November 21, 2017

Category Archives: Health policies

New Health Policy Brief: Medicare’s New Physician Payment System

New Health Policy Brief: Medicare’s New Physician Payment System

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) provides a primer on the Medicare payment part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. For more than two decades, Congress and the federal government have struggled with how to reimburse providers in the Medicare program and at the same time promote high-quality care that uses medical resources judiciously. Revising Medicare fee schedules has been a perennially thorny political ritual. While MACRA passed both houses of Congress with overwhelming bipartisan support, a request soon after the law’s enactment from the Department of Health and Human Services (HHS) for information on…Continue Reading

About That Cadillac Tax

About That Cadillac Tax

In December 2015, Congress delayed implementation of the so-called Cadillac tax, a 40 percent excise tax on high-cost employer health benefit plans. Now scheduled to be implemented in 2020, the Cadillac tax would effectively cap the current tax exclusion for employer health benefits. By excluding health benefits from taxable incomes, the current tax break creates incentives for employers to pay more of employees’ compensation via health benefits instead of taxable wages, possibly leading to overuse of health care services and driving up health costs. Economists are generally keen to reduce or cap “tax expenditures,” like the current tax exclusion, to help prevent overuse of tax-favored items. We also tend to worry about …Continue Reading

What Does A New Era Of Physician Accountability Mean For Patients?

What Does A New Era Of Physician Accountability Mean For Patients?

With the implementation over the next several years of the Medicare Access and CHIP Reauthorization Act (MACRA) and the gradual build-out of Physician Compare, a website launched by the Affordable Care Act (ACA), we are entering a new era of physician accountability. MACRA replaced the unworkable sustainable growth rate (SGR) formula with a far-reaching quality measurement and payment system for physicians who treat Medicare patients. Beginning in 2019, physician payment will be much more tightly tied to quality and performance measures. Combined with newly invigorated private-sector attention to the inefficiencies of physician payment, MACRA may trigger a “disruptive innovation” in health care…Continue Reading

Increasing Access To Dental Care For Seniors To Improve Overall Health

Increasing Access To Dental Care For Seniors To Improve Overall Health

Shirley, like other senior residents in downtown San Diego, faces stark choices in day-to-day life. With more than 40 percent of seniors in San Diego living below the self-sufficiency level, many, like Shirley, have to choose between paying rent and buying medicine, between purchasing food and taking care of their teeth—choices none of us would ever want to make. Shirley is among many low-income seniors who are missing some or all of their teeth because of lack of access to affordable oral health care. When Shirley was growing up, her mom never took her to the dentist because the family didn’t have the money for routine dental care. As an adult, most of Shirley’…Continue Reading

Health Affairs Web First: For Medical Procedures, Costs Vary Greatly By Locale

Health Affairs Web First: For Medical Procedures, Costs Vary Greatly By Locale

There are many reasons for geographic differences in health expenditures, including utilization, the cost of doing business, and providers’ and insurers’ ability to negotiate prices. A new study, released as a Web First by Health Affairs, examined the variations in the prices for 242 common medical services in 41 states and the District of Columbia, using a national multipayer commercial claims database for the years 2012 and 2013. The authors, David Newman, Stephan T. Parente, Eric Barrette, and Kevin Kennedy, examined prices across states, compared overall price levels by state, and explored price variation within states. They sometimes found more than a threefold variation. Alaska had the highest average health care prices, followed by…Continue Reading

On Zika Preparedness And Response, The US Gets A Failing Grade

On Zika Preparedness And Response, The US Gets A Failing Grade

There are worrying signs that the United States is unprepared to contain a likely Zika virus outbreak this summer. The critical problems are: insufficient resources for mosquito control, surveillance, and health care; highly variable capabilities and quality of service among public health and mosquito abatement authorities; and weak legal powers to implement critical interventions. The Pan American Health Organization (PAHO) reports that 35 countries and territories in the Americas have confirmed local, vector-borne transmission of Zika since 2015. In the US, local mosquito-borne transmission has been reported in Puerto Rico, the US Virgin Islands, and American Samoa. Puerto Rico, in particular…Continue Reading

State Options To Control Health Care Costs And Improve Quality

State Options To Control Health Care Costs And Improve Quality

The recent debate on health care reform has occurred mostly at the national level. The Affordable Care Act, or ACA, was a momentous change for the American health care system. So far, 20 million people have gained health insurance coverage due to the ACA — a historic reduction in the number of uninsured people in the United States. The ACA also contained several tools designed to control health care costs. For example, it created the Center for Medicare and Medicaid Innovation, or CMMI, which is authorized to test new payment and delivery methods to lower costs and improve quality for individuals who receive benefits from federal…Continue Reading

Why the Obamacare 2016 Open Enrollment Stalled: The Big Unwritten Story About Obamacare––How Unaffordable It Is For the Working and Middle Class

Why the Obamacare 2016 Open Enrollment Stalled: The Big Unwritten Story About Obamacare––How Unaffordable It Is For the Working and Middle Class

Back on December 22nd when the President triumphantly announced 6 million enrollments on HealthCare.gov and the administration pointed to "unprecedented demand" on the exchanges, I was the skunk at the garden party arguing in the Washington Post that it was all just churn as existing customers were only trying to escape all of the big rate increases. Well guess what? It was all churn. TheContinue Reading

Health Affairs Web First: Significant Shifts Detected In Public Opinion About The ACA

Health Affairs Web First: Significant Shifts Detected In Public Opinion About The ACA

Since the Affordable Care Act (ACA) became law in 2010, Americans have remained deeply divided in their overall assessments of the law and whether it should continue. A new study, being released as a Web First by Health Affairs, compared public opinion about the ACA between 2010 and 2014 and found a significant increase in appreciation for the tangible effects of the law in widening access to health insurance. The proportion of Americans who believed that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those who considered reform to have some or a great impact increased by 19 percentage points. (See exhibit below.) The study also found…Continue Reading

Building Health Care Systems In Post-Earthquake, Post-Constitution Nepal

Building Health Care Systems In Post-Earthquake, Post-Constitution Nepal

Nepal finds itself at a critical juncture in its history. On September 20, 2015 a new Constitution was brought into full force, crystallizing the coming of age of the world’s youngest democratic republic. Today, challenges abound in Nepal — recovery from the worst natural disaster in 80 years, a brutal border conflict with India, and entrenched poverty. And as a landlocked nation with limited options for exporting goods, Nepal continues to face economic stagnation. Yet the new Constitution brings us great hope. It is among the world’s most progressive, particularly when it comes to the provision of Universal Health Coverage, stating overtly, “Every citizen shall have right to get basic health care free of cost from the state.” As the World Health Organization…Continue Reading

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