Health Affairs

On April 5, 2013, the Department of Health and Human Services released its final Letter to Issuers on Federally Facilitated and State Partnership Exchanges. This letter lays down guidelines for insurers that will sell qualified health plans on the federal exchanges in 2014. A proposed version of this letter was published for comment on March 1, 2013, which I blogged about here. The final issuer letter tracks the proposed letter with few significant changes. In part because I am supposed to be on vacation in France and in part because of limited access to technology, I am not going to review the issuer letter in depth, but rather refer the reader to my earlier post, providing here only a brief overview of the final letter that highlights the respects in which it differs from the proposed rule discussed in my earlier post.

In his post “Why don’t Republicans Have a Vision for Health Reform” (April 2, 2013) John Goodman offers interesting comments on my earlier post “Reflections on The Federal Budget Resolutions” (March 21, 2013). I thank him for the comments.

My post was focused strictly on the vision for U.S. health care that Democrats and Republicans on Capitol Hill now project through the Senate budget resolution and the House budget resolution. Goodman, on the other hand, builds from my post a bridge to the vision some Republicans – including Goodman himself – have in the past projected for U.S. health care.

I can understand why Goodman used the well-known technique of the bridge, because he believes that Republicans currently do not have vision for health care. On this point, however, I beg to differ. There actually is a current Republican vision. It has been expressed through the House budget resolution.

Today, Health Affairs released a Web First article by Tsung-Mei Cheng describing early results from a pilot project underway in several of China’s rural provinces that combines new case-based payments for providers and evidence-based clinical pathways for management of patients. Before and after studies and analyses show a reduction in overall length of hospital stays, drug spending and usage, and patients’ out-of-pocket spending. Patient-provider communication and relations reportedly improved, and hospitals did not experience any revenue losses.

On April 3, 2013, the Department of Health and Human Services released proposed regulations establishing standards to govern navigators and non-navigator assisters in the federally facilitated exchange as well as clarifying standards on the role of navigators and on who can serve as a navigator in all exchanges.

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.)

You are invited to join us on Wednesday, April 11, when Health Affairs will hold a briefing to discuss its April 2013 issue, “Triple Aim Goes Global.”

The April issue examines how all high-income countries are struggling to pursue better health, better care, and lower cost – and to bring all of these goals into alignment. The issue received funding support from The Commonwealth Fund, the Nuffield Trust, and Imperial College London.

The briefing will take place at the Barbara Jordan Conference Center at the Kaiser Family Foundation, 1330 G Street, NW, in Washington, DC, on Thursday, April 11, 2013, 8:00 a.m. – 12:30 p.m.

On Good Friday, March 29, 2013, the Department of Health and Human Services released a final rule regarding increased federal Medicaid percentage changes under the Affordable Care Act for covering adults who are newly eligible under the ACA’s Medicaid expansions. HHS published the original proposed rule on this topic in August of 2011 as part of a larger rule on the ACA’s Medicaid changes. Other parts of this rule dealing with Medicaid eligibility were finalized in March of 2012, but the parts of the proposed rule dealing with federal financial assistance were not included at that time. Because the final rule contains significantly more detail than the proposed rule, HHS is publishing the rule as final, but soliciting further comment on parts of the rule. HHS also released on March 29, 2013, a series of Frequently Asked Questions, explaining its approach to the expansion of Medicaid through the use of Medicaid funds to purchase private insurance for Medicaid recipients in the exchange, the approach that Arkansas and possibly other states are proposing. This FAQ is discussed at the end of this post.

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation discusses the Multi-State Plan Program created under the Affordable Care Act. Under the program, at least two health insurance plans choosing to participate will offer coverage through every state-run, federally facilitated, and partnership exchange created under the law. Insurance companies meeting the eligibility criteria have until March 29, 2013, to submit applications to participate in 2014.

The program was created to enhance competition among health plans within the new exchanges. It will be administered by the federal Office of Personnel Management, or OPM, which also administers the Federal Employees Health Benefits program offering coverage through a variety of health plans.

