Health Affairs

New Congressional Budget Office projections for health insurance coverage, 2024-2034 .Jessica Hale and colleagues estimate that currently, 92.3 percent of the US population is insured, and 7.7 percent are uninsured. The uninsured rate is expected to rise to 8.9 percent in 2034, with those adults ages 19-44 most affected. Medicare and Marketplace enrollment are also projected to grow. Read the full study: https://bit.ly/4bXLgcS

In their new Forefront article, Laura Benzing, Hannah Godlove, and Megan Burke from ATI Advisory and The SCAN Foundation discuss how state policy makers can consider opportunities to address the LTSS gap under existing authorities including expanding Medicaid eligibility and State Plan Amendments, Section 1115 Demonstrations, Older Americans Act funding, and other state-driven initiatives. "Individuals near Medicaid eligibility are unlikely to qualify for Medicaid or be able to afford LTSS out of pocket. However, because the annual average cost of LTSS is $67,000, LTSS unaffordability impacts a broader group than those with incomes below 221 percent of poverty ($33,282 per individual in 2024). Therefore, the insights and recommendations discussed below can be used to address the needs of a broad range of individuals who have difficulty affording LTSS. The literature refers to this broad population who cannot always afford LTSS as “the forgotten middle” or “middle income.” Understanding the characteristics and needs of individuals near Medicaid eligibility is the first step to addressing the LTSS gap." Read the full article here: https://bit.ly/46daNxH

Active pharmaceutical ingredients (APIs) are a critical input for manufacturing pharmaceuticals. However, production is highly centralized and vulnerable to supply shocks. Melissa Barber of Yale University and her team of coauthors @global-health-centre examine the effects of the COVID-19 pandemic on prices and export volume for APIs exported from India during the COVID-19 pandemic. The researchers find that the COVID-19 pandemic resulted in an 80 percent decrease in the volume of APIs for key essential medicines exported from India, while API prices did not change significantly. Read the full study: https://bit.ly/4d2i6uo

Robert Berenson of the Urban Institute and Kevin Hayes outline ways to fix the Medicare Physician Fee Schedule and ultimately improve value-based payment efforts. The authors conclude that the “Centers for Medicare and Medicaid Services (CMS) should correct misvalued services and establish a hybrid payment for primary care that blends fee-for-service and population-based payment.” They also recommend that “Congress alter the thirty-five-year-old statutory basis for setting Medicare fees to allow CMS to explicitly consider policy priorities such as workforce shortages in refining fee levels.” Read the full article: https://bit.ly/3SiH0O6

In their new Forefront article, Gui Woolston and Amy Finkelstein of Aledade, Inc. and the Massachusetts Institute of Technology (MIT) call on Medicaid programs across the country to take advantage of opportunities to pursue test-and-learn approaches through randomized evaluations to achieve their policy goals and ultimately improve members’ health. "At the Connecticut Medicaid program that I (Gui) ran until May 2024, we believe that engaging in test-and-learn approaches based on rigorous evaluation methods such as randomized evaluations (often called randomized controlled trials or RCTs) is crucial to achieving these policy goals and ensuring that programs work for our members. Despite this, Medicaid offices across the country face a range of barriers to getting these evaluations off the ground. We propose two approaches that can overcome these challenges, along with five practical steps states can take to effectively pursue RCTs. By rigorously evaluating our programs and sharing results, we can build knowledge to help allocate resources more effectively, better serve our members, and support other Medicaid programs nationwide." Read the full article here: https://bit.ly/3VWlY9f

In his new forefront article Rob Lott, the Senior Deputy Editor of Health Affairs, pays tribute to our Director of Events, Debbie Boylan, who sadly passed away last week. "Some have said, with tongue in cheek, that the people of Washington, DC can be sorted into two distinct camps: political hacks and policy wonks. Somehow, Debbie embodied the best features of both: she was really good at building affinity and understanding how stakeholders defined and defended their priorities. She also had a deep understanding of policy’s impact on people’s lives, and of the important and imperfect role that policymakers had in shaping that policy, for better and for worse. These skills became lessons she shared with the many young professionals who crossed her path over the years. She was the rare mentor who could make her mentees feel like genuine friends and partners, on equal footing even as they learned from her years of experience." Read the full article here: https://bit.ly/3YdL3ir

In the July issue of Health Affairs, Shiram Parashuram of the NORC at the University of Chicago and his team of coauthors explore the effects of the Next Generation Accountable Care Organization (NGACO) on Medicare Parts A and B spending between 2016-21. The researchers conclude that NGACO was associated with significant reductions in Medicare Parts A and B spending with annual declines growing larger “in nearly every subsequent year of the model” but no decline in net spending. Read the full article: https://bit.ly/3LzQeBQ

In the July issue of Health Affairs, Sungchul Park of Korea University and Rishi Wadhera of Beth Israel Deaconess Medical Center examine the use of high- and low-value health care among US adults by income level. The researchers find that “those with high incomes were significantly more likely than those with low incomes to use nearly all high-value services.” These results were consistent across all age categories. For low-value care, there was no consistent pattern in the use of these services among adults. Read the full paper: https://bit.ly/3WhKLot

Sources of coding intensity in Medicare Advantage: Paul Jacobs of the Agency for Healthcare Research and Quality examines the relative impacts of in-home health risk assessments and chart reviews on risk scores used for payments to Medicare Advantage (MA) plans. The author concludes, after examining 22.9 million MA enrollees, that encounter-based risk scores for MA enrollees were 7.4 percent higher when in-home health risk assessments and chart reviews were included. These findings were associated with a $15 billion increase in payments to MA plans in 2021. Read the full study: https://bit.ly/46mmkLa

In their new Forefront article, J. Nwando Olayiwola, Ene Anteyi, Faith Obanua, Andy Rollins, Laura B. Baustien, Tamara Smith, Stephanie M. Franklin, and Candy Magaña from Humana discuss how health plans and health care organizations need comprehensive strategies to address low/limited health literacy as a foundational contributor to health inequities. "For health plans and care delivery organizations in particular, health literacy is critical because it is necessary for optimal health maintenance, prevention, health resource use, treatment and medication compliance, patient experience, and health-related decision making. Limited health literacy is considered a key contributor to total cost of care. It also contributes to US health care system inefficiency, estimated to add $106–$238 billion in costs to the health care system, through more frequent use of inpatient services, emergency department visits and revisits, and more costly care needs from poor health." Read the full article here: https://bit.ly/3YcWA1A