Follow The Money: The Flow Of Funds In The Pharmaceutical Distribution System
About 10 percent of all health care spending is on prescription drugs, and the spending is growing at a rapid rate. This has prompted calls for government intervention to regulate drug prices or otherwise control their rapid increase. But any intervention should be predicated on a clear understanding of the economic forces that drive price increases, and the parties responsible for them. Much attention has focused on the average wholesale or “list” price set by manufacturers prior to discounts. These prices have been increasing — the average list price of branded drugs rose 12.4 percent in 2015, and has increased...
Source: Health Affairs Blog - June 13, 2017 Category: Health Management Authors: Neeraj Sood, Tiffany Shih, Karen Van Nuys and Dana Goldman Tags: Costs and Spending Drugs and Medical Innovation Big Pharma pharmacy benefit managers Research and Development Source Type: blogs

CMS Releases Data On Effectuated Enrollments, Plan Cancellations
On June 12, 2017, the Centers for Medicare and Medicaid Services released effectuated enrollment data for the 2017 open enrollment period. (press release) They also released a Health Insurance Exchanges Trends Report, which summarizes information CMS has collected from a voluntary exit report in force since August of 2016. The effectuated enrollment report shows that 10.3 million of the 12.2 million consumers who actively selected or were passively re-enrolled in a health plan for 2017 remained enrolled as of March 15, 2017. Of these, 8.7 million or 84 percent received premium tax credits (averaging $371.46) and 5.9 millio...
Source: Health Affairs Blog - June 13, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage advanced premium tax credits cost-sharing reduction payments effectuated enrollment plan cancellations Source Type: blogs

Iowa Submits 1332 Waiver Request, Claiming It Is Necessary To Avoid An Individual Insurance Market Collapse
Perhaps the most immediate problem facing federal and state health policymakers—and consumers—is what can be done for marketplace consumers in “bare counties” for 2018. As of early June, 2017, there are 47 counties in Ohio, Missouri, Kansas, and Washington where there are currently no insurers offering to provide marketplace coverage for 2018. Approximately 38,000 Affordable Care Act marketplace enrollees live in these counties (only 0.3 percent of the total), but under current law they have no access to the ACA’s premium tax credits and cost-sharing reduction payments that make health care affordable for lower-i...
Source: Health Affairs Blog - June 12, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage bare counties 1332 waivers advance premium tax credits cost-sharing reduction payments high-risk pools reinsurance Source Type: blogs

Two Things Health Researchers And Allies Can Do Right Now To Advance LGBT Research
Editor’s note: In a related piece, former US Assistant Secretary for Aging and administrator of the Administration for Community Living Kathy Greenlee also reflects on the elimination of the sexual orientation and gender identity measure from the National Survey of Older Americans Act Participants. Over the past two decades, the field of Lesbian, Gay, Bisexual, and Transgender (LGBT) health research has grown exponentially, thanks, in part, to dedicated researchers who developed strategies for identifying LGBT people in federal data and to a series of initiatives aimed at increasing sponsorship of LGBT health studies by ...
Source: Health Affairs Blog - June 12, 2017 Category: Health Management Authors: Tara McKay and Gilbert Gonzales Tags: Featured Health Equity Population Health Quality Behavioral Risk Factor Surveillance System Census data LGBT issues sexual orientation and gender identity Source Type: blogs

Collecting Sexual Orientation And Gender Identity Information On Older Americans Is Good Public Policy
Editor’s note: Measures of sexual orientation and gender identity (SOGI) have been added to several federal surveys over the years, but recently the SOGI measure was eliminated from the National Survey of Older Americans Act Participants conducted by the Administration for Community Living. Kathy Greenlee, former US Assistant Secretary for Aging, and administrator of the Administration for Community Living, reacts to this development. In 1984, a lesbian friend much older than me gave me very specific advice: “You should never come out to your doctor. And if you do, you should make sure they never write it down.” My f...
Source: Health Affairs Blog - June 12, 2017 Category: Health Management Authors: Kathy Greenlee Tags: Featured Health Equity Quality LGBT issues older americans act Source Type: blogs

