John Colbert

April 22, 2019

HEALTH REFORM DEVELOPMENTS

John Colbert

April 22, 2019

The Affordable Care Act that became law in 2010 was aimed at expanding the number of individuals with health insurance coverage, reducing health care costs, and increasing the quality of care provided. Although much progress has been made since that year, certain difficulties continue to be unresolved, with a main one being a portion of the U.S. population still lacking adequate coverage.

During the 2016 Presidential campaign, Senator Bernard Sanders (I-VT) ignited great enthusiasm among his followers for his pledge to see to it that a Medicare For All bill would be enacted if he were elected. That notion is as relevant today as it was back then as evidenced by several prominent Democrats who have entered the race for the next presidential election and gone on record in support of his approach.

He introduced an updated version of his proposed legislation (S. 1129) on April 10, 2019. It would replace nearly all forms of private health insurance with a government-managed, single payer version of Medicare that guarantees coverage to all Americans. The universal health care program would include coverage of primary care, hospital stays, mental health treatment, and prescription drugs. This latest iteration also includes coverage for dental, vision, hearing, and home and community-based long- term care services, which resembles the House version of H.R. 1384 that was introduced by Rep. Pramila Jayapal (D-WA) on February 27. Under provisions of the Sanders bill, states would be allowed to provide additional benefits from their own budgets, and the Indian Health Service (IHS) and Veterans Health Administration (VHA) would remain in place. The legislation does not specify how it will be financed.

Provision Of Non-Medical Services For Social Needs That Affect Health

The Trump Administration at the beginning of April 2019 released guidance indicating that beginning in 2020, Medicare Advantage plans, private health plans that contract with Medicare, will be allowed, but not required, to offer chronically ill enrollees non-medical services for social needs that affect health. Plans will be able to select which non-medical services they offer, as long as there is a “reasonable expectation that the services will help people with chronic conditions improve or maintain their health or overall function.” Examples of services include: home-delivered meals, transportation for non-medical needs, pest control, indoor air quality equipment (e.g., an air conditioner for a patient with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs). The new coverage flexibility was made possible by the Creating High Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S. 870), which was a component of the Bipartisan Budget Act of 2018 (P.L. 115-123) that the President signed into law in February 2018.

House Reaction To A Lawsuit To Invalidate The Affordable Care Act

In February 2018, attorneys general in 20 states filed a lawsuit claiming that the 2017 Tax Cut law and the Jobs Act’s reduction of the individual responsibility tax penalty to zero, in effect made the Affordable Care Act’s individual mandate unconstitutional. The following December, a federal court judge in Texas entered a judgment that if the suit is upheld, the entire ACA would become invalidated. Democratic attorneys general in 17 states subsequently intervened to defend the entirety of the health reform law. The U.S. House of Representatives in April 2019 joined the fray by passing a measure (H.Res. 271) by a vote of 240-186, condemning the Trump Administration’s support for the lawsuit that would invalidate the ACA. Eight Republicans joined their Democratic colleagues in supporting the resolution, essentially agreeing that a replacement plan must be installed before the law is repealed.

Despite being rebuffed in their efforts in 2017 when Republicans controlled both chambers in Congress, a desire by that party to repeal and replace the ACA has not vanished totally. Its members recognize that a comprehensive replacement plan will have to be designed prior to attempting to launch any repeal effort in the future.

return to april 2019 trends

100th DAY OF THE 116TH CONGRESS

John Colbert

April 22, 2019

Trends Archives

Tuesday, March 16 marked the 100th day of the 116th Congress, a period of considerable activity. Both the House Energy and Commerce Committee and the Ways and Means Committee have marked up bills involving the Affordable Care Act and drug pricing. On the Senate side of Capitol Hill, the Health, Education, Labor, and Pensions Committee has sought information from a wide range of sources regarding how to reduce health care costs for taxpayers, employers, and families after concluding a series of five Senate health committee hearings exploring the same topic.

