http://healthaffairs.org/blog The Policy Journal of the Health Sphere Wed, 19 Jun 2013 16:08:07 +0000 en-US hourly 1 http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/?utm_source=rss&utm_medium=rss&utm_campaign=unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/#comments Wed, 12 Jun 2013 20:02:54 +0000 Chris Fleming http://healthaffairs.org/blog/?p=32048 Health Affairs Web First study released today. Over the 2000-2009 period, US natives accounted for about $1 trillion in average annual health care spending; all immigrants spent about one-tenth of that amount, or $96.7 billion. Unauthorized immigrants accounted for $15.4 billion of that total, or 15.9 percent.

Analyzing health expenditure data from the Medical Expenditure Panel Survey by nativity and legal status, Stimpson and coauthors found that just 7.9 percent of unauthorized immigrants had health care spending from public sources, averaging $140 per person per year. By contrast, 30.1 percent of US natives had health care spending from public sources, for an average of $1,385 per person per year. Average emergency department expenditures for unauthorized immigrants were $54 per year, compared to $138 per year for US natives.

The authors also found that an estimated 5.9 percent of unauthorized immigrants received care that providers are not reimbursed for, compared to 2.8 percent of US natives in the same category. They posited that this may be because unauthorized immigrants are much more likely to lack health insurance when compared to US natives.]]> http://healthaffairs.org/blog/2013/06/12/unauthorized-immigrants-account-for-only-1-4-percent-of-us-medical-spending/feed/ 1 http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/?utm_source=rss&utm_medium=rss&utm_campaign=saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/#comments Mon, 10 Jun 2013 18:00:32 +0000 Arthur Kellermann http://healthaffairs.org/blog/?p=31962 The New York Times on Jan 8, 2008, it was widely assumed it would be the next to go. However, at its darkest hour, Grady received help from an unexpected quarter.

In the June issue of Health Affairs, a young physician, Dr. Kate Neuhausen, describes how she and other leaders of a little-known student organization mobilized hundreds of health professions students from around the state of Georgia to join the fight for Grady’s survival. It is difficult to overstate how perilous the hospital’s situation was at the time. Because Grady provides such a disproportionate share of uncompensated care in the state of Georgia, it would have been impossible for metro Atlanta’s hospitals and private health care providers to absorb the sudden loss of more than 900 inpatient beds; the highly specialized trauma, burn and psychiatric services Grady provides; or the displacement of tens of thousands of inpatient days and hundreds of thousands of outpatient visits. The resulting social, medical and financial upheaval would have sent shockwaves throughout the region—the economic engine for the state and a vital financial, commercial and transportation hub for the Southeastern United States.

Fortunately, Atlanta’s business community and philanthropies grasped the gravity of the situation. So did Georgia’s governor, the leaders of Georgia’s General Assembly, the Commissioners of Fulton and DeKalb Counties, the appointed members of the Hospital Authority that ran Grady, the leadership of Emory University and Morehouse School of Medicine (which provides the hospital’s medical staff), Grady’s employees, and its patients. But each group had a different concept of what needed to be done. Urban-rural, partisan and racial politics came into play. Time was running out.]]> http://healthaffairs.org/blog/2013/06/10/saving-grady-reflections-on-kate-neuhausens-narrative-matters-essay/feed/ 0 http://healthaffairs.org/blog/2013/06/06/the-uninsured-after-implementation-of-the-affordable-care-act-a-demographic-and-geographic-analysis/?utm_source=rss&utm_medium=rss&utm_campaign=the-uninsured-after-implementation-of-the-affordable-care-act-a-demographic-and-geographic-analysis http://healthaffairs.org/blog/2013/06/06/the-uninsured-after-implementation-of-the-affordable-care-act-a-demographic-and-geographic-analysis/#comments Thu, 06 Jun 2013 15:00:35 +0000 Rachel Nardin, Leah Zallman, Danny McCormick, Steffie Woolhandler, and David Himmelstein http://healthaffairs.org/blog/?p=31785 The Congressional Budget Office (CBO) estimated in March 2012 that the ACA would newly insure 30-33 million people, leaving 26-27 million uninsured in 2016.

In June 2012, however, the Supreme Court ruled that states may opt-out of Medicaid expansion. Since then, the governors of 14 states have announced their intention to opt-out, 6 are undecided, 3 are leaning against and 2 toward the expansion. Opt-outs will likely leave several million more uninsured, but little is known about who is likely to remain uninsured under the ACA.

