Health Affairs

JUST RELEASED | The November 2024 issue on Health Insurance, Pharmaceuticals & More is now available. Read the introduction from the Editor-In-Chief and explore the new issue: https://lnkd.in/gFaN7VWF

In her new Forefront article, Sheela Ranganathan of the O'Neill Institute for National and Global Health Law discusses how, on September 30, a federal district judge in Florida held for the first time that lawsuits initiated by whistleblowers under the False Claims Act are unconstitutional, dismissing a Medicare fraud case because the whistleblower was not a properly appointed federal officer under Article II of the U.S. Constitution. "In the opinion, Judge Mizelle only addressed the Appointments Clause argument. She explained that the Appointments Clause requires that “principal” officers—such as ambassadors, Supreme Court Justices, and senior agency heads of the U.S.—must be appointed by the President subject to Senate confirmation. It also allows certain “inferior” officers to be appointed by the President, courts of law, or agency department heads. Another category of government officials encompass “employees,” who make up “the broad swath of lesser functionaries’ in the Government’s workforce,” to whom the Appointments Clause does not apply (because they are not “officers”). Judge Mizelle noted that “much hangs in the balance when distinguishing between officers and employees.” Indeed, the scope of the Appointments Clause, which is instrumental in maintaining the federal government’s separation of powers, has been in dispute for decades because the Constitution does not specify the exact types of positions or nature of responsibilities that require a particular type of appointment." Read the full article here: https://bit.ly/3YzyCMv

Anna Larson of Epstein Becker & Green, P.C. and co-authors explore the temporal relationship between states adopting recommendations issued by the federal Advisory Committee on Immunization Practices (ACIP) and delays in school entry immunization requirements. Read the full article here: https://lnkd.in/e4cv6mmS

JUST RELEASED: The November 2024 Issue of Health Affairs on Health Insurance, Pharmaceuticals, and more. Learn more about the issue and our upcoming November events!

In their new Forefront article, Kathleen Noonan and Mary Naylor from Camden Coalition and the University of Pennsylvania discuss how, as our nation ages, with the need to address more mental health and loneliness challenges than ever, it is time to design new place-based care models that capitalize on the strengths of our old-style institutional care and current approaches to community-based services. "There is reason to be concerned, given the challenges experienced by Medicare Advantage (MA) plans in implementing nonmedical supplemental benefits. To date, only a small proportion of MA plans are taking advantage of the more complex benefits, the geographic reach of these benefits is limited, and rarely are newly available health and social supports aligned to meet the individualized and continually evolving needs of vulnerable older adults. The primary approach to MA plans’ nonmedical supplemental benefit delivery is a transactional model that is often costly, inefficient, and disruptive to the lives of people who depend on such services on a continuing basis. Intentional investment in alternative models is essential to ensure that the implementation of states’ 1115 waivers does not follow this path." Read the full article here: https://bit.ly/3UvCk8I

In her new Forefront article, A. Susana Ramirez from the University of California, Merced discusses how the NIH’s current system for funding scientific research perpetuates health disparities by privileging established, well-resourced institutions and reinforcing an individual-level focus on disease risk and intervention. "Funding agencies play a pivotal role in shaping the landscape of scientific research, effectively determining which health issues are prioritized and how they are framed. As the foremost public funder of biomedical and public health research in the world, the National Institutes of Health (NIH) wields substantial influence. By directing billions of dollars annually toward specific research projects, the NIH not only sets the agenda for scientific inquiry but also constructs the very definition of health “problems.” This power to prioritize certain diseases, conditions, and research approaches over others means that the NIH’s funding decisions profoundly shape the direction and focus of health research. Yet, the processes by which funding decisions are made—often favoring well-established, resource-rich institutions and researchers while underrepresenting the perspectives and needs of communities experiencing the most significant inequities—marginalize primary cause and ecosocial intervention research." Read the full article here: https://bit.ly/3UyfU6R

In his new Forefront article, Zachary Baron of the O'Neill Institute for National and Global Health Law discusses how the sweeping relief sought by plaintiffs in a recent lawsuit filed in Texas could erode protections for consumers against unanticipated financial liabilities and could increase premiums in the individual market. "The lawsuit alleges that the regulatory requirements for STLDI (short-term, limited duration health insurance) and fixed indemnity policies exceed the tri-departments’ rulemaking authority, contradict statutory provisions and legislative intent, ignore procedural requirements, provide an inadequate record, and “invade[] the province of state regulatory authority.” The complaint includes sweeping claims concerning the “true intent” behind the STLDI and fixed indemnity regulation, alleging it seeks “to eliminate health insurance options for Americans . . . all under the guise of consumer protection.” The plaintiffs also allege a violation of the Nondelegation doctrine, a judicially created principle that prohibits Congress from passing its legislative functions to administrative agencies." Read the full article here: https://bit.ly/3YrBT0y

In their new Forefront article, Atul Grover and Johnathan Jaffery from the Association of American Medical Colleges (AAMC) discuss how regulation of health system consolidation should take into account all aspects of the market for health care goods and services within the range of geographic areas that are relevant to patients, including the rapid consolidation of the insurer market and the consolidation of other parts of the health care ecosystem. "This sole focus on provider consolidation is problematic for several reasons, not least because even the largest providers have far less market share than other players in the health care market, most notably insurers. In this article, we discuss why current critiques of health system consolidation often distort important market dynamics. Next, we discuss the importance of identifying the most appropriate measure of geography in analyses of market consolidation, and close by emphasizing the need for doctors and hospitals to adapt to insurer consolidation." Read the full article here: https://bit.ly/3YLYEOa

Announcement | Health Affairs Scholar, a journal of emerging and global health policy, is now indexed in the Directory of Open Access Journals (DOAJ). The journal covers core health policy topics, innovative translational research in health care technology, population health, and global health. Learn more: https://lnkd.in/egGDNWeN

In her new Forefront article, Sara Rosenbaum from The George Washington University discusses how on December 4, 2024, the US Supreme Court will hear United States v Skrmetti, which raises the question of whether a state law that prohibits medically necessary gender-affirming care for transgender people violates the 14th Amendment’s protections against discrimination based on sex. "The question effectively on the table in Skrmetti is whether Bostock’s definition of “sex” applies in a 14th Amendment equal protection context and therefore prohibits state laws that discriminate against transgender people where medically necessary gender-affirming health care is concerned. If the Bostock definition applies (and logic would seem to dictate “yes”), then state transgender health care bans would lose the automatic legal presumption that state laws regulating health care normally enjoy. Instead, a state seeking to maintain such a law would carry the heavy burden of proving that its ban in fact furthers an important governmental interest and does so by means that are substantially related to that interest." Read the full article here: https://bit.ly/3NPGnsE