HHS Requests Feedback On ACA Regulations; Evidence On Effect Of CSR Payment Uncertainty Continues To Mount
On June 8, 2017, the Centers for Medicare and Medicaid Services posted a request for information at the Federal Register entitled “Reducing Regulatory Burdens Imposed by the Patient Protection and Affordable Care Act & Improving Healthcare Choices to Empower Patients.” (press release ) The request is made pursuant to President Trump’s Executive Order of January 20, 2017, which ordered the departments in charge of implementing the Affordable Care Act to take steps to afford the states more flexibility and control, reduce regulatory and fiscal burdens, and increase the openness of interstate markets for health care...
Source: Health Affairs Blog - June 9, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA 1332 waivers AHIP American Hospital Association American Medical Association Blue Cross Blue Shield Association cost-sharing reduction payments National Association Of Insurance Commissioners United States Chamber of Comm Source Type: blogs

From Obamacare To Trumpcare
Last year, we created a hub to help you find Health Affairs resources related to potential changes to the Affordable Care Act and our health system as a whole. We’ve now redesigned the site and expanded our content to include information and analysis from a variety of sources and multiple points of view. Our goal is to provide a comprehensive collection of thought leadership and emerging knowledge on policy issues related to the current health reform debate. There is a need for trusted, timely, and organized analysis of changes in the health care system. The Health Affairs Obamacare to Trumpcare Hub fills this role. We a...
Source: Health Affairs Blog - June 9, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Featured Source Type: blogs

Nursing Home Certificate-Of-Need Laws Should Be Repealed
Imagine if your state had a regulation explicitly limiting the number of hotels in a local area. Rather than letting the market dictate the supply of hotel beds, the number of beds would be set by a regulatory body. One does not need a degree in economics to quickly see that this bed constraint would distort competition. As demand grew in a local market, new hotels could not easily open, resulting in higher hotel occupancy and fewer beds available for consumers. Because existing hotels could get customers regardless of the quality they offer, there would be little incentive to invest in good service or make big capital imp...
Source: Health Affairs Blog - June 9, 2017 Category: Health Management Authors: David Grabowski Tags: Featured Medicaid and CHIP Medicare Quality certificate-of-need laws nursing homes roemer's law Source Type: blogs

How States Are Addressing Uncertainty With 1332 Waivers
While the future of the American Health Care Act is uncertain, states continue to be interested in reforming their health care systems. We believe that states will ramp up efforts to exercise authority they have under existing law to address their state’s health care needs. While Medicaid’s 1115 waivers deservedly get the most attention, the public profile of 1332 waivers is increasing as states look to improve their health care markets. We have written previously about the promise and challenges of Section 1332 waivers, and believe they provide states with tools to make the Affordable Care Act work better in their sta...
Source: Health Affairs Blog - June 9, 2017 Category: Health Management Authors: Heather Howard and Dan Meuse Tags: Costs and Spending Following the ACA Insurance and Coverage Payment Policy Alaska American Health Care Act Minnesota Oklahoma Section 1332 waivers state health insurance market Source Type: blogs

CMS Outlines Pre-Enrollment SEP Verification Process, Reaches Out To Those In Both Medicare And Marketplaces
The Centers for Medicare and Medicaid Services has released a slide deck describing in greater detail the process that they intend to use for pre-enrollment verification of special enrollment period (SEP) eligibility. CMS has also begun sending out Medicare periodic data matching notices to consumers enrolled in both Medicare and a marketplace plan, but those notices may be misleading. How CMS Will Verify Pre-Enrollment Eligibility For Special Enrollment Periods On June 23, 2017, pre-enrollment verification will begin for new applicants (not already enrolled in marketplace coverage) who claim SEPs for loss of minimum essen...
Source: Health Affairs Blog - June 8, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage special enrollment periods Source Type: blogs