To estimate the number and characteristics of US residents who will remain uninsured in 2016, we analyzed data from the Census Bureau’s 2012 Current Population Survey, a nationally representative survey of the non-institutionalized US population.]]> http://healthaffairs.org/blog/2013/06/06/the-uninsured-after-implementation-of-the-affordable-care-act-a-demographic-and-geographic-analysis/feed/ 2 http://healthaffairs.org/blog/2013/06/04/racial-disparities-in-health-care-justin-dimick-and-coauthors-june-health-affairs-study/?utm_source=rss&utm_medium=rss&utm_campaign=racial-disparities-in-health-care-justin-dimick-and-coauthors-june-health-affairs-study http://healthaffairs.org/blog/2013/06/04/racial-disparities-in-health-care-justin-dimick-and-coauthors-june-health-affairs-study/#comments Tue, 04 Jun 2013 18:47:06 +0000 Ashish Jha http://healthaffairs.org/blog/?p=31758
Over the past decade, two primary theories have emerged to explain disparities and propose solutions to address them. The first focuses on issues around cultural competence, and suggests that many of the gaps in care are due to poor communication between providers and patients. Given the long history of discrimination against black Americans, the cultural competency theory argues that low trust on the part of patients, combined with the ineffective communication and lack of cultural sensitivity, leads to black patients receiving worse care with resultant poor outcomes. Ultimately, the cultural competency theory begs an approach to health disparities that requires more effective training of providers that care for minority patients.

The second theory of racial disparities in care suggests that the site of care really matters -- that disparities are driven by the fact that black patients are more likely to receive care at poor quality hospitals. There is ample evidence for this theory as well - our prior work showed that care for black patients is highly concentrated among a small number of hospitals and these places generally provide a lower quality of care for all their patients. This theory calls for a somewhat different set of solutions: focusing on helping the subset of “minority-serving” providers to improve.

The Dimick Study

Of course, there need not be any contradiction between these two theories and one may suspect that both are likely at play. It is in this context that we have a terrific new study by Justin Dimick and colleagues from the University of Michigan, in the newly released June issue of Health Affairs, that helps us better understand why black patients generally have higher mortality after major surgeries than their white counterparts, and how we might try to reduce this gap.]]> http://healthaffairs.org/blog/2013/06/04/racial-disparities-in-health-care-justin-dimick-and-coauthors-june-health-affairs-study/feed/ 3 http://healthaffairs.org/blog/2013/06/03/new-health-affairs-medicaid-expansion-and-vulnerable-populations/?utm_source=rss&utm_medium=rss&utm_campaign=new-health-affairs-medicaid-expansion-and-vulnerable-populations http://healthaffairs.org/blog/2013/06/03/new-health-affairs-medicaid-expansion-and-vulnerable-populations/#comments Mon, 03 Jun 2013 20:01:25 +0000 Chris Fleming http://healthaffairs.org/blog/?p=31733 Health Affairs’ June issue, released today, examines the challenges and benefits for states deciding whether to embrace the law’s Medicaid expansion or opt out. Several studies in the issue also look at population disparities in health care, especially during the recent recession. Selected content in the issue is supported by grants from the New York State Health Foundation and Blue Shield of California Foundation.

Medicaid Opt-out: What Cost to States? Last summer’s US Supreme Court ruling about the Affordable Care Act allows states to decline the law’s Medicaid expansion provision, something fourteen governors have chosen to do. Carter Price and Christine Eibner, both of the RAND Corporation, analyzed how this would affect coverage and spending. They estimate that in these states 3.6 million fewer people would be insured, and federal transfer payments to those states could fall by $8.4 billion. According to the authors, those states will be spending some $1 billion in the short term on uncompensated care. They conclude that in terms of coverage, costs, and federal payments, states and their citizens would fare better by expanding Medicaid coverage.

In a related article, Thomas DeLeire of the University of Wisconsin and coauthors looked at Wisconsin’s four-year-old public insurance program—the BadgerCare Plus Core Plan—for childless adults with incomes of up to 200 percent of the federal poverty level. The authors compared administrative claims data from the first year of the program with the previous year. They found that program participants who were automatically enrolled in the program (and who tended to have very low incomes) showed a 29 percent increase in outpatient visits; a 46 percent increase in emergency department use; and a 59 percent decrease in hospitalizations, including a 46 percent decline for preventable hospitalizations. These results demonstrate that expanding public insurance coverage will increase access to outpatient care and reduce hospitalizations, but the authors caution that unless consumers have sufficient access to primary care, coverage expansions may also increase emergency department visits, shrinking any corresponding cost savings.]]> http://healthaffairs.org/blog/2013/06/03/new-health-affairs-medicaid-expansion-and-vulnerable-populations/feed/ 0 http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/?utm_source=rss&utm_medium=rss&utm_campaign=implementing-health-reform-progress-but-much-work-remains http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/#comments Thu, 25 Apr 2013 14:26:06 +0000 Timothy Jost http://healthaffairs.org/blog/?p=30413 stakeholder calls in every state where a federal exchange (now called a “marketplace”) will be established. It is also locating navigator programs, signing up insurers, and preparing for the October 1, 2013 beginning of open enrollment. The states have also been very active, either trying to implement their own state exchanges and the 2014 ACA market reforms or doing everything they can dream up to keep implementation from moving ahead.