Congress already has enjoyed a measure of success by having some health care bills signed by President Trump, including: the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839) and the Medicaid Extenders Act of 2019 (H.R. 259). Progress is being made to enable other pieces of health legislation to advance, such as the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (H.R. 269) and the Poison Center Network Enhancement Act of 2019 (H.R. 501). Other items requiring attention this session involve legislation to renew expiring programs that involve Community Health Centers and Teaching Health Centers.

A hearty perennial that keeps Congress active is completing work on 12 appropriations bills. House Democrats were forced to cancel a vote on top-line budget numbers because of intra-party disagreement. Some party members supporting H.R. 2021 want to increase defense spending in 2020 by $17 billion for a total of $664 billion and non-defense spending by $34 billion for a total of $631 billion. Other Democrats insist that non-defense spending be raised to the same level as defense spending.

In the health arena, there is little support for the Trump Administration’s FY 2020 budget request involving medical research. Many Republican legislators are inclined to reduce government spending whenever possible, but Subcommittee Chairman Roy Blunt (R-MO) of the Senate Subcommittee for Labor-HHS Appropriations indicated that re-prioritizing funding for the National Institutes of Health (NIH) after a decade of stagnation has been his number one priority. The Administration’s budget request to reduce NIH support by $4.9 billion (a 13% cut) is not a choice he intends to make when the Labor-HHS spending bill is written.

The release of the Mueller Report on April 18 regarding whether President Trump was involved in collusion with Russia or obstruction of justice involving the U.S. presidential election in 2016 has not resulted in producing total calm in political waters that have been roiled for the past two years. A traditional role of Congress is to conduct hearings to examine the performance of federal agencies and to investigate suspected wrongdoings. As of April 2019, it is clear that Democrats in the House of Representatives will use that power to hold hearings on important matters they believe remain insufficiently addressed by the Mueller Report.

Meanwhile, the 2020 election cycle appears to be in full swing even though votes will not be cast for another 19 months. The Democrats lack no shortage of candidates who deem themselves worthy of residing in the big house at 1600 Pennsylvania Avenue, N.W. come January 2021.

return to april 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

April 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 12th of many profiles and the fourth in 2019 is presented as follows:

Name and Title: Yasmen “Yas” Simonian, PhD, MLS(ASCP)CM, FASAHP Dean and Brady Presidential Distinguished Professor

Place of birth: Tehran, Iran

University: Weber State University

How long have you been in your position? Eleven years

What’s the value of a university education? Opens a world of opportunities. The sky is the limit.

What is the value of ASAHP? Networking, CE, opportunities to present, share ideas, and more.

Your philosophy on education in seven words: Learn lots and then make a decision.

If I could teach in another field, which one and why? History of Medicine, I like the subject.

Before I retire I want to: Leave a legacy that will make a difference for many years to come.

In college, I was known for: Helping others and partying.

What music is playing in my car/office? In the car Greek dancing music and in the office mellow classical.

The last book I read for fun was: Becoming Michelle Obama

My favorite trip was: Greece any day

If I could travel anywhere it would be: Spain, Italy, Greece, Armenia, Serbia, Romania, Middle East

Four people I’d take to coffee or have a glass of wine with: Farogh, Hassan, Helen, mom

The best advice I ever received was: Listen before you talk.

My hobby is: Dancing, cooking, traveling, music.

My passion is: Being with my family and friends.

My pet peeve is: People not putting things back from where they got it from.

A perfect day is: A sunny day on a beach under an umbrella

Cats or dogs? Dog

E-book or hardback? Both

Beach or mountains? Both

I wish I could: Cure cancer

Only my friends know I: Ask me later.

My favorite saying is: You can do it.

return to april 2019 trends

VARIETIES OF PLAGUES BOTH OLD AND NEW

John Colbert

April 22, 2019

Trends Archives

The word plague is versatile, whether used as a noun to describe the assault of a communicable disease on a population or as a verb to convey chronic emotional distress. The first category may best be exemplified by the endemic Black Plague that devasted human life in late Medieval and Renaissance Europe. One historical account in the journal Bulletin of the History of Medicine led to an estimate that the mortality rate from the Black Death and its collateral effects devastated 60% of the entire European population (50 million of its estimated 80 million inhabitants).

