Category Archives: Health Care

State Prison Partnerships Can Improve Public Health and Safety

Source: Maria Schiff and Stephen Fehr, Stateline, March 19, 2018

Nearly all people in prison eventually leave, many of them with chronic diseases or behavioral conditions that may affect public health and safety in the communities where they will live. In a positive trend, corrections departments are partnering with health care agencies in some states to make it possible for offenders’ conditions to be treated when they re-enter the community.

Officials say the collaborations – in states such as Connecticut, Iowa, Missouri and Ohio— are promising because they can improve public health and safety while providing states with a better return on the money spent on treating offenders while they are in prison. Departments of correction collectively spent $8.1 billion on prison health care in fiscal 2015…..

U.S. tax law fuels changes to employee benefit and compensation programs

Source: Willis Towers Watson, February 21, 2018

Willis Towers Watson’s recent pulse survey on impacts from the new tax law reveals that the most common changes organizations have made or are planning or considering include expanding personal financial planning, increasing 401(k) contributions, and increasing or accelerating pension plan contributions. Other potential changes include increasing the employer health care subsidy, reducing or holding flat the employee payroll deduction, or adding a new paid family leave program in accordance with the Family Medical and Leave Act’s tax credit available for paid leave for certain employees.

Press Release

The Potential Impact of Short-Term Limited-Duration Policies on Insurance Coverage, Premiums, and Federal Spending

Source: Linda J. Blumberg, Matthew Buettgens, Robin Wang, Urban Institute, Research Report, February 2018

From the abstract:
On February 20, 2018, the Departments of Treasury, Labor, and Health and Human Services released a proposed regulation that would increase the maximum length of short-term, limited-duration insurance policies to one year. These plans, sold to individuals and families, are not federally required to comply with the Affordable Care Act regulations that prohibit annual and lifetime benefit limits, require coverage of all essential health benefits, and otherwise prohibit insurers from setting premiums or choosing whether to sell coverage to particular people based on applicants’ health status and health history. As such, these plans do not meet minimum essential coverage standards under the law; thus, the Congressional Budget Office does not consider them private insurance. If implemented, the rule would permit these plans to compete against the ACA-compliant plans.

Importantly, this change would be implemented on top of an array of other significant policy changes made since the beginning of 2017. We analyze the implications of the 2017 policy changes relative to the ACA as originally designed and implemented, in addition to the potential consequences of the proposed expansion to short-term limited-duration policies. In estimating the effects of these changes on insurance coverage, premiums, and federal spending, we take into account the variations in state circumstances and state-specific laws on short-term plans.

This brief was updated February 26, 2018. The title and notes for table 4 were altered to remove references to current law that had been inadvertently copied from tables 1–3.

Supreme Court: Union Retiree Health Benefits Weren’t Vested for Life

Source: Allen Smith, SHRM, February 22, 2018

Draft language in CBAs and benefits documents thoughtfully.

Retiree health care benefits end when a collective bargaining agreement (CBA) between a company and a union expires, unless the CBA provides otherwise, the Supreme Court ruled Feb. 20. The decision underscores the importance of giving careful thought to all language proposed and agreed to at the bargaining table, said David Pryzbylski, an attorney with Barnes & Thornburg in Indianapolis. Make sure the language in the CBA clearly expresses the parties’ intent, he stated. Benefits documents should as well, labor relations attorneys say. ….

Workers’ compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers

Source: Liza Topete, Linda Forst, Joseph Zanoni and Lee Friedman, American Journal of Industrial Medicine, Early View, January 31, 2018
(subscription required)

From the abstract:
The working poor are at highest risk of work-related injuries and have limited access to occupational health care.

To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers’ compensation (WC) among the working poor.

Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs.

Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated.

Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

How Are Health Centers Responding to the Funding Delay?

Source: Kaiser Family Foundation, Fact Sheet, February 2018

From the summary:
Health centers play an important role in our health care system, providing comprehensive primary care services as well as dental, mental health, and addiction treatment services to over 25 million patients in medically underserved rural and urban areas throughout the country. Health care anchors in their communities and on the front lines of health care crises, including the opioid epidemic and the current flu outbreak, health centers rely on federal grant funds to support the care they provide, particularly to patients who lack insurance coverage. However, the Community Health Center Fund (CHCF), a key source of funding for community health centers, expired on September 30, 2017, and has since been extended through only March 31, 2018. The CHCF provides 70% of grant funding to health centers. With these funds at risk, health centers have taken or are considering taking a number of actions that will affect their capacity to provide care to their patients. This fact sheet presents preliminary findings on how health centers are responding to the funding uncertainty.

