Health Policy Happenings, 9.10.21

Health Policy Happenings, 9.10.21

After taking last week off while out of town, we’re back again for another roundup of what’s going on in the health policy world! You can check out past HPH here.

Congress is currently considering proposals in the reconciliation bill to reign in the cost of prescription drug costs, including allowing Medicare to negotiate drug prices and a plan put forward by the Biden Administration. The $3.5T bill aims to significantly address health care and other social determinants of health.

This article was very helpful in outlining why drugs cost so much and the various stakeholders in the current conversation.

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Health Policy Happenings, 8.27.21

Health Policy Happenings, 8.27.21

Every time I see an interesting article related to health policy or public health, I store it in a (now very long) note to remember to share it later. Pandemic notwithstanding, there is a lot going on in the policy world that we should be following. Let’s get to it.

In the U.S., our public health and health care delivery systems are separate, but in Costa Rica they merged starting in the 1970s with serious evidence of improvement in many health metrics. You don’t want to miss this piece by Atul Guwande.

There are more than 4 million direct care givers and nearly 42 million family members who provide informal support to someone 50 or older. How we support paid and family member caregivers for the challenging work they do is disgraceful.

New research quantifies how we spend differently in health care by race and ethnicity. It found that White individuals used more ambulatory care and pharmaceuticals while Black individuals used more inpatient and emergency department services, indicating the possibility of delayed health care-seeking, potentially due to lack of access

Medicare enrollment continues to rise as our population ages, as does Medicare spending. Medicare Advantage programs were created with the intent to lower the cost of providing Medicare services, but that isn’t the reality on the ground – spending for MA enrollees was actually $321 higher than spending for enrollees in traditional Medicare in 2019.

More consumers have been shopping at dollar stores during the pandemic in an attempt to make a limited income meet all their needs. This trend has further highlighted the growing problem of neighborhoods lacking affordable or accessible grocery stores, often called “food deserts,” although that is somewhat of a misnomer.

Tori Cooper, the director of community engagement for the transgender justice initiative at the Human Rights Campaign, is the first Black transgender woman selected to serve on the Presidential Advisory Council on HIV/AIDS.

I knew that the cost of services varied wildly between hospitals but I had no idea how much your insurance plan could impact what a service costs within the same hospital. We really need hospitals to comply with price transparency regulations and then we need to find a way to make it accessible and useful for consumers.

There are serious health impacts from heat, which are often felt disproportionately by Black and Hispanic communities as a result of decades of disinvestment.

Medicare bears some blame for why drug prices keep increasing, especially in the case of the new Alzheimer’s drug Aduhelm which is priced at $56,000 annually.

Estimates have shown that the cost of COVID-19 hospitalizations among the unvaccinated in June and July 2021 (the majority of which would have been preventable hospitalizations with vaccination) was over $2 billion.

There has been an infusion of funds over the course of the pandemic to help health care providers offset the financial impact of delayed and cancelled care. This brief lays out where the money came from and where it went.

The House has taken a significant step in two funding bills to remove restrictions that limit access to abortion care. This is the result of decades of advocacy from members of Congress and advocates, but it faces a less than welcoming future in the Senate.

Health insurers alone cannot fix health disparities but they do have a role to play.

Even though there have been job losses during the pandemic, leading to loss of employer sponsored health insurance, there has not been an overall increase in the number of uninsured due to improved access to public coverage options like Medicaid and Marketplace plans.

Yet another consequence of underinvestment in public health – states have heavily relied on consultants during the pandemic with little evidence of their performance.

Some say FDA approval of the Pfizer vaccine was too slow, other say too fast. But what if it was just right?

In the 1990s, Oregon expanded access to health care for the working poor through managed care and focused on primary and preventive care to keep costs low. While this approach minimized expensive hospitalizations, it did not prepare the state to handle an influx of patients during a crisis that requires intensive, inpatient care.

The lack of centralized oversight of VA nursing homes contributed to devastating outcomes from COVID-19 among residents.

See you next Friday for more happenings!

Supreme Court to Rule on Access to Abortion in Louisiana

Supreme Court to Rule on Access to Abortion in Louisiana

I would say “how has it been 6 months since I posted here?!” but then again, I know that happened – the last semester of my second year of medical school and Step 1 happened. So here I am, 6 months later, getting back on the horse. I’ve still been posting over on Instagram, but I’m also just getting back to posting there after a break for my dedicated Step 1 study period.

A while back, I posted on my Instagram stories about oral arguments at the Supreme Court for June Medical Services v. Russo and asked if folks wanted to learn more about the role of the judiciary in abortion care. After hearing a resounding yes, I’m finally getting around to it. This was initially intended to be a post on IG, but the judicial system and processes that go with it are *complicated* to say the least and resulted in a post that was far too long. So I’m going to share here instead.