Often referred to as the White Plague, during the first half of the 20th century in the U.S., large county tuberculosis (TB) hospitals across the nation housed patients requiring specialized care. A most deadly disease, a provisional total of only 9,029 TB cases were reported in the U.S. in 2018, (an incidence of 2.8 cases per 100,000 persons). The rate among patients born outside this country, however, was more than 14 times higher than that of individuals born here. Risk factors include HIV infection status, a history of homelessness, and residence in a congregate setting.

Until the mid-1950s, polio outbreaks triggered fears of becoming a patient confined for the rest of one’s life in an iron lung. When the Global Polio Eradication Initiative (GPEI) began in 1988, cases of poliomyelitis were reported from 125 countries. Since then, only Afghanistan, Nigeria, and Pakistan have experienced uninterrupted transmission of wild poliovirus (WPV).

Although declared eliminated in the U.S. in 2000, total cases of measles nationwide as of April 11, 2019 already have surpassed those of 2018 and likely soon will eclipse totals for 2017 and 2018 combined, according to the CDC. During the 1940s and early 1950s, the editor of this newsletter in his youth was afflicted with mumps, measles, whooping cough, German measles, chickenpox, and scarlet fever. None of those conditions was considered rare back then, which happily is quite the opposite of the present day, reflecting the current widespread availability of vaccines, effective drugs, and improved standards of living.

Meanwhile, the relative disappearance of some diseases has been replaced by the emergence of other conditions primarily associated with a sense of being plagued by doubts and uncertainties about the purported advantages of modern day life. For example, despite evidence of the positive role that vaccines play in preventing disease, some parents refuse to have their children immunized because of a fear that it causes autism. According to a recent national Pew Research Center study, when Americans peer 30 years into the future, they see a country in decline economically, politically, and on the world stage. Such grim predictions reflect a sour public mood while more extreme forms of hopelessness contribute to suicide continuing to remain among the top 10 causes of mortality in the U.S. since 2008.

Nevertheless, poking through a cloud of despair is a hearty ray of sunshine in the form of knowledge that the health professions remain a sound career choice. An aging population characterized by chronic ailments will require health care services that are not easily transportable to other countries or replaceable by robots.

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GLOBAL SYNDEMIC OF OBESITY, UNDERNUTRITION, AND CLIMATE CHANGE

John Colbert

March 26, 2019

Trends Archives

A syndemic is a portmanteau term, constituting a style of writing often employed by James Joyce in Finnegans Wake and Lewis Carroll in Through The Looking-Glass, to denote a fusion between the words synergy and epidemic. The 23 February-1 March 2019 issue of the British journal The Lancet furnished readers with an opportunity to obtain an enhanced understanding of how obesity, undernutrition, and climate change affect most inhabitants of every nation and region worldwide. A proposition is advanced that the entities do so by co-occurring in time and place; interacting with each other to produce complex sequelae; sharing common underlying societal drivers; and representing three of the gravest threats to human health and survival. One form of purported multifold damage linking the problematic threesome is agriculture's drive towards higher value products, such as processed and animal-source foods that consume great amounts of energy, generate methane and other waste products, and are marketed and consumed heavily in unhealthy quantities.

For example, conceptualizing obesity as a global syndemic might have some utility. Obesity illustrates a pivotal syndemic problem that would appear to require international-level policy interventions to curb the power and influence of multinational corporations, representing Big Sugar and Big Food, which are seen as targeting low-income populations. Viewed within this particular context, advocating in favor of a global syndemic might serve as a constructive political tool to propel positive alliances to take action against multinational corporations. A related perspective is that tearing down silos in the academy and health policy; strengthening government action and community voices; dismantling corporate power to better designate who eats what and where; and promoting improved, more sustainable business models for a healthier future should be syndemic in nature.

return to march 2019 trends

IMPACT OF MARIJUANA LAWS ON HEALTH AND LABOR SUPPLY

John Colbert

March 26, 2019

Trends Archives

As the proportion of the older segment of the population continues to increase both numerically and proportionately, a useful exercise might be to examine how various laws affect them. For example, given the increased popularity of state legislation to legalize the use of marijuana for medical purposes (now legal in 33 states and the District of Columbia) and also for recreational purposes (currently legal in 10 states and DC), use of that substance can be assessed from the standpoint of health and the labor supply for older individuals. A step in that direction is represented by the results of a study reported in the Journal of Policy Analysis and Management on February 6, 2019. Investigators quantified the effects of state medical marijuana laws (MML) on the health and labor supply of adults age 51 and older, focusing on the 55% with one or more medical conditions with symptoms that may respond to medical marijuana.

