King v. Burwell: Foundations Fund Analyses and Publish Viewpoints

March 3rd, 2015

As the US Supreme Court is set to hear arguments tomorrow in yet another case about the Affordable Care Act, a few foundations have funded analyses and published commentaries about this controversial case.

If you haven’t been following the build-up to this case, I would suggest this March 2 New York Times article, “Lawyer Put Health Act in Peril by Pointing Out 4 Little Words” as good background reading. Reporter Adam Liptak describes a Harvard Law School–educated lawyer down in Greenville, South Carolina, who apparently found this vulnerability in the ACA. The law “seemed to say [that] its tax-credit subsidies were limited to people living where an insurance marketplace, known as an exchange, had been ‘established by the state,’” the reporter explains.

Liptak goes on to say that if a majority of the Supreme Court justices accept this argument, “more than six million Americans could lose health care coverage and insurance markets could collapse in about three dozen states where the federal government runs the exchanges, imperiling the health care law itself.”

Foundation-Funded Analyses and Publications

“What’s at Stake as Health Law Lands at Supreme Court Again,” Sarah Varney, March 3, Kaiser Health News, a service of the Henry J. Kaiser Family Foundation.

“The Implications of King v. Burwell: Highlights from Three Analyses of the Consequences of Eliminating ACA Tax Credits in 34 States,” Linda J. Blumberg, Matthew Buettgens, and John Holahan of the Urban Institute, released March 2. Funded by the Robert Wood Johnson Foundation. This is a two-page summary.

See also: “Response to the Heritage Foundation’s Criticisms of the Urban Institute’s King v. Burwell Analyses,” Linda J. Blumberg, Matthew Buettgens, and John Holahan, February 24. The Heritage Foundation, a conservative think tank, is not a philanthropic foundation. (Note to readers: This document apparently was not funded by any foundation.)

“Supreme Court Insurance Subsidies Decision Could Trigger Price Spikes,” Julie Appleby, February 26, Kaiser Health News, a service of the Kaiser Family Foundation. Read the rest of this entry »

The Gates Foundation Makes a “Big Bet for the Future” of Health and Development in Low-Income Countries

March 2nd, 2015

Bill Gates and Melinda Gates, who cochair the Bill & Melinda Gates Foundation, sent out a novel Annual Letter for 2015 that lays out an optimistic scenario for significant and rapid improvements in global health and development over the next fifteen years.

The Gates Foundation Annual Letter typically offers a reflection on the foundation’s successes and challenges in health and development over the previous year and charts the foundation’s priorities for the coming year.

The 2015 Gates Annual Letter presents a vision of improvement in the lives of poor people by 2030, and an explanation of how progress to date has laid the groundwork for the possibility of remarkable achievements over the next fifteen years. The predictions are presented in terms of their “Big Bet for the Future” of people in poor countries.

Predicted Breakthroughs in Health

The Gateses predict that in the next fifteen years, the world will make “unprecedented progress in global health,” through accelerating attention to reducing the number of children in low-income countries who die before age five, eradicating diseases, reducing incidence of HIV, and improving the ability of countries in Africa to feed their people.

Another Rapid Reduction in Child Deaths in Low-Income Countries

Citing progress since 1990 in reducing child deaths, the Gateses note that the percentage of children who die before age five has been cut in half over twenty-five years, largely through better vaccines and treatments in low-income countries. They declare, “We believe global health equity is an achievable goal,” and they announce their intention of taking to scale proven interventions to save newborn lives in poor countries. As a result of more widespread use of simple, low-cost interventions (such as promotion of breastfeeding, injectable antibiotics, resuscitation of newborns, skin-to-skin contact with newborns [by drying and warming them just after they are born], and umbilical cord care), the Gateses predict that within the next fifteen years it will be possible to cut in half again the number of children who die before age five.

In addition to the attention being put on newborns, child health in poor countries will get a boost from the inclusion of new vaccines for diarrhea and pneumonia within government vaccine programs; these will reduce the lethal impact of these two top killers of children.

The number of women dying in childbirth in poor countries will go down by two-thirds over the next fifteen years, as more women give birth in health care facilities and get better access to contraceptives so they can space out their pregnancies safely. Investments in improving household access to sanitation facilities and building strong health systems in low-income countries will also begin to pay off in terms of improving child health. Read the rest of this entry »

Supporting Efforts to Advance Adult Dental Coverage and Access in Medicaid

February 26th, 2015

While comprehensive dental coverage is a required benefit for children served by Medicaid, the same is not true for adults. Dental benefits are optional for adults enrolled in Medicaid, and dental coverage is often among the first programs to be trimmed in tight fiscal times—most recently, Illinois Gov. Bruce Rauner (R) made such a proposal. Forty-six states and the District of Columbia currently offer some dental benefit to Medicaid-enrolled adults, but only thirty-two cover services beyond emergency care, and even fewer, fifteen, offer a comprehensive benefit.

As many states expand Medicaid coverage for adults through the Affordable Care Act (ACA), there are new opportunities to increase much‐needed dental coverage in Medicaid and avoid the dangerous and costly consequences of untreated dental disease.

A February 17 webinar hosted by the Center for Health Care Strategies (CHCS), “Dental Coverage and Access for Adults in Medicaid: Opportunities for States,” highlighted the experiences of two Medicaid-expansion states—Colorado and Kentucky—in implementing dental benefits for Medicaid-enrolled adults. The webinar was the first in a series funded by the DentaQuest Foundation and the Robert Wood Johnson Foundation as part of a CHCS initiative to improve oral health care access and quality for low-income adults. The webinar began by outlining the national dental coverage and access landscape for Medicaid-enrolled adults, as well as strategies undertaken to expand dental benefits.

Inadequate dental coverage is a significant barrier to oral health care access for low-income adults, who often cannot afford to pay out-of-pocket and have no other consistently available options for oral health care. Low-income people are 40 percent less likely than those with higher incomes to have visited the dentist in the past twelve months, and that frequent lack of care drives an epidemic of dental disease in this low-income population. Further, 42 percent of people with incomes below 100 percent of the federal poverty level (FPL) have untreated tooth decay, compared with 12 percent of Americans with incomes above 400 percent of the FPL. Oral health care access is even more challenging for vulnerable populations—such as people with chronic illness, racial/ethnic minorities, or people with disabilities—who have more tooth decay, dental infections, and tooth loss than the general adult population.

The nondental consequences of dental disease include elevated risks for diabetes, heart disease, and stroke, as well as potential lost workdays and reduced employability. Oral health care coverage and access challenges have also led to an increase in dental-related hospital visits over the past several years. Because up to 16 million newly eligible adults are expected to gain Medicaid coverage by 2024, many state Medicaid agencies are reconsidering how they can meet the oral health needs of this population. Read the rest of this entry »

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