ACA
kkrisberg | March 14, 2014It’s not the first study to examine the enormous health and economic benefits of vaccines. But it’s certainly another impressive reminder about the power — and value — of prevention.
In a study published online earlier this month in the journal Pediatrics, researchers found that childhood immunizations among babies born in 2009 will prevent 42,000 early deaths and 20 million cases of disease, saving the nation $13.5 billion in directs costs (medical costs and disease outbreak control) and more than $68 billion in total societal costs (premature death and lost productivity). That means that…
kkrisberg | February 7, 2014Higher insurance rates don’t mean people stop seeking care at publically funded health centers, found a recent study of family planning clinics in Massachusetts. The findings speak to serious concerns within public health circles that policy-makers may point to higher insurance rates as a justification to cut critical public health funding.
Published in the Jan. 24 issue of Morbidity and Mortality Weekly Report, the study examines trends among uninsured patients seeking care at Massachusetts health centers that receive Title X Family Planning Program funds. (The federal Title X program…
lborkowski | January 21, 2014Both houses of Congress have now passed, and President Obama has signed, the omnibus spending bill, and it’s a welcome relief from budget battles through the end of this fiscal year (September 30, 2014). I was especially curious to see what the bill contained for the Prevention and Public Health Fund, an important part of the Affordable Care Act that has suffered under previous budget manuevering.
Section 4002 of the Affordable Care Act established the Prevention and Public Health Fund "to provide for expanded and sustained national investment in prevention and public health programs to…
kkrisberg | January 8, 2014With so much pressure on the Affordable Care Act to immediately live up to high expectations, and with opponents who seem gleeful at the news that Americans are having a hard time signing up for affordable health care, it’s reassuring to read that the health reform law can readily take a few blows and keep moving forward.
In a December analysis released by the Urban Institute, authors Linda Blumberg and John Holahan write that the “Affordable Care Act is unlikely to suffer long-term damage even if the marketplaces experience low enrollment and some adverse selection in the first year.” (…
lborkowski | January 6, 2014Now that it’s 2014, millions more people in the US have health insurance coverage (either Medicaid or private insurance), thanks to the Affordable Care Act. In the weeks ahead, many of the newly insured will be visiting healthcare providers to address ongoing health concerns. The Washington Post’s Sandhya Somashekhar and Karen Tumulty highlighted one person with a pent-up demand for healthcare, Sharon Kelly of Louisville, Kentucky:
Kelly said that having Medicaid coverage on Jan. 1 “is a huge relief,” adding, “I’m a redhead and I used to live in California. I have things on my skin that are…
lborkowski | December 10, 2013A coalition of public-health organizations, including the Robert Wood Johnson Foundation (RWJF) and Campaign for Tobacco-Free Kids, has released a report criticizing most U.S. states for under-investing in smoking prevention and cessation. Broken Promises to Our Children: The 1998 State Tobacco Settlement 15 Years Later calculates that states over the past 15 years, states have collected a total of $391 billion from tobacco settlements and tobacco taxes, but spent only 2.3% of that amount on tobacco prevention programs.
The report compares states’ tobacco-prevention expenditures to the levels…
lborkowski | November 27, 2013Wonkblog's Sarah Kliff has helpfully compiled "A guide to surviving Obamacare debates at Thanksgiving," and it starts off with a good one: "Your mom wants to know whether Obamacare is a total disaster." Kliff's response focuses on the disastrous rollout of Healthcare.gov, the online marketplace that was supposed to allow for easy health-insurance enrollment for people who need to get coverage. With the website improving but by no means problem-free, the enrollment numbers so far are dismally low. Kliff points out that some states that built their own online marketplaces have successfully…
lborkowski | November 19, 2013I've written before about the importance of the Affordable Care Act's Medicaid expansion and about the role of community health centers in delivering primary care to underserved patients. With roughly half of the states declining the now-optional Medicaid expansion and an uncertain federal funding environment, though, the extent to which health centers will be able to serve the newly insured is up in the air. A new report from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative puts some numbers on the variability. Under different Medicaid expansion and funding scenarios…
lborkowski | October 1, 2013Today is an exciting day in US healthcare history: For the first time, uninsured US residents can go online to shop for individual health insurance policies and feel confident of a few things: they can easily see information to make meaningful comparisons between plan options; they won’t be rejected or charged an astronomical rate based on their health history; and once they have a policy, they won’t be unpleasantly surprised by an omission of an essential benefit like hospital or maternity care.
In addition, insurance shoppers with incomes between 100% and 400% of the federal poverty level…
lborkowski | September 27, 2013A few of the recent pieces I've liked:
Brian Beutler in Salon: The $200K lesson I learned from getting shot
Sarah Kliff, Sandhya Somashekhar, Lena H. Sun and Karen Tumulty in the Washington Post: How eight lives would be affected by the health law
Sendhil Mullainathan in the New York Times: The Mental Strain of Making Do With Less
Patricia Sagastume at Al Jazeera America: Dengue fever presence in Florida at a 'pretty serious level'
Alan Durning at DC Streetsblog: Apartment Blockers (about how the costs of underground parking contribute to high rents)
lborkowski | August 12, 2013The Washington Post’s Lena H. Sun writes about Obamacare implementation, and finds that it differs greatly between Maryland and Virginia, which share a border but have very different attitudes toward the Affordable Care Act. Both have large uninsured populations (around 800,000 in Maryland and 844,000 in Virginia), but Virginia’s opposition to the law means it’s getting far less federal money and leaving its poorest residents with fewer options for affordable insurance coverage.