Three principle findings emerged from the analysis. First, active state MMLs lead to lower pain and better self‐assessed health among older adults, including a 3.4% increase in the probability of reporting very good or excellent health. Second, state MMLs lead to increases in older adult labor supply, with effects concentrated on the intensive margin, with post-MML full-time employment increasing by 5%. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. These findings highlight the role of health policy in supporting work among older adults and the importance of including them in assessments of state medical marijuana laws. Age patterns of disease suggest that the health benefits of MML passage could be concentrated among older adults. The authors contend that if the implementation of an MML, by promoting access to marijuana for medical use, reduces symptoms associated with work‐impeding health conditions, then MMLs could enhance labor supply among the fastest growing segment of the population. This policy effect could facilitate greater retirement savings and also potentially delay the initiation of Social Security benefit claims

return to march 2019 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

March 25, 2019

Trends Archives

Emerging Technologies To Support An Aging Population

Emerging technologies that have significant promise to improve quality of life for all Americans, particularly those with physical or cognitive burdens due to aging or disability, are identified in a new report from the White House Task Force on Research and Development for Technology to Support Aging Adults. The report, Emerging Technologies to Support an Aging Population, highlights innovations with the potential to improve quality of life, enhance individual choice, reduce caregiver stress, reduce healthcare costs. Research and development needs also are identified. The report outlines six areas in which technology has the potential to improve the lives of aging adults: key activities of independent living; cognition; communication and social connectivity; personal mobility; transportation; and access to healthcare. The report can be obtained here.

School Success: An Opportunity For Population Health

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement hosted a workshop in Oakland, California, at the California Endowment’s Oakland Conference Center on June 14, 2018. The workshop featured presentations that described the relationship between the health and education sectors and shared examples of public health interventions and activities in schools that support school success and are potential opportunities for population health action. The day began with two keynote presentations reflecting on how educational attainment influences health outcomes and how health status affects educational performance. Keynote speakers were followed by Ted Talk style presentations describing school-based public health interventions and the workshop concluded by addressing policies, issues, and opportunities pertaining to shared measurement, legal issues, payment mechanisms, and equity. Steven Woolf from the Center on Society and Health at Virginia Commonwealth University articulated why educational success matters for health. He stated that although the health and education systems work toward similar ends, they have functioned as silos for many years without much communication. Woolf presented an overview of what shapes health through five domains: (1) health systems, (2) individual behaviors, (3) the physical and social environment, (4) public policies and spending, and (5) socioeconomic factors. The public policy and spending domain is of specific importance given that it drives the other domains. Proceedings of the workshop can be obtained here.

CARE Act Implementation: Progress And Promise

The AARP Public Policy Institute published a Spotlight report, The CARE Act Implementation: Progress and Promise. The Caregiver Advise, Record, Enable (CARE) Act became law in 40 states and territories in just four years, while additional states have initiated the legislative process. The swift uptake indicates policy maker recognition of the support family caregivers need to perform the medical/nursing tasks they face at home after a family member or friend is discharged from the hospital. The landmark 2012 AARP and United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care, funded by The John A. Hartford Foundation, drove the rapid policy adoption of the CARE Act. The report also inspired the creation of the Home Alone AllianceSM, a partnership of public, private, and nonprofit organizations coming together to change the way health care organizations and professionals interface with family caregivers. This Spotlight provides an update on CARE Act implementation, bringing in views from the field. The report can be obtained here.

return to march 2019 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

March 25, 2019

Trends Archives

Selected Estimates Based On National Health Interview Survey, January To September 2018

