July 28, 2009
Congressional Research Service. Private Health Insurance Provisions of H.R. 3200. CRS Report R40724, July 27, 2009.[Full Text (pdf)]
This report summarizes key provisions affecting private health insurance in H.R. 3200, Americas Affordable Health Choices Act of 2009, as ordered reported by House Committees on Education and Labor and on Ways and Means. Specifically, this report focuses on Division A or I of H.R. 3200 from those committees. Division A of H.R. 3200 focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. In general, H.R. 3200 would require individuals to maintain health insurance and employers to either provide insurance or pay into a fund, with penalties/taxes for non-compliance. Several insurance market reforms would be made, such as modified community rating and guaranteed issue and renewal. Both the individual and employer mandates would be linked to acceptable health insurance coverage, which would meet required minimum standards and incorporate the market reforms included in the bill. Acceptable coverage would include 1 coverage under a qualified health benefits plan QHBP, which could be offered either through the newly created Health Insurance Exchange the Exchange or outside the Exchange through new employer plans; 2 grandfathered employment based plans; 3 grandfathered nongroup plans; and 4 other coverage, such as Medicare and Medicaid. The Exchange would offer private plans alongside a public option. Based on income, certain individuals could qualify for subsidies toward their premium costs and cost-sharing deductibles and copayments; these subsidies would be available only through the Exchange. In the individual market the nongroup market, a plan could be grandfathered indefinitely, but only if no changes were made to the terms and conditions of that plan, including benefits and cost-sharing, and premiums were only increased as allowed by statute. Most of these provisions would be effective beginning in 2013.
July 26, 2009
Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health. 2009 Jul 16. [Abstract (html)]
Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.
via Understanding evidence-based public health policy | Institute for Health Research and Policy | University of Illinois at Chicago.
July 25, 2009
P. Cunningham. Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans with Chronic Conditions. The Commonwealth Fund, July 2009. [Full Text (pdf)]
Using data from the 2001–2005 Medical Expenditure Panel Survey, this study shows that nearly 40 percent of nonelderly adults with three or more chronic conditions had out-of-pocket expenses and premiums exceeding 5 percent of income for two consecutive years, compared with 20 percent of people who had a single chronic condition and 14 percent who had no chronic conditions. Prescription drug spending accounts for over half of the out-of-pocket spending by individuals who have multiple chronic conditions and who have had persistently high financial burdens that last two years or more. The prevalence of persons with persistently high financial burdens is likely to increase in the future, because of expected increases in prescription drug costs as well as chronic disease prevalence.
July 25, 2009
The Economic Effects of Health Care Reform on Small Businesses and Their Employees. The Council of Economic Advisors CEA released a report on small businesses and health care, examining the challenges currently faced by smaller firms in the health insurance market and the likely impacts of health care reform on small businesses and the workers they employ. July 25, 2009. [Full Text (pdf)]
July 25, 2009
Aparna Mathur. Medical Bills and Bankruptcy Filings, American Enterprise Institute, July 19, 2006. [Summary (html)][Full Text (pdf)]
Using PSID data, we estimate the extent to which consumer bankruptcy filings are induced by high levels of medical debt. Our results suggest that nearly 27 percent of filings are a consequence of primarily medical debt, while in approximately 36 percent of cases medical debts co-exist with primarily credit card debts. Studying the post-bankruptcy scenario, we find that filers are 19 percent less likely to own a home even several years after the filing, compared to non-filers. However, the consequences are less adverse for medical filers i.e those who filed due to high medical bills compared to other filers.
July 25, 2009
Henshaw et al., Restrictions on Medicaid Funding for Abortions: A Literature Review Guttmacher Institute, June 2009. [Summary (html)][Full Text (pdf)]
The current version of the Hyde Amendment– passed in 1997 — allows federal funding for abortion in cases of rape and incest, or if the woman’s life is endangered by a “physical disorder, physical injury or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself.”
Seventeen states have policies allowing the use of their own funds to provide all or most medically necessary abortions for Medicaid beneficiaries. Four states — Hawaii, Maryland, New York and Washington — voluntarily adopted such policies, while the rest implemented them after courts said they were in violation of their state constitutions. Thirty-two states and Washington, D.C., allow use of Medicaid funds in circumstances allowed under the Hyde Amendment, and South Dakota currently is in violation of federal Medicaid law because it will only pay for abortions in cases where the woman’s life is in danger.
Stanley Henshaw and colleagues at the Guttmacher Institute conducted a literature review of studies published from 1979 to 2008 examining the impact of restrictions on Medicaid funding of abortion. After identifying 38 relevant studies, the researchers evaluated each one on five measures of quality: the reasonableness of the assumptions in the study’s statistical models; if the populations of interest and the outcomes of interest were accurately measured; if possible confounding variables were adequately controlled; the adequacy of the statistical models; and whether the study was cross-sectional or longitudinal. The researchers considered longitudinal studies preferable to cross-sectional studies because the longitudinal studies “control for unmeasured state characteristics that are constant over time.”
The review found that Medicaid funding restrictions for abortion seemed to delay some women from having the procedure by two to three weeks. However, the net impact on second-trimester abortions is not clear, in part because a decrease in procedures past 12 weeks’ gestation “could be explained if some Medicaid-eligible women carried pregnancies to term because they were unable to pay for the more expensive later abortions or if they went to other states for less costly abortion services.”
The studies included in the review found little evidence that funding restrictions resulted in illegal abortion procedures. However, the review did find one death that was directly related to the Medicaid restrictions and two that were indirectly related.
Source: Monthly Women’s Health Research Review
July 19, 2009
Medicare Payment Advisory Commission. A Data Book: Healthcare Spending and the Medicare Program (June 2009). A 200-page compendium of very useful data on current spending and historical trends.
July 15, 2009
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of H.R. 3200, the America’s Affordable Health Choices Act of 2009, as introduced on July 14, 2009. This analysis does not reflect any modifications or amendments made after that date. [Full Text (pdf)]
July 15, 2009
Medicaid matching rate reform has long been recognized as needed on equity grounds. But there are considerable political barriers to changing the method states have come to depend on to allocate billions of dollars every year. This year, as Congress seriously considers major health care reform, the topic of changes in federal matching rates has emerged, almost of necessity, as Congress looks for ways to reconcile the objective of expanded health insurance coverage with the limited ability of the lower income states (where many of the uninsured reside) to pay more than they currently do for their Medicaid programs.
Federal Medicaid payments to the state have long been based on a formula that calculates a Federal Medical Assistance Percentage (FMAP) for each state based on its per capita income. The formula generally provides higher percentages for lower-income states, and lower percentage for high-income states subject to a lower limit of 50 percent which ensures the federal government pays at least half the cost of Medicaid in every state.
We suggest a new approach to setting federal Medicaid matching rates–one that is relatively easy to understand and has some desirable properties of interstate equity. The objective is to determine what would it take to provide for equal benefits for the poor and equal tax burdens for state taxpayers? We simply ask what matching rates would be needed to provide each state with the ability to achieve the U.S. average level of benefits per poor person while spending a uniform average percentage of state taxpayer income on the state share of Medicaid.