The lawmakers who wrote the ACA included two main ways to help those without employer-sponsored health insurance…
kkrisberg | July 26, 2013With immigration at the forefront of national debate, Jim Stimpson decided it was time to do a little more digging.
"There's a lot of rhetoric around immigrants' use of public services in general and health care specifically, and I thought with impending federal immigration reform it would be useful to have some sort of contribution about the facts of unauthorized immigrants' use of health services in the United States," said Stimpson, a professor within the University of Nebraska's School of Public Health and director of the university's Center for Health Policy.
So together with colleagues…
lborkowski | May 21, 2013At the Washington Post's Wonkblog, Ezra Klein has put up two posts about healthcare costs that are well worth reading. The first is about Oregon's Medicaid program, which has been the basis for some exciting recent research on how Medicaid coverage affects recipients' lives and is now trying to reduce the growth in healthcare costs by improving community health. The second is an interview with Bill Gates, whose Gates Foundation is trying to reduce global deaths of children under age five. Both pieces address one of today's key healthcare questions: How can we best use finite resources to…
lborkowski | February 15, 2013One of the less-noticed provisions of the Affordable Care Act is a requirement that pharmaceutical companies report to the Department of Health and Human Services the gifts and other payments they give to doctors and teaching hospitals -- and that HHS in turn make that information available to the public. (It's sometimes referred to as the "Physician Payment Sunshine Act," after legislation previously introduced in Congress by Senator Chuck Grassley.) Earlier this month, HHS released its final regulations to implement this provision. Beginning August 1, 2013, drug and device companies will…
lborkowski | January 30, 2013In Wonkblog yesterday, Sarah Kliff highlighted an important aspect of immigration reform: Undocumented immigrants who gain legal status will also gain access to the Affordable Care Act’s options for getting health insurance. The Congressional Budget Office estimated that the ACA would reduce our nonelderly uninsured by 32 million, but 23 million people would remain without health insurance – and one-third of those people would be undocumented immigrants.
The ACA has two main mechanisms for offering affordable coverage to the uninsured: 1) expansion of Medicaid eligibility to all legal…
lborkowski | December 28, 2012In looking back at the year 2012, one of the most momentous occasions was the Supreme Court decision on the Affordable Care Act. Here are a few of our posts on the topic:
Broccoli, Coercion, and Severability: Three days of SCOTUS arguments on the Affordable Care Act: Liz summarized the legal issues the Court was considering: the constitutionality of the law's individual mandate, whether the federal government could force states to expand their Medicaid programs as a condition of continuing to participate in Medicaid, and whether the law as a whole could stand if a single provision were to be…
lborkowski | October 19, 2012by Kim Krisberg
At Palm Beach Groves in Lantana, Fla., a small, seasonal business that ships fresh citrus nationwide, employees have regularly voted between getting a raise or keeping their employer-based health insurance. Health coverage always wins, as many employees' ages and pre-existing conditions would have made it nearly impossible to get coverage on their own.
In her 12 years with Palm Beach Groves, general manager Louisa McQueeney has seen insurance premiums go up anywhere from 12 percent to 32 percent a year. Coverage for her family alone — herself, her husband and daughter — was $1…
lborkowski | October 4, 2012Monday was the start date for an Affordable Care Act provision aimed at reducing high rates of hospital readmission among Medicare patients. This year, hospitals determined to have excess readmissions for patients with acute myocardial infarctions, heart failure, and pneumonia can lose up to one percent of their Medicare reimbursements for the year -- and in future years, the list of applicable conditions will get longer and the percentage of payments at risk will rise to three percent. But to what extent are readmissions under hospitals' control?
First, a bit of background: Readmissions are…
lborkowski | August 24, 2012The extent to which the Affordable Care Act succeeds in making affordable health insurance more widely available depends to a great degree on the success of the state-based health insurance exchanges that are currently being developed. A piece by Ewout van Ginneken and Katherine Schwartz in the latest New England Journal of Medicine offers some advice and cautions about the exchanges, based on the experiences of the Netherlands and Switzerland. Both those countries rely extensively on private insurers plus substantial government involvement.
Risk adjustment is one key to exchanges' success.…
lborkowski | August 9, 2012Millions of people will gain insurance under the Affordable Care Act, but will they be able to get appointments with healthcare providers? Coverage doesn't automatically translate into access, and some newly insured individuals will struggle to find physician practices that will take them on as patients. In particular, states that adopt the (now optional) Affordable Care Act Medicaid expansion, which extends eligibility to adults up to 133% of the poverty level, may encounter a severe shortage of providers willing to accept new Medicaid patients. Although Medicaid reimbursement levels vary…