Some results for the period January to September 2018 are: (1) the percentage of persons who had a usual place to go for medical care was 87.7%, which was lower than, but not significantly different from, the 2017 estimate of 88.3%; (2) the percentage of the population that failed to obtain needed medical care due to cost at some time during the past 12 months was 4.7%, which was not significantly different from the 2017 estimate of 4.5%; (3) the prevalence of obesity among U.S. adults aged 20 and over was 31.7%, which was not significantly different from the 2017 estimate of 31.3%; (4) the percentage of persons who had excellent or very good health was 66.3%, which was not significantly different from the 2017 estimate of 66.4%; and (5) the percentage of adults aged 65 and over who needed help with personal care from other persons was 7.0%, which was not significantly different from the 2017 estimate of 6.7%.

Electronic Health Behaviors Among U.S. Adults With Chronic Disease

As reported on March 3, 2019 in the Journal of Medical Internet Research, a study explored (1) the differences in technology use; (2) Web-based health information seeking and use behaviors; (3) attitudes toward seeking health information on the Web; and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. About one in three (37.2%) participants reported at least one chronic disease diagnosis. Seventy-five percent of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0% vs 25.8% and 43.3% vs 27.9%). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% vs 35.0%), changing the way they cope with a chronic condition or manage pain.

HEALTH TECHNOLOGY CORNER

Use Of Toilet Seats To Detect Chronic Heart Failure

A paper published on January 18, 2019 in JMIR mHealth and uHealth indicates that a toilet seat–based cardiovascular monitoring system with an integrated electrocardiogram, ballistocardiogram, and photoplethysmogram developed by a Rochester Institute of Technology team is capable of clinical-grade measurements of systolic and diastolic blood pressure, stroke volume, and peripheral blood oxygenation. Toilet seat–based estimates of blood pressure and peripheral blood oxygenation were compared to a hospital-grade vital signs monitor. This system could be positioned uniquely to capture trend data in the home that previously has been unattainable. Demonstration of the clinical benefit of the technology requires additional algorithm development and future clinical trials. With one million new cases of congestive heart failure diagnosed each year, if the FDA eventually approves the product, it could make it easier for hospitals to monitor patients with this condition in the comfort of their own homes.

Medical And Health Data Wearable

OneLife Technologies Corp., a mobile medical software/data collection company, offers the first AT&T LTE-M certified medical wearable. The OnePulse smartwatch goes beyond tracking steps by providing activity trackers, reminders, and alert technologies. Powered by AT&T wireless connectivity, the advanced wearable securely and independently transmits certain critical medical and health data to the cloud, allowing clinicians, patients, and their caregivers to monitor user status and well-being. The AT&T LTE-M connection allows clinicians near real-time access to patient data in a highly secure environment, offering caregivers the ability to intervene when necessary. The OnePulse technology provides data at the wrist for heart rate, location, movement, and sleep. OneLife’s proprietary Bluetooth protocol also has the ability to connect easily to other health and medical devices, e.g., blood pressure cuff, glucometer, and a weight scale.

return to march 2019 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

March 25, 2019

Trends Archives

The month of March 2019 was characterized by a considerable amount of activity on Capitol Hill and by the Trump Administration involving the topic of higher education. Regarding the latter, mention was made on page three of this issue of the newsletter about President Trump’s introduction of a federal budget proposal for FY 2020, which begins on October 1 of this year. Apart from proposed spending reductions in key health programs and activities, his budget includes a cut for the Department of Education, a stream-lined repayment process for student loans, and the elimination of the Public Service Loan Forgiveness program. The Department’s reduction would be about $8.5 billion or 12%, including a cancellation of surplus funds in the Pell Grant program. Whether any of these proposed changes ever see the light of day will require the approval of Congress, which does not seem highly likely.

