When Student Loans Linger

More than 1.5 million borrowers who first took out loans before 2000 still have debt. Borrowers with debt from the mid-1990s or earlier tend to have higher default rates, have lower credit scores, and live in lower-income neighborhoods than more recent student loan borrowers.  A report from the Urban Institute discusses policy solutions that could provide relief for borrowers and decrease the chances of recent borrowers holding loans for decades. 

The report can be obtained at https://www.urban.org/sites/default/files/publication/101492/when_student_loans_linger.pdf.

Helping States Strengthen Efforts To Address Affordability Of Health Care

Altarum’s Healthcare Value Hub released a scorecard today rating 42 states and the District of Columbia on their adoption of evidence-based policy actions to improve affordability of health care for residents.

The scorecard can be obtained at https://www.healthcarevaluehub.org/application/files/3815/7836/5366/Healthcare_Affordability_Scorecard_-_Summary_Report.pdf.

States Request Supreme Court To Review ACA Decision

Twenty states and the District of Columbia petitioned the Supreme Court on January 3, 2020 to review this term a recent federal appeals court decision that held the Affordable Care Act's individual mandate unconstitutional. 

The petition can be obtained at https://oag.ca.gov/system/files/attachments/press-docs/California%20v.%20Texas%20Petition%20for%20a%20Writ%20of%20Certiorari.pdf.

Low-Tech Solutions That Advance Value

Combining low-tech and high-tech solutions has the greatest potential to help hospitals and health systems reduce cost, improve outcomes, and enhance the patient experience, according to a new issue brief from the American Hospital Association. The report has examples of how hospitals and health systems are using low-tech solutions to achieve value, from reducing energy use to addressing the social determinants of health and implementing team-based care.

The issue brief can be obtained at https://www.aha.org/system/files/media/file/2019/12/value-initiative-issue-brief-8-low-tech-solutions-advance-value.pdf.

ACA’s Individual Mandate Struck Down

The Fifth Circuit Court of Appeals on December 18, 2019 struck down the Affordable Care Act’s individual mandate, affirming a lower court’s ruling in part. Unlike the lower court, the Fifth Circuit did not decide on the constitutionality of the rest of the health care law, leaving it to that same lower-court judge to determine whether there are parts of the ACA that might pass legal muster. A breakdown from the Commonwealth Fund describes what it means if the ACA disappears.

Additional information can be obtained at

https://www.commonwealthfund.org/blog/2019/fifth-circuit-appeals-court-strikes-down-affordable-care-acts-individual-mandate.

Business Leaders’ Views On The 2020 Policy Environment

The third annual review of top policy trends by PricewaterhouseCoopers (PwC) identifies seven policy areas in 2020 where uncertainty could shift due to the groundswell among citizens, regulators, and businesses. Influencers to watch are highlighted, along with shifts that businesses should be prepared to get ahead of regulatory scrutiny and enforcement proactively. Health care is included in the analysis.

More information can be obtained at https://www.pwc.com/us/en/library/risk-regulatory/strategic-policy/top-policy-trends.html.

Fiscal Year 2020 Spending Agreement Passes House, Sees Senate Action This Week

The House today passed two appropriations packages that would provide funding for Fiscal Year 2020, after agreement on the spending deal was reached by congressional and Administration leaders on Monday. The Senate is expected to pass the bills (the Labor-HHS-Ed bill is one of eight large bills that make up one minibus package, while four national security bills make up another minibus package) prior to the December 20 midnight deadline when the current Continuing Resolution ends. Overall, the bill includes $184.9 billion in discretionary funding, an increase of $4.9 billion over the 2019 enacted level and $43 billion over the President’s 2020 budget request.

The bill includes a total of $94.9 billion for HHS, an increase of $4.4 billion above the 2019 enacted level and $16.8 billion above the President’s budget request -- with the largest increase ($2.6 billion) directed to the National Institutes of Health. The bill provides $7.04 billion for HRSA, a $193 million increase over the FY 2019 level. HRSA Title VII health professions programs will receive $424.5 million, a $32.3 million increase over the FY 2019 level. The Behavioral Health Workforce Education & Training program receives $102 million, geriatric programs receive $40.7 million, and the Health Careers Opportunity Program will be funded at $15 million.

The Department of Education receives a total of $72.8 billion in discretionary appropriations – $1.3 billion above the 2019 enacted level and $8.7 billion above the President’s budget request. For Higher Education programs, the bill provides $2.5 billion, an increase of $163 million above the 2019 enacted level and $941 million above the President’s budget request. For federal student aid programs, the bill provides $24.5 billion, which is $75 million above the 2019 enacted level and $1.5 billion above the President’s budget request. Within this amount, the bill provides $865 million for the SEOG program, $1.2 billion for Federal Work Study, and an increase to the maximum Pell grant to $6,345.

The legislative package which includes the Labor-HHS-ED bill may be accessed here and a division by division summary may be found here. A table included HRSA Title VII programs be accessed here.

Improving Teen Well-Being

High-school-aged teens in the U.S. are not flourishing. A rapid evidence review, funded by Well Being Trust and conducted in partnership with  Adolescents and Children Together for Health, makes recommendations for intervention and research design as well as highlights opportunities to focus interventions more broadly on social determinants of health.

The report can be obtained at https://www.academyhealth.org/sites/default/files/rer_movingpolicyupstreamadolescentflourishingdec2019.pdf.

Register Now for the Spring 2020 IPEC Institute

The Interprofessional Education Collaborative (IPEC) is holding its 18th faculty development institute titled Building Effective IPE for Collaborative Practice on May 19-21, 2020 at the AAMC Learning Center in Washington, DC.

