Tag Archives: Health Policy
An Association Of Health Funders And The Changing Political Landscape
As the professional association for health foundations and corporate-giving programs, Grantmakers In Health (GIH) connects the hundreds of health funders who are spread across the American landscape, keeping them up-to-date on rapidly changing developments and providing opportunities for them to share what they’re learning and doing in their respective communities.
Times like now—when dramatic changes to the health care landscape are anticipated—accentuate the importance of this role. In 2017 it will be especially important that we help funders understand, and respond to, significant expected changes in public policies and programs that affect the communities they serve.
We will not simply be in crisis mode, however. Our concern for both informing and shaping the bigger picture of philanthropy’s health and health care priorities is ongoing.
As the year begins, the future of the Affordable Care Act (ACA) is naturally a high priority for us. Health funders are rightly anxious to understand the changes that are likely with a new Congress and presidential administration. Many grantmakers have invested for years at a national or state level to support the implementation of the ACA. They are keenly aware that rolling back the law will have consequences not only for people’s access to health care services, but also, more broadly, for jobs and state economies.
In an immediate response to these concerns, GIH has organized a series of webinars for its membership that offers the perspectives of a range of policy experts. Immediately post-election, these topics included strategies for adapting health reform–related grant making, the future of Medicaid, and the election’s implications for the State Children’s Health Insurance Program (CHIP) and other children’s coverage. Upcoming webinars will include bipartisan views of the new Trump administration’s health priorities and plans, the implications of a possible repeal of the ACA without implementing an immediate “replace” strategy, and the 2016 election’s possible effects on the health of immigrant communities.
Other ACA-related programming will include activities taking place at our annual conference in June, as well as meetings, calls with funders, and publications, including in-depth interviews about foundation strategies. Because changes to the ACA, Medicaid, and other programs will heighten the importance of state-level actions, our 2017 programming will pay special attention to elevating what funders are doing in states and sharing this information nationally.
In addition to this focus on policy changes that will affect access and coverage, we also want to identify health investment areas in which the new administration seems to be interested. We anticipate that addiction, delivery system reform, veterans’ health, and rural health will be on that list.
Health Affairs Web First: US Six-Month Drug Market Exclusivity Extensions Could Yield Nearly $100 Million
For the past few years, US lawmakers have considered legislation that would grant six additional months of market exclusivity for previously approved drugs that have been successfully tested and subsequently approved by the Food and Drug Administration (FDA) for treating rare diseases. This proposal is intended to incentivize pharmaceutical manufacturers to invest in rare disease research.
A new study, released by Health Affairs as a Web First, analyzed the thirteen supplemental applications approved by the FDA that earned rare disease status from 2005 through 2010 to estimate the costs of the clinical trials and potential economic gain arising from a six-month exclusivity extension. According to the authors, Aaron S. Kesselheim, Ben Rome, Ameet Sarpatwari, and Jerry Avorn, the median discounted financial gain for each drug would have been $94.6 million, with blockbuster drugs predictably enjoying the highest returns. The authors’ analysis also suggests that these manufacturers had spent a median of $29.8 million on trials that gained supplemental approval for rare disease indications.
“These results confirm that market exclusivity extensions can generate substantial returns to the manufacturers that are eligible for the incentive — sums that are generally much greater than the cost of performing the requisite clinical trials,” the authors conclude. As a result, “this solution could prove costly to the health care system.” They add, “Any proposal to extend market exclusivity protections in the US prescription drug market should undergo rigorous analysis that weighs the benefits of predicted investment in research against the costs of the incentives to governmental and private-sector payers.”
The authors are all affiliated with the Program on Regulation, Therapeutics, and Law (PORTAL) at the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School.
This study, which was supported by the Laura and John Arnold Foundation, will also appear in Health Affairs’ February issue.
Interstate Insurance Sales: Wishful Thinking, Or A Viable Policy Option?
Anyone who followed the recent election cycle knows that President-elect Donald Trump made “repeal and replace” a cornerstone of his campaign — referring, of course, to the Affordable Care Act (ACA). He, like Mitt Romney and John McCain did in their respective bids for the presidency, has proposed permitting insurers to sell insurance plans across state lines as a possible alternative to the ACA, or at least as a component of a potential alternative.
In this post, we’ll take a look at the possible advantages of allowing interstate insurance sales, as well as the reasons opponents say such a policy simply won’t work. First, though, let’s take a closer look at the current situation.
The ACA Already Allows Interstate Insurance Sales
A provision in section 1333 of the Affordable Care Act allows states to establish what are called “health care choice compacts,” which permit insurers to sell policies to individuals and small businesses in any state that participates in the compact — provided they abide by specific rules. And several states have explored the possibility. In fact, a few have even enacted statutes pertaining to interstate compacts.
But as of yet, nothing has materialized. Several explanations point to why:
- Complacency on the part of regulators, at both the federal and state level
- Lack of interest among insurers
- Lack of demand from consumers
- Prohibitively restrictive regulations
- Insufficient time so far for the concept to take root
Whatever the reason or combination of reasons may be, the upshot is that interstate insurance sales are already legal under certain conditions.
