Health Affairs

Nondiscrimination And Chronic Conditions — The Final Section 1557 Regulation

Before the Affordable Care Act (ACA), those with serious or chronic health conditions were often denied health insurance coverage or paid high prices for substandard plans with coverage exclusions . Many went uninsured and untreated. For them, the ACA...

Published Wed, Jul 20 2016 8:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Public Health, Following the ACA, Insurance and Coverage, Equity and Disparities, Americans With Disabilities Act, ACA, HIV/AIDS, chronic conditions, Section 1557 waiver, LGBT issues, HHS OCR

FDA Sanctions Off-Label Drug Promotion

Physicians have the authority to prescribe drugs for any reason they believe will benefit the patient, regardless of whether the use is on- or off-label. Off-label prescription is neither illegal nor unethical when based on the best available evidence...

Published Tue, Jul 19 2016 8:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Public Health, Quality, Drugs and Medical Technology, Health Professionals, Supreme Court, FDA, Big Pharma, First Amendment, Amarin, false claims act, off-label drugs

Losing The ‘All’ in All-Payer Claims Databases

The legal and policy questions following the US Supreme Court ’s ruling in Gobeille v. Liberty Mutual Insurance Co , 577 U.S. ____ (2016) have been widely discussed, including in Health Affairs Blog posts by Sage , Brown and King , and Newman . The Court...

Published Mon, Jul 18 2016 8:45 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Featured, Costs and Spending, Health Professionals, Maine, Supreme Court, APCDs, Gobeille v. Liberty Mutual Insurance Co., ERISA

How Policymakers Can Foster Organizational Innovation In Health Care

Editor’s note: This post is part of a series based on the 5th Forum: Learning from each other – Scaling ideas up to the next level . The forum was held in Berlin, Germany on June 9 and 10, 2016 and organized by the Center for Healthcare Management . For...

Published Fri, Jul 15 2016 8:30 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Featured, Organization and Delivery, Costs and Spending, risk adjustment program, Center for Healthcare Management 5th Forum, Medicare DRG program

Insurers Can Reduce Drug Prices, If Policymakers Let Them

Whilst decrying rapid increases in drug spending and prices, elected officials have actually made it increasingly difficult for insurers to do anything about it. As payers, insurers are the only parties in the health care system who have both the means...

Published Thu, Jul 14 2016 11:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Medicare, Featured, Costs and Spending, Drugs and Medical Technology, Gilead, Prescription Drugs, Big Pharma, Eric Schneiderman, reimbursement policy

Kentucky Medicaid Program At A Crossroads

On June 22, 2016, Kentucky Governor Matt Bevin (R) announced the release of Kentucky HEALTH ( Helping to Engage and Achieve Long Term Health ), a Medicaid section 1115 demonstration project proposal. Kentucky has experienced tremendous change over the...

Published Thu, Jul 14 2016 6:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Health Reform, States, Coverage, Access, Quality, Medicaid, Health Philanthropy, GrantWatch, Health Care Delivery, Featured, Insurance and Coverage, Medicaid and CHIP, Substance Use Prevention, Matt Bevin, Kentucky, section 1115 waiver proposal

Health Expenditure Projections: When Does ‘New’ Become ‘Normal’?

The Centers for Medicare and Medicaid Services (CMS) has released its latest forecast of medical spending for the next decade. The headline number is that medical care as a share of gross domestic product (GDP) is expected to increase from its current...

Published Wed, Jul 13 2016 1:30 PM by Health Affairs BlogHealth Affairs Blog

Filed under: Medicare, Featured, Payment Policy, Insurance and Coverage, Costs and Spending, Medicaid and CHIP, ACA, ACOs, spending projections, MACRA, Alternative Payment Models

Health Affairs Web First: Moderate Health Spending Growth Projections, 2015–25

New estimates released on July 13 from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project an average rate of national health spending growth of 5.8 percent for 2015–25, exceeding the expected average growth in gross...