At first I thought I’d work my way forward from Roe v. Wade to today, but it seems more relevant to start in the present and look back to see how we got here. This post is going to look at the specifics of June Medical (and I’ll update it as soon as there is a decision!) and then forthcoming posts will look at Roe, Casey, Whole Woman’s Health (in more detail than presented here), and others.

So let’s head down to the land of beignets and jambalaya and get to it.

The Supreme Court is due to hand down a decision any day now in June Medical Services. At issue in the case is this: does the decision of the U.S. Court of Appeals for the 5th Circuit’s to uphold Louisiana’s law requiring physicians who perform abortions to have admitting privileges at a local hospital conflict with the Supreme Court’s 2016 ruling in Whole Woman’s Health v. Hellerstedt.

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Health Care Sharing Ministries

Health Care Sharing Ministries

Last week, Washington State fined one of the larger health care sharing ministries $150,000 and banned it from offering its product in the state because it was operating as an unauthorized insurer. Other states are warning consumers to watch out for these plans, which can look like insurance but are not.  Health care sharing ministries (HCSMs) are organizations in which members share common religious or ethical beliefs and agree to make payments to (or share) the medical expenses of other members.

The groups originated in the 1980s in small religious communities and were exempted from following coverage guidelines mandated by the ACA. An estimated 1 million people belong to a HCSM, up from 200,000 before the ACA was passed a decade ago. 

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Federally Qualified Health Centers Do It All

Federally Qualified Health Centers Do It All

Did you know that 1 in 12 people rely on Federally Qualified Health Centers (FQHC) for health care?

What is a FQHC? It’s a community-based organization that provides comprehensive primary care and preventive care to all persons, regardless of ability to pay or health insurance status.

The care includes health, oral, and mental health/substance abuse services. FQHCs operate under the Health Resources and Services Administration (HRSA), which is part of HHS.

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Will the ACA Survive the Scales of Justice Yet Again?

Will the ACA Survive the Scales of Justice Yet Again?

In late December, the U.S. Court of Appeals for the 5th Circuit struck down the individual mandate of the Affordable Care Act but ducked the central question – is the rest of the ACA valid after Congress zeroed out the tax penalty for not having health insurance?

The case was sent back to the lower court to reconsider how much of it survives; the lower court judge previously ruled the entire law unconstitutional. This move reduces the likelihood of the Supreme Court considering the case before the 2020 election, but the Democratic-led states defending the law might appeal directly to SCOTUS.

The case was brought by 18 Republican-led states and the ACA has been defended mainly by a coalition of Democratic attorneys general, as the Administration refuses to defend the law.

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More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

Since the passage of the ACA, more than 20 million Americans have gained health insurance. But the fight for affordable and accessible universal coverage continues.

Here are just some of the proposals that have been introduced in Congress:

  • The Medicare for All Act of 2019 (H.R. 1384/S.1129) would establish a national health insurance program administered by HHS.
  • The State Public Option Act (H.R. 1277/S.489) would allow states to offer residents of all incomes the option to buy into Medicaid. This option would compete with private plans on the ACA Marketplace.
  • The Medicare Buy-In & Health Care Stabilization Act of 2019 (H.R. 1346) would allow individuals aged 50 to 64 to buy into Medicare and provide some marketplace stabilization.
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Back to Basics: Congress

Back to Basics: Congress

✌🏼out to my third semester of medical school & the 2019 Congressional session.

Not to worry, both will be back in full force in January!

Before I head for my vacation in the Conch Republic, I want to drop a basic civics lesson.

The basic of all basics – Congress refers to our bicameral (two chamber) legislature, made up of the House of Representatives and the Senate. It is one of three branches of government. It writes the laws and controls the money.

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All the Health Priorities in the $1.4 Trillion Spending Deal

All the Health Priorities in the $1.4 Trillion Spending Deal

The end of the year bipartisan spending deal will allocate $1.4 trillion in federal funding for the remainder of the fiscal year (through Sept. 30) and avoid a shutdown. The House has already passed the deal and the Senate is poised to do the same by tomorrow.

So what health priorities made the cut for this deal?

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The Power of the Purse

The Power of the Purse

Congress will send a $1.4 trillion spending deal to the President this week. It will fund the government and avert an end-of-the-year shutdown. The House has already passed the deal and the Senate will take it up by the end of the week. The government is currently operating under a continuing resolution that expires Dec. 20.

Read about the health-related specifics of what’s included in the deal here. But first let’s start with some key concepts related to Congress’ power of the purse.

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