It’s also important to note that most large companies are self-insured, which means they are not affected by state regulations and this whole discussion of selling insurance across state lines doesn’t apply to them.
Top 10 healthcare trends for 2017
2017 will be a transition year shaped by changes proposed by President-elect Donald Trump and a Republican Congress. Chief healthcare concerns include legislative proposals to “repeal and replace” the Affordable Care Act (ACA), along with the continued movement to implement alternative payment models (APMs) as called for in the Medicare Access and CHIP Reauthorization Act (MACRA). We will address the potential changes ahead when it comes to shifting health benefits, provider supply, new care models, transparency, and the continued growth of consumerism. 2017 will be a dynamic year as we pivot and move in a new political direction.
As Commercial Capitation Sinks, Can California’s Physician Organizations Stay Afloat?
http://www.chcf.org/publications/2016/11/commercial-capitation-sinks
California is seeing the decline of capitation — fixed prepayment for care of a defined population — particularly for commercial health insurance products. This issue brief explores the impact of this trend on the state’s medical groups and independent practice associations (IPAs). The main question at hand is whether California’s delegated model will remain sustainable with lower levels of commercial capitation.
The analysis is based on both quantitative and qualitative data. The medical group and IPA leaders interviewed for this research made a number of observations, including:
- The near future is uncertain. Declining capitation has not yet had a big impact on their operations, but they suspect it may soon.
- Change thus far has been slow enough that organizations have been able to adapt.
- Declining prepayment will not impact clinical decisionmaking.
- Medicare and Medi-Cal offer more opportunities to accept capitation, but these do not necessarily compensate for the loss of commercial capitation.
- Leaders are concerned that high deductibles may adversely affect the health of patients.
The research points to the importance of continuing to track changes in the payment environment of California’s capitated, delegated physician organizations. Although the decline in commercial capitation has been slow enough that it has not yet led to significant changes in operations, it may soon do so.
The full issue brief is available as a Document Download.
Click to access PDF%20CommercialCapitationSinks.pdf
Dynamics of Decline: The Truth About HMOs
http://www.chcf.org/articles/2016/11/dynamics-decline-truth-hmos
California’s commercial health maintenance organization population shrank from 11.9 million to 9.8 million enrollees between 2004 and 2015 (see figure below), a 17.5% decline. But the decline has not been consistent across all HMOs — Kaiser’s commercial enrollment has actually grown during this period.
Two new publications from CHCF take a closer look at how commercial managed care enrollment (including individual enrollment) and the public sector’s embrace of managed care are shifting the way physician organizations are paid — important trends that could affect California’s delivery system.
When It Comes to Seeing a Doctor in California, the Uninsured Still Fare Worst
http://www.chcf.org/articles/2017/01/when-seeing-doctor
With repeal of the Affordable Care Act (ACA) on the horizon, and no replacement plan in sight, millions of Californians are at risk of losing their coverage. Approximately 5 million Californians are currently covered under the ACA. The state’s uninsured rate, which hit a historic low under the ACA, could start to rise again depending on what happens in Washington in the coming weeks and months.
It’s worth remembering the multiple barriers that people without insurance face in our health care system. I am reminded of some key findings from a 2015 survey of California physicians that the University of California, San Francisco, released last fall with support from the California Health Care Foundation.
The survey asked, among other questions, if physicians were accepting new patients who had various types of insurance (private, Medicare, or Medi-Cal) or who were uninsured. The survey also asked physicians if any of their existing patients were uninsured.
As the slides below show, the uninsured face the hardest time getting accepted into a physician’s practice. Only 38% of all California physicians said they accepted new uninsured patients in 2015; only 55% said they had any uninsured patients. The sample of physicians includes emergency department (ED) doctors who are legally required to see all persons who come to an ED, regardless of whether they have insurance.
Health Spending Projections: 2015-2025
National health spending will reach $5.6 trillion by 2025. Get the data on payers, per enrollee costs, payment sources, and spending on types of services.
Repealing Obamacare without replacement would hike premiums 20% and leave 18 million uninsured, report says
http://www.latimes.com/politics/la-na-obamacare-repeal-costs-20170117-story.html
Repealing Obamacare without a replacement would result in higher costs for consumers and fewer people with insurance coverage, according to a report Tuesday from the nonpartisan Congressional Budget Office.
In the first year, insurance premiums would jump by 20% to 25% for individual policies purchased directly or through the Obamacare marketplace, according to the report. The number of people who are uninsured would increase by 18 million.
Those numbers would only increase in subsequent years. Premium prices would continue to climb by 50% the next year, with the uninsured swelling to 27 million, as full repeal took effect, the report said.
Americans may be beginning to worry about such costs. For the first time, more Americans view the Affordable Care Act as a “good idea,” rather than a bad one, according to a new Wall Street Journal/NBC News poll also released Tuesday.
HENRY KOTULA 