Health Insurance Reform In The USA—What, How, And Why?

Source: Theodore Joyce, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The U.S. Congress failed to repeal and replace the Affordable Care Act (ACA). Will the country limp along with a politically unsupported ACA or is this an opportunity for a serious discussion about health insurance reform in the United States? In this Point/Counterpoint, Adam Gaffney, a physician and instructor in Medicine at the Harvard Medical School and a member of the Cambridge Health Alliance, argues for a national insurance program that provides first-dollar coverage to all Americans. Dana Goldman, the Leonard D. Schaeffer Chair and distinguished Professor at the University of Southern California, and Kip Hagopian, co-founder of Brentwood Associates and Managing Partner at Apple Oaks Partners LLC, also argue for universal coverage, but one consistent with standard principles characteristic of automobile or home insurance. These widely differing approaches to health insurance reform could not be more timely or more cogently argued.


It Is Time For Universal Coverage Without Breaking The Bank
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

….So what can be done now that “repeal and replace” has failed? There is a call for bipartisan solutions, but proposals are often short on details. What specifics we do get involve modest reforms to reduce cost-sharing and stabilize the existing markets. This is not enough; we need fundamental reform, and five goals should undergird a bipartisan plan:
• make coverage universal and progressive;
• build on, but do not replace, the private insurance system;
• keep it affordable and sustainable; reduce incentives for adverse selection (avoidance of bad health risks); and
• create incentives for prevention and long-term investment…..

Health Insurance Reform In The United States—What, How, And Why?
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

Last summer, Republican efforts to repeal the Affordable Care Act (ACA)—seven-years in the making—dramatically collapsed. Yet, if the failed Senate vote in July marked a pause in conservative reform efforts, it only further animated the health care reform debate on the left side of the political spectrum.

In this article, I argue that one of the reform models under discussion—single-payer national health insurance (NHI)—is the most potent and realistic policy solution. First, I make the case that universal coverage is economically feasible. Second, I examine why achieving universal coverage remains paramount. Third, I describe how universal coverage can be quickly and effectively achieved via NHI enrollment. Fourth, I discuss benefit design, emphasizing the importance of comprehensive benefits, and first-dollar coverage. And finally, I explore the role of the public and private sectors, arguing that health care coverage must remain entirely within the public sphere if the goal of universal health care is to be, at long last, attained…..

Medicare-For-All: Not Our Only Option For Universal Coverage
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The failure to meet ambitious but attainable goals—cover everyone, control costs—has created opportunity for radical reform. Dr. Gaffney advocates for universal health coverage via the burgeoning “Medicare-for-All” approach that has dominated the progressive health reform landscape for decades. As appealing as it may be from the outside, the strategy ignores several key health policy realities, namely the proper amount of insurance, the historic limitations of Medicare, the pitfalls of cutting costs by reducing administration, and the rising pressure of private markets in international health insurance…..

Universal Underinsurance Is Not The Same As Universal Health Care
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

I begin my response to Dana Goldman and Kip Hagopian’s admirably clear reform proposal on a point of agreement. Today, 28 million Americans remain uninsured according to the United States Census Bureau. The three of us clearly agree that this status quo is unacceptable, and that universal coverage is attainable, affordable, and right.

Beyond that, however, it becomes clear that we have very different visions for the future of American health care……

For better patient care, prevent nurse burnout

Source: Futurity, January 30, 2018

“Compassion practices” can have a positive effect on nurses’ work and well-being, a new study suggests.

The phrase refers to relatively conventional organizational practices that reward and recognize caregiving work and include job-related resources to cope with stress and provide pastoral care. “We know there is a burnout epidemic among nurses.”

Nursing is among the top 10 fastest-growing occupations in the United States, but the number of nurses exiting the profession currently outpaces the number of those entering. And the turnover rate is getting even higher.

The Robert Woods Johnson Foundation recently reported that nearly 20 percent of nurses leave the profession during their first year and one in three is gone within two years…..