Final rules have been issued governing the exchanges, the 2014 market reforms, the premium tax credits, and the premium stabilization programs, while guidance has been issued on the federal exchanges and the navigator program. Final rules on Medicaid eligibility and appeals are expected shortly. A public hearing was held on April 23, 2013 regarding the proposed employer responsibility regulations, while another will be held on May 29, 2013 reviewing proposed individual responsibility regulations. Final rules will follow in due course. In sum, implementation is progressing, although a lot of ground must be covered between now and 2014.]]> http://healthaffairs.org/blog/2013/04/25/implementing-health-reform-progress-but-much-work-remains/feed/ 2 http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/?utm_source=rss&utm_medium=rss&utm_campaign=rachael-fleurence-on-patient-engagement http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/#comments Wed, 03 Apr 2013 19:15:32 +0000 Rachael Fleurence http://healthaffairs.org/blog/?p=29805 In today's Q and A on Patient Engagenment, we feature Rachael Fleurence, a Senior Scientist at PCORI where she leads the research prioritization initiative to help identify important patient and stakeholder generated questions and establish a rigorous research prioritization process to rank these questions. (Also, check out her recent blog post and follow the link to her February Health Affairs article here.)]]> http://healthaffairs.org/blog/2013/04/03/rachael-fleurence-on-patient-engagement/feed/ 0 http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/?utm_source=rss&utm_medium=rss&utm_campaign=reflections-on-the-federal-budget-resolutions http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/#comments Thu, 21 Mar 2013 12:53:37 +0000 Uwe E. Reinhardt http://healthaffairs.org/blog/?p=29573
Alas, for governance, the President has missed that deadline for fiscal 2014 (starting in October 1, 2013). He is likely to submit a budget only by early April – two months late. In the meantime, both chambers have worked up their own budget resolutions, without the President’s budget as a starting point. It shows, because the tax- and spending numbers in these two budgets, and the visions for America they reflect, differ so starkly that it is hard to imagine the emergence of a joint conference report reconciling the two budgets in one that could pass both chambers.

But all is not lost. At least the American people now have before them the visions the two parties have for our country, especially in regard to health policy.]]> http://healthaffairs.org/blog/2013/03/21/reflections-on-the-federal-budget-resolutions/feed/ 1 http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/?utm_source=rss&utm_medium=rss&utm_campaign=ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/#comments Wed, 13 Mar 2013 15:33:46 +0000 Jesse Singer http://healthaffairs.org/blog/?p=29197 Health Affairs (“What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology”) about the unrealized promise of health IT to lower costs and improve care.

Electronic health records (EHRs) are a tool, not a solution. But our experience at the New York City Department of Health and Mental Hygiene with the Primary Care Information Project (PCIP) demonstrates that with the proper support, EHRs can be a powerful tool for improving clinical care and managing population health. Now we are about to turn another corner on our journey, to see if we can use the data we collect from New York City EHRs to paint an accurate picture of the population at large.

Since 2005, PCIP has helped more than 3,200 providers implement EHRs, and we currently provide assistance to more than 7,700 providers in New York City. Our staff members help with everything from choosing an EHR to billing, coding, and documenting workflows, to assisting providers with navigating the federal EHR incentive program, to reviewing their clinical quality measures and helping them with numerous quality improvement (QI) activities. We are the home of New York City’s Regional Extension Center (REC), one of 62 such centers nationwide that are funded to support primary care providers through the transition to an EHR and help them achieve the federal Meaningful Use standards.]]> http://healthaffairs.org/blog/2013/03/13/ehrs-are-a-tool-not-a-solution-the-nyc-primary-care-information-project/feed/ 4 http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/?utm_source=rss&utm_medium=rss&utm_campaign=a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/#comments Mon, 11 Mar 2013 15:20:36 +0000 Sara Rosenbaum http://healthaffairs.org/blog/?p=29116 PPACA § 1302(b)(4)(B)] This provision applicable to health insurance products sold in the individual and small group markets and therefore subject to the essential health benefits (EHB) coverage standard, requires the Secretary of Health and Human Services to bar the use of insurance coverage rules that discriminate on the basis of disability. See

However, final EHB rules issued on February 20^th, 2013 effectively leave this ban unimplemented. A draft CMS document made available to the public on February 21 by Inside Health Policy suggests that the agency will monitor qualified health plans (QHPs) for potential discrimination. But the monitoring process suggested in the draft excludes any mechanism for detecting one of the most potent forms of plan discrimination, the use of benefit designs and coverage determination procedures that cause the denial of coverage for children and adults whose disabilities prevent them from “recovering” from their disability. Whether the ACA protections are left unimplemented remains to be seen.]]> http://healthaffairs.org/blog/2013/03/11/a-lost-opportunity-for-persons-with-disabilities-the-final-essential-health-benefits-rule/feed/ 5