Where does the truth lie?
The typical hallmarks of a death spiral are risk pool deterioration and declining enrollment, which drive rising premiums, which in turn drive greater beneficiary disenrollment. However, deterioration of th...
Source: Health Affairs Blog - August 7, 2017 Category: Health Management Authors: Michael Chernew and Christopher Barbey Tags: Following the ACA Insurance and Coverage individual market medical loss ratio reinsurance risk corridor payments Source Type: blogs
Appellate Ruling Deals Setback To Opponents Of Contraceptive Coverage Mandate
On August 4, 2017, the Third Circuit Court of Appeals affirmed the district court’s decision for the government in Real Alternatives v. HHS, a case involving objections to the requirement to provide contraceptive coverage without cost-sharing imposed by the Affordable Care Act’s preventive services mandate. Specifically, the case involved two issues: whether the government must exempt an employer that objects on moral, as opposed to religious, grounds to contraceptive coverage from the requirement to provide such coverage, and 2) whether individuals who object to contraceptives on religious grounds must be allowed to p...
Source: Health Affairs Blog - August 6, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptive coverage Preventive Services Mandate Source Type: blogs
Stopping Epidemics At The Source: Applying Lessons From Cholera To The Opioid Crisis
On September 8, 1854, acting on the advice of Dr. John Snow, London municipal authorities removed the pump handle from the Broad Street well in an effort to halt a major outbreak of cholera. Although an anesthesiologist by profession, Snow had methodically mapped the homes of new cases of cholera. He found that many clustered around the Broad Street pump.
Snow’s findings, still regarded as a classic example of epidemiology, established the principle: “that the most important information to have about any communicable disease is its mode of communication.” Dr. Snow did not establish the biologic mechanism of cholera o...
Source: Health Affairs Blog - August 4, 2017 Category: Health Management Authors: Chester Buckenmaier III and Eric Schoomaker Tags: Featured Public Health Quality Department of Veterans Affairs military health care Opioid Addiction opioid epidemic Source Type: blogs
People Post: Staff And Board Changes, Honors, In Health Philanthropy
Gail C. Christopher, senior adviser and vice president for the Truth, Racial Healing and Transformation initiative at the W.K. Kellogg Foundation, “has decided to exercise her option for retirement from the foundation and devote her creative energy to writing, speaking and developing the Ntianu Center for Healing and Nature,” according to a June 7 Kellogg press release. Her departure is effective August 31. Christopher founded the Ntianu Center, which is located in Maryland, to honor her firstborn child, who died in infancy, the release noted.
Tracey Greene-Washington joined the Kate B. Reynolds Charitable Trust in Mar...
Source: Health Affairs Blog - August 4, 2017 Category: Health Management Authors: Lee-Lee Prina Tags: GrantWatch Public Health California Health Care Foundation Children Grantmakers In Health health equity Health Philanthropy maternal-fetal medicine W.K. Kellogg Foundation Source Type: blogs
