Category Archives: Health Care

Growth Of Public Coverage Among Working Families In The Private Sector

Source: Douglas Strane, Genevieve P. Kanter, Meredith Matone, Ahaviah Glaser, and David M. Rubin, Health Affairs, Vol. 38 No. 7, July 2019
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From the abstract:
Working families have increasingly enrolled their children in Medicaid or the Children’s Health Insurance Program in recent years. Parents’ place of employment affects the availability and cost of family health insurance, making it a determinant of pediatric public insurance enrollment. We examined that enrollment in the period 2008–16 in families working full time and earning more than 100 percent of the federal poverty level at three types of employers. Among low-income families (100–199 percent of poverty), children’s public health insurance coverage was highest for those with parents employed at small private firms, increasing from 53 percent to 79 percent, while the public insurance coverage rate also increased among children with parents working for large private firms (from 45 percent to 69 percent). Among moderate-income families (200–299 percent of poverty) working at small private firms, public coverage increased from 21 percent to 64 percent. Increases in the number of working families with pediatric public insurance were driven by employees of large private firms. Maintaining high pediatric insurance coverage rates will require policies that recognize the changing role of public insurance for working families as the cost of employer-based coverage grows.

Blue-Collar Workers Had Greatest Insurance Gains After ACA Implementation

Source: Sumit D. Agarwal, Anna L. Goldman, and Benjamin D. Sommers, Health Affairs, Vol. 38 No. 7, July 2019
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From the abstract:
Analyzing national survey data, we found that workers in traditionally blue-collar industries (service jobs, farming, construction, and transportation) experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. Compared to other occupations, these had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly purchased nongroup insurance.

The CHIP Dip

Source: Federal Funds Information for States, Issue Brief 19-20, July 1, 2019
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From the summary:
Beginning in fiscal year (FY) 2020, states will face increased costs for the Children’s Health Insurance Program (CHIP). The 23-percentage point increase in the federal CHIP matching rate—included in the Affordable Care Act (ACA)—will be reduced in FY 2020 and fully phased out in FY 2021. FFIS estimates that state costs could increase by approximately $4.3 billion (302%) to maintain total spending, although several factors remain uncertain.

The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor

Source: Wendi C. Thomas, MLK50 & ProPublica, June 27, 2019

Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years. ….. Its own employees are no exception. Since 2014, Methodist has sued dozens of its workers for unpaid medical bills, including a hospital housekeeper sued in 2017 for more than $23,000. That year, she told the court, she made $16,000. She’s in a court-ordered payment plan, but in the case of more than 70 other employees, Methodist has garnished the wages it pays them to recoup its medical charges….

Related:
This Memphis Hospital System Flouts IRS Rules by Not Publicly Posting Financial Assistance Policies
Source: Wendi C. Thomas, MLK50 & ProPublica, June 27, 2019

Nonprofit hospitals must post financial assistance policies for the public to see, including in emergency rooms. But Methodist Le Bonheur Healthcare’s five Shelby County emergency rooms had no signs or displays when a reporter checked.

Prevalence and Characteristics of Virginia Hospitals Suing Patients and Garnishing Wages for Unpaid Medical Bills
Source: William E. Bruhn, Lainie Rutkow, Peiqi Wang, Stephen E. Tinker, BS3; Christine Fahim, Heidi N. Overton, Martin A. Makary, JAMA, Research Letter, June 25, 2019

An estimated 20% of US consumers had medical debt in collections in 2014. Medical debt has been increasing with direct patient billing, rising insurance deductibles, and more out-of-network care being delivered, even at in-network facilities. Bills sent directly to patients may use the undiscounted price of a hospital’s services and can result in financial hardship and avoidance of future medical care. Hospitals need to be paid for care delivered, but some bills are unpaid. Hospitals may negotiate, reduce, or write off payments. Some have begun adopting a range of aggressive strategies for collecting unpaid bills, including suing patients and garnishing their wages or bank savings. We examined garnishment legal actions among Virginia hospitals.

Employers take action to improve access to quality, affordable health care

Source: Willis Towers Watson, Press Release, May 8, 2019

An increasing number of employers intend to provide their workforce with better access to high-quality and cost-effective health care by embracing a myriad of solutions such as high-performance networks, centers of excellence, onsite or near-site health centers, and accountable care organizations. Nearly one-half (45%) of employers say they intend to adopt these types of solutions by 2021, compared to just 32% that have already done so, according to research from leading global advisory, broking and solutions company Willis Towers Watson’s Health Care Access and Delivery Survey.

Notably, the survey also uncovered employers’ top concerns around delivering high-quality, comprehensive health care to their workforce and found they’re most concerned about inadequate access to mental health services (54%) and substance abuse treatment (47%)…..

Rising Mortality Rates Among Working-Age Americans

Source: Emily Fazio, Regional Financial Review, Vol. 29 no. 9, May 2019
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Mortality in the U.S. is rising. As a result, life expectancy at birth has fallen every year since its peak in 2014. This paper discusses the rise in mortality and the influence of increased rates of suicide and fatal drug overdoses. It also looks at geographic differences in mortality. Third, this paper considers the impact of economic conditions on changes in mortality, suicide rates, and fatal drug overdoses.

California’s Behavioral Health Services Workforce Is Inadequate for Older Adults

Source: Janet C. Frank, Kathryn G. Kietzman, and Alina Palimaru, UCLA Center for Health Policy Research, Health Policy Brief, January 2019

The Workforce Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers…..

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

Source: Carolyn C. Foster, Rishi K. Agrawal, and Matthew M. Davis, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Property Tax Exemptions for Nonprofit Hospitals: What Are They Worth? Do They Earn Them? Evidence From New York City

Source: Geoffrey Propheter, Public Budgeting and Finance, Early View, First published: March 25, 2019
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From the abstract:
This study estimates the property tax expenditure for nonprofit hospitals (NPHs) in New York City using Medicare and IRS data from 2011 through 2013. After comparing the estimates to various definitions of community benefits, it is concluded that NPHs generally earn their property tax break. Evidence is also presented that using book values is a reasonably accurate method for estimating the property tax expenditure nationwide. Finally, econometric analyses reveals that net income is negatively associated with community benefits, suggesting justification for taxing higher net income hospitals and reallocating the funds to similarly sized but lower net income hospitals.

Robotic health care is coming to a hospital near you

Source: Mattie Milner, Stephen Rice, The Conversation, May 7, 2019

Medical robots are helping doctors and other professionals save time, lower costs and shorten patient recovery times, but patients may not be ready. Our research into human perceptions of automated health care finds that people are wary of getting their health care from an automated system, but that they can adjust to the idea – especially if it saves them money.

Hospitals and medical practices are already using a fair amount of automation. For instance, in one San Francisco hospital and other places, delivery robots – about the size of a mini-fridge – zip through the hallways delivering pills, bringing lunch to patients and ferrying specimens and medical equipment to different labs. Some hospitals are set up for delivery robots to open remote-control doors and even use elevators to get around the building.