Published Wed, Jul 13 2016 1:10 PM by Health Affairs BlogHealth Affairs Blog

Filed under: Medicare, Featured, Payment Policy, Costs and Spending, CMS, CMS Office of the Actuary, spending projections

Dynamic Debate: Health Affairs Forum Begins Value-Based Payment Discussion

“Continuous improvement is better than delayed perfection.” You can bet that Mark Twain wasn’t thinking about reforming health care payment systems when he spoke these words more than a century ago, but that doesn’t mean they aren’t relevant to the issue...

Published Wed, Jul 13 2016 8:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Medicare, Quality, Hospitals, Featured, Payment Policy, Insurance and Coverage, Costs and Spending, Health Affairs Event, quality measurements, value-based payment, Hospital Readmission Reductions Program, Hospital-Acquired Condition Reduction Program

Labor, IRS Propose New Health Plan Reporting Requirements; CMS Makes Its Case On Cost Sharing

Most of the regulations and guidance analyzed in the “Following the ACA” Health Affairs Blog series are issued by the Centers for Medicare and Medicaid Services of the Department of Health and Human Services. HHS shares jurisdiction over the implementation...

Published Tue, Jul 12 2016 2:43 PM by Health Affairs BlogHealth Affairs Blog

Filed under: Following the ACA, Insurance and Coverage

The 2016 Medicare Trustees Report: Is Medicare Doomed?

The June 22 release of the annual Medicare Trustees Report has, as usual, elicited conflicting responses. Some have focused on the positive—Medicare spending per enrollee has continued to grow at a historically slow rate—while others have...

Published Tue, Jul 12 2016 11:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Public Health, Medicare, Aging, Long-Term Care, Payment Policy, Costs and Spending, Long-term Services and Supports, Medicare Advantage, MACRA

CMS Provides New Clarity For Family Planning Under Medicaid

Family planning services and supplies have been a part of the Medicaid program since it was first established half a century ago. And over the past several decades, Medicaid has become the dominant public funding source for family planning in the United...

Published Tue, Jul 12 2016 8:00 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Public Health, States, Quality, Featured, Costs and Spending, Medicaid and CHIP, Equity and Disparities, Women's Health, CMS, contraceptive coverage, family planning, long-acting reversible contraceptives

IRS Taxpayer Watchdog On Agency’s Implementation Of ACA: ‘Commendable,’ But Work Remains

Implementing Health Reform. The National Taxpayer Advocate Service (TAS) has recently released volume 1 of its Objectives Report to Congress for fiscal year 2017 . The TAS reports that, overall, “The IRS has done a commendable job of implementing the...

Published Mon, Jul 11 2016 1:31 PM by Health Affairs BlogHealth Affairs Blog

Filed under: Following the ACA, Costs and Spending, APTC, IRS, premium tax credits, National Taxpayer Advocate Service

Congress Shouldn’t Pass The 21st Century Cures Act In A Summer Rush

The full Senate may in the next few days consider companion legislation to the 21st Century Cures Act that passed the House last year. The legislation—currently 19 separate bills—makes substantial changes to the way the Food and Drug Administration...

Published Mon, Jul 11 2016 11:30 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Public Health, Quality, Featured, Drugs and Medical Technology, regulation, NIH, FDA, Congress, 21st Century Cures Act

A Fair Plan For Fairer Drug Prices

As the biological basis of more diseases are fully revealed, and the drugs targeting medical problems become more focused and effective, more patients are finding themselves on costlier specialty medicines . At the same time, consumers find themselves...

Published Mon, Jul 11 2016 8:30 AM by Health Affairs BlogHealth Affairs Blog

Filed under: Medicare, Quality, Featured, Payment Policy, Insurance and Coverage, Costs and Spending, Drugs and Medical Technology, FDA, 340B Drug Discount program, 340B program, drug pricing, value-based payment, prescription drug spending

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