Compassion Practices, Nurse Well-Being, and Ambulatory Patient Experience Ratings
Source: Laura E. McClelland, Allison S. Gabriel, Matthew J. DePuccio, Medical Care, Vol. 56 no. 1, January 2018
(subscription required)

From the abstract:
Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences.

To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients’ experience ratings in the ambulatory clinic setting.

Research Design:
Surveys were collected from ambulatory nurses in January and February of 2015 in 30 ambulatory clinics affiliated with an academic medical center. Patient experience ratings were collected April to June of 2015.

One hundred seventy-seven ambulatory nurses (Registered Nurses, LPNs, medical assistants), as well as 3525 adult patients from the ambulatory clinics.

Ambulatory nurses assessed compassion practices, emotional exhaustion, and psychological vitality. Patient experience ratings were patient perceptions of courtesy and caring shown by nurses and patients’ ratings of the outpatient services.

Compassion practices are significantly and negatively associated with nurse emotional exhaustion and positively associated with nurse psychological vitality. At the clinic-level, compassion practices are significantly and positively associated with patient perceptions of caring shown by nurses and overall patient ratings of the outpatient clinic. Supplemental analyses provide preliminary evidence that nurse well-being mediates the relationship between compassion practices and patient ratings of their care experience.

Our findings illustrate that compassion practices are positively associated with nurse well-being and patient perceptions of the care experience in outpatient clinics.

Delivering Public Health Insurance through Private Plan Choice in the United States

Source: Jonathan Gruber, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
The United States has seen a sea change in the way that publicly financed health insurance coverage is provided to low-income, elderly, and disabled enrollees. When programs such as Medicare and Medicaid were introduced in the 1960s, the government directly reimbursed medical providers for the care that they provided, through a classic “single payer system.” Since the mid-1980s, however, there has been an evolution towards a model where the government subsidizes enrollees who choose among privately provided insurance options. In the United States, privatized delivery of public health insurance appears to be here to stay, with debates now focused on how much to expand its reach. Yet such privatized delivery raises a variety of thorny issues. Will choice among private insurance options lead to adverse selection and market failures in privatized insurance markets? Can individuals choose appropriately over a wide range of expensive and confusing plan options? Will a privatized approach deliver the promised increases in delivery efficiency claimed by advocates? What policy mechanisms have been used, or might be used, to address these issues? A growing literature in health economics has begun to make headway on these questions. In this essay, I discuss that literature and the lessons for both economics more generally and health care policymakers more specifically.

Selection in Health Insurance Markets and Its Policy Remedies
Source: Michael Geruso Timothy J. Layton, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
Selection (adverse or advantageous) is the central problem that inhibits the smooth, efficient functioning of competitive health insurance markets. Even—and perhaps especially—when consumers are well-informed decision makers and insurance markets are highly competitive and offer choice, such markets may function inefficiently due to risk selection. Selection can cause markets to unravel with skyrocketing premiums and can cause consumers to be under- or overinsured. In its simplest form, adverse selection arises due to the tendency of those who expect to incur high health care costs in the future to be the most motivated purchasers. The costlier enrollees are more likely to become insured rather than to remain uninsured, and conditional on having health insurance, the costlier enrollees sort themselves to the more generous plans in the choice set. These dual problems represent the primary concerns for policymakers designing regulations for health insurance markets. In this essay, we review the theory and evidence concerning selection in competitive health insurance markets and discuss the common policy tools used to address the problems it creates. We emphasize the two markets that seem especially likely to be targets of reform in the short and medium term: Medicare Advantage (the private plan option available under Medicare) and the state-level individual insurance markets.

The Questionable Value of Having a Choice of Levels of Health Insurance Coverage
Source: Keith Marzilli Ericson, Justin Sydnor, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
In most health insurance markets in the United States, consumers have substantial choice about their health insurance plan. However additional choice is not an unmixed blessing as it creates challenges related to both consumer confusion and adverse selection. There is mounting evidence that many people have difficulty understanding the value of insurance coverage, like evaluating the relative benefits of lower premiums versus lower deductibles. Also, in most US health insurance markets, people cannot be charged different prices for insurance based on their individual level of health risk. This creates the potential for well-known problems of adverse selection because people will often base the level of health insurance coverage they choose partly on their health status. In this essay, we examine how the forces of consumer confusion and adverse selection interact with each other and with market institutions to affect how valuable it is to have multiple levels of health insurance coverage available in the market.