Faculty teams, healthcare partners, and single learners are invited to come together for dedicated time to emerge with a programmatic action plan for developing, expanding, and implementing interprofessional education curricula that will prepare students for collaborative practice.

Space is limited and will be granted on a first come, first served basis. Super early bird registration ends on Friday, January 3.

Visit www.ipecollaborative.org to register today.

Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns

The Centers for Medicare & Medicaid (CMS) make risk-adjusted payments by using beneficiaries’ diagnoses to pay higher capitated rates to Medicare Advantage Organizations (MAOs) for sicker beneficiaries with higher risk scores. It may create financial incentives for MAOs to make beneficiaries appear as sick as possible, however, to obtain higher payments. CMS estimates that from 2013 through 2016, Medicare paid $40 billion in overpayments that resulted from plan-submitted diagnoses that were not supported by beneficiaries’ medical records.

A report from the HHS Office of Inspector General can be obtained at https://oig.hhs.gov/oei/reports/oei-03-17-00470.pdf.

Health Profession Opportunity Grant Legislation Passes in the House

The House of Representatives passed H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act of 2019 today on a party line vote. H.R. 3398, the Pathways to Health Careers Act of 2019, was incorporated into the legislative package. It reauthorizes the Health Profession Opportunity Grant (HPOG) program at significantly increased funding levels and greatly expands opportunities for individuals to develop the education and skills required to enter a host of allied health professions and nursing, particularly for low income individuals. ASAHP worked with House Committee staff in support of the HPOG legislation. To date, there has not yet been a HPOG companion bill introduced in the Senate.

Senate Committee Advances Title VII Reauthorization

Today the Senate HELP Committee passed S. 2997, the Title VII Health Care Workforce Act of 2019, by voice vote, which reauthorizes Title VII HRSA health care workforce programs. The legislative package from Sen. Enzi (R-WY) and Sen. Reed (D-OR) includes S. 299, the Geriatrics Workforce Improvement Act, from Sen. Collins (R-ME) and Sen. Casey (D-PA), which authorizes the Geriatrics Workforce Enhancement Program (GWEP) and the Geriatric Academic Career Awards (GACA) program. The House passed their Title VII reauthorization bill in October.

The Senate HELP Committee press release may be accessed here.

FY20 Spending Bills Agreement Reached

The bicameral chairs and ranking members of the Appropriations Committee reached a deal in principle today of the FY 20 spending bills.

A couple of “minibuses” will be needed to pass all 12 appropriations bills, with House votes likely to begin on Tuesday. All 12 bills need to be enacted by Friday, December 20th at midnight to avoid the need for another Continuing Resolution.

Free College 101

Confusion surrounds the definition and implementation of free-college programs. A new report from the Georgetown University Center on Education and the Workforce discusses the basic terminology of free college, along with some common questions about education finance and student financial aid.

The report can be obtained at https://cew.georgetown.edu/wp-content/uploads/cew-free_college_101.pdf.

America’s Health Rankings

Although the U.S. has made significant progress at improving health over the past three decades, longstanding issues and emerging challenges threaten those gains, a new report from America’s Health Rankings finds. Produced by United Health Foundation, it highlights health trends over both the past three decades and past year.

The report can be obtained at https://assets.americashealthrankings.org/app/uploads/ahr_2019annualreport.pdf.

Compromise Measure To Fund MSI Extended

The Senate approved an amendment to the House-passed FUTURE Act that would permanently restore the annual appropriation of $255 million for minority serving institutions that expired September 30, as well as streamline both the Free Application for Federal Student Aid (FAFSA) and the process borrowers use to repay income-driven student loans. The amendment also provides for a small increase in the maximum Pell Grant award. 

A description of the compromise solution can be obtained at https://www.help.senate.gov/ranking/newsroom/press/senate-education-leaders-propose-bipartisan-solution-to-permanently-fund-historically-black-colleges-and-universities-and-minority-serving-institutions.

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 5

In week five (November 24-30, 2019) of the 2020 Open Enrollment, 504,041 individuals selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year. 

Additional information can be obtained at https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-weekly-enrollment-snapshot-week-5.

Health Profession Opportunity Grant Legislation Advancing in the House

The Pathways to Health Careers Act of 2019 has been fully incroprated into a large legislative package, H.R. 3. The Pathways to Health Careers Act of 2019 passed the House Ways and Means Committee earlier this year and reauthorizes the Health Profession Opportunity Grant (HPOG) program at significantly increased funding levels and greatly expands opportunities for individuals to develop the education and skills required to enter a host of allied health professions and nursing, particularly for low income individuals. ASAHP worked with House Committee staff in support of the HPOG legislation. The Committee on Rules will likely consider the bill early next week, and the legislative package may be voted on the House Floor as early as Wednesday, December 11.

An HPOG Fact Sheet may be accessed here.

Values And Experiences That Could Shape Health Reform

Commonwealth Fund researchers discuss the findings of a survey that explored how Americans’ values align with their health care experiences and views on health reform. 

Findings can be obtained at http://features.commonwealthfund.org/health-care-in-america-values-experiences.

Future Of Preexisting Conditions Protection

If a pending court decision finds the Affordable Care Act (ACA) and its guarantee of coverage for preexisting conditions to be unconstitutional, or if the law’s opponents successfully repeal it, coverage of 54 million Americans with health problems would be at risk. An Op-Ed in The Hill discusses this matter. 

The Op-Ed can be obtained at https://thehill.com/opinion/healthcare/472963-american-health-care-has-a-new-third-rail.