Public Health Funding And OMB Director Mulvaney ’s “Taxpayer First” Test
The first formal budget of the Trump era—billed as a “Taxpayer First” budget—contains some very bad news when it comes to the health of the American public. It proposes dramatic cuts in federal investments that keep us healthy and protected from harm, including a $1.2 billion cut from the budget for the Centers for Disease Control and Prevention (CDC). This is on top of the catastrophic cuts that will occur with the loss of the Prevention and Public Health Fund if the Affordable Care Act is repealed. It is the opposite of both what American taxpayers have asked for and what is owed to them. Office of Management and...
Source: Health Affairs Blog - June 8, 2017 Category: Health Management Authors: Edward L. Hunter Tags: Costs and Spending Featured GrantWatch Public Health Centers for Disease Control and Prevention Chronic Care Consumers Effectiveness Health Philanthropy Health Promotion and Disease PreventionGW vaccines Source Type: blogs

The Private Sector Can Lead In Delivery System And Payment Reform
Editor’s Note: This is the fourth in a five-part Health Affairs Blog series, produced in conjunction with the Bipartisan Policy Center, examining current issues and care models in the delivery system reform effort. Each post will be jointly authored by Democratic and Republican leaders in health policy. Check back for more posts in the series. Employers and other private purchasers of medical services have played an important role in spurring health care delivery system and payment reform. The development of managed care has been accelerated by federal and state policies over the years but originated with private sector...
Source: Health Affairs Blog - June 8, 2017 Category: Health Management Authors: Chris Jennings and James Capretta Tags: Costs and Spending Featured Organization and Delivery Payment Policy bipartisan delivery system reform CalPERS reference pricing shoppable services Source Type: blogs

Dichotomous Endings: A Physician ’ s Personal Reflection
My grandfather was the patriarch of his family, at the center of a tightknit Lebanese immigrant community in Toronto, Canada. Some of my warmest childhood memories are from Sundays at my grandparents’ home, where there was always family, community, and delicious food. Both in their mid-seventies, they remained exceptionally active and maintained an impressive social calendar. From my perspective as barely a teenager, it somehow seemed that family life would go on forever in this way. So, it is not surprising that I remember vividly when my grandfather first became ill. He had learned from his doctor that his kidneys were...
Source: Health Affairs Blog - June 8, 2017 Category: Health Management Authors: Ryan Van Wert Tags: End of Life & Serious Illness Quality advance care planning Cancer end-stage renal disease Hospice care Source Type: blogs

State Medicaid Lessons For Federal Health Reform
The objective of this Blog post is to summarize these lessons. Health Savings Accounts And Cost Sharing Several states, including Arkansas, Indiana, and Michigan, have used 1115 waivers to implement HSAs, monthly contributions, and cost sharing, typically in the form of copays. In these states, Medicaid enrollees in certain eligibility categories make monthly contributions to their accounts instead of making payments to an insurer. Most states also contribute to the accounts. These contributions typically are used to cover enrollees’ copays, but in a few states, contributions accrue in the account and can be disbursed ba...
Source: Health Affairs Blog - June 7, 2017 Category: Health Management Authors: Melinda Buntin, John Graves and Nikki Viverette Tags: Featured Medicaid and CHIP Payment Policy Quality Arkansas Healthy Indiana Plan Michigan Section 1115 Waivers Source Type: blogs

Confronting The Trade-Offs In Health Reform: What We Learned From The ACA
Implicitly or explicitly, all health care reform involves trade-offs, in which policy makers balance competing goals and interests to reach a preferred outcome. The US Senate may soon take up the US House’s American Health Care Act (AHCA), a bill that would radically rebalance the trade-offs made in the Affordable Care Act (ACA). The Congressional Budget Office (CBO) has recently released its estimates of the net effects of the AHCA on coverage and spending. We can, and should, compare and contrast these outcomes with evidence from the ACA. Like most large pieces of legislation, the ACA got some things right and some thi...
Source: Health Affairs Blog - June 7, 2017 Category: Health Management Authors: Clifford Marks, Janet Weiner and Daniel Polsky Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP Medicare ACA repeal and replace American Health Care Act Essential Health Benefits Leonard Davis Institute of Health Economics Source Type: blogs