For those who like to look for silver linings, there are at least two events in the past few weeks that could provide a glimmer of hope. First, both the Budget Committee in the Republican controlled House has passed a budget and, for the first time in four years, the budget committee in the Democratic controlled Senate has also passed a budget. Both the House and the Senate have passed their budgets. The Senate’s budget passed by a slim 50 to 49 vote margin. And for a short time, there had been some uncertainty whether the House would approve its budget because it doesn’t eliminate the deficit fast enough for some House conservatives – some indication of the pressure the right is putting on the leadership.

The second glimmer of hope is that the President has been reaching out to Congressional Republicans in a way that he had not done during his first term–taking a group of Senate Republicans to dinner and meeting with the House Republican leadership on their home turf. However, as Mitch McConnell (R KY) was quick to point out, meeting with Republicans is far different than finding common ground or strategies for compromise.

To no great surprise, the budget documents themselves suggest two very different and divergent views of the country’s future–differences that will make finding a compromise a serious challenge.

While all of the attention of the public and of the media has been focused on the Supreme Court’s June 28 decision upholding the constitutionality of the Affordable Care Act (ACA) and on examining the nuances and consequences of that decision, the federal government has steadily moved ahead with implementation of the ACA.  With the... Read the rest of this entry »

The Joint Select Committee on Deficit Reduction wasn’t dubbed the “super committee” for nothing. In theory at least, it had immense and unprecedented power.  If the select committee had been able to produce a consensus plan on deficit reduction, that legislation would have been guaranteed an up or down vote in the House and Senate... Read the rest of this entry »

In our current political environment, wins are more important than policy successes, and for too long that has driven a juvenile mindset which engages in “magical thinking” in which beliefs trump facts, and benefits can be achieved without costs. So it’s no surprise that Republican leadership recognized that opposition to the individual mandate would be... Read the rest of this entry »

Physician/writer Atul Gawande was the winner of this year’s Health Services Research Impact award at the National Health Policy Conference cohosted by AcademyHealth and Health Affairs earlier this week. At Tuesday’s lunch, Gawande was scheduled to receive his award for the important policy impact of his efforts to bring surgical checklists into use around the... Read the rest of this entry »

We are pleased to announce the “most-read” Health Affairs journal articles published in 2009. The number 1 article published in 2009 was on “Annual Medical Spending Attributable To Obesity” by Eric Finkelstein and colleagues.  All articles below are open to all readers for the next 2 weeks—through February 12, 2010. Top-viewed articles published in 2009... Read the rest of this entry »

As President Barack Obama and his allies press their case for health care reform, the president exhorts that his vision will slow the growth of medical expenditures, expand coverage to millions, and improve the quality of care.  In the trenches, where millions of medical interventions occur daily, physicians and hospital managers who do the heavy lifting describe a... Read the rest of this entry »

A new study published today in Health Affairs finds that the decade-long nurse shortage is easing, or even ending, partly as a result of the continuing recession. Study author Peter Buerhaus of the Vanderbilt University School of Nursing and colleagues found that older nurses are delaying retirement or returning to the workforce and part-time nurses... Read the rest of this entry »

Last week’s New Yorker article by Atul Gawande highlighted the phenomenally high variations in cost of medical care and services between regions in the United States, specifically focusing on McAllen, Texas. Gawande’s spotlight on McAllen was based on many studies of our health care system. For Gawande’s readers, we would like to point you to... Read the rest of this entry »

Despite economic hard times, Massachusetts still shows gains in insurance coverage and access to care as a result of its 2006 state health reform. However, some of the early gains in reducing barriers to health care and improving affordability had eroded by the fall of 2008, according to Urban Institute researchers in a new study published last week on the... Read the rest of this entry »

This week’s Health Wonk Review, the roving digest of the best of health policy blogging, features new posts on health reform, including the public plan option, health care costs, health IT, and more. This week’s host is Tinker Ready of Boston Health News.

There is widespread agreement that greater investment in information technology (IT) is critical to reforming U.S. health care. The use of such technologies as electronic health record systems, personal health records, e-prescribing, and computerized physician order entry holds the potential for vastly improving care at a reasonable cost. The recently enacted economic stimulus legislation included... Read the rest of this entry »