The Congressional arena had its own highlights with hearings on reauthorizing the Higher Education Act (HEA). Last renewed in 2008, this legislation authorizes various programs within the Department of Education, including the federal aid programs that support students wanting to pursue a postsecondary education. The House Committee on Education and Labor conducted the first of five scheduled bipartisan HEA hearings on the topic, “The Cost of College: Student Centered Reforms To Bring Higher Education Within Reach” and the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on “Reauthorizing The Higher Education Act: Simplifying The FAFSA And Reducing The Burden Of Verification.” Both events were covered thoroughly by ASAHP staff. Comprehensive summaries were placed on the Association’s NEWSWIRE on March 12 (Senate Hearing) and March 14 (House Hearing). These items then were distributed to the membership on March 15.

Meanwhile, a set of proposals from the White House was released on how to reform the HEA through legislation and revise higher education regulations. The list calls for the accreditation process to focus on student outcomes, asserting that current compliance-focused federal requirements inhibit innovation and that accrediting organizations need to return to the primary purpose of ensuring educational quality. Congress is requested to streamline the 10 federal recognition standards to focus on educational quality and student learning. The proposals also call for defining accrediting organizations by the mission of their institutions, rather then geographically, as regional accreditors currently are structured.

Department Of Education Negotiated Rulemaking

The Department of Education (USDE) held the second of four sessions of its negotiated rulemaking (a process to reach agreement on the terms of a proposed administrative rule or regulatory change) on accreditation and other topics on February 19-22, 2019 in Washington, DC. The first session was on January 14-16, 2019, the third one is scheduled for March 25-28, 2019, and the fourth on April 1-3, 2019. A main committee focuses on accreditation while three subcommittees address distance learning and educational innovation, faith-based entities’ participation in Title IV programs, and TEACH Grants. At the February session, the committee received reports from the subcommittees, responded to questions posed by the Department, and addressed several proposed regulations, including: permitting accrediting organizations to waive certain criteria for institutions to encourage innovation, transferring credit among institutions, and limiting the number of states in which a regional accrediting organization could operate.

Borrower Defense to Repayment Regulations

On November 1, 2016, the Department of Education published final regulations concerning borrower defense to repayment and other related matters in the Federal Register. The original effective date (July 1, 2017) of these regulations was delayed by the Department, but by order of the U.S. District Court for the District of Columbia, the 2016 final regulations from the Obama Administration must take effect. They govern loan forgiveness for defrauded borrowers, ban some types of mandatory arbitration agreements, give federal officials new tools to go after troubled colleges, and require for-profit colleges to warn students if alumni have low loan repayment rates. The current Administration now must implement them.

return to march 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

March 25, 2019

Trends Archives

The 1st Session of the 116th Congress featured the introduction of the Medicare For All Act Of 2019 (H.R. 1384) in the House of Representatives by Pramila Jayapal (D-WA). The bill had 107 Democrat co-sponsors. It calls for transforming the Medicare program into a single payer system that would be implemented over a two-year period beginning after the bill is signed into law. Beneficiaries could keep their current health insurance coverage during the two-year transition period, but would lose it once the Medicare plan began. Individuals automatically would be enrolled in the program at the time of birth in the U.S. Coverage would include inpatient and outpatient hospital care; ambulatory services; primary and preventive care (also chronic care); prescription drugs; biologics; medical devices; mental health and substance abuse treatment services; laboratory and diagnostic services; maternity care; dental and vision care; and long-term care. Health plans and employers still could provide additional benefits not covered by the Act. No co-payments, premiums, deductibles, or similar charges would be imposed.

It cannot be expected that a piece of legislation this broad will be passed and enacted anytime soon. Many vested interests stand to be affected quite dramatically. They include: providers, insurance companies, pharmaceutical firms, medical device manufacturers, and individuals who are satisfied with their present coverage. Figuring out how to pay for benefits is another challenging aspect that has serious ramifications for the nation’s tax structure.

The Medical Device Tax As A Means Of Offsetting Health Care Costs

When the Patient Protection and Affordable Care Act (ACA) became law nine years ago this month, it was anticipated that new taxes would help to offset some of its costs. One example is a medical device tax. This 2.3% federal excise levy on the medical device industry has been suspended and delayed since the law was enacted. More recently, the tax was delayed retroactively and will not go into effect until January 1, 2020. Senators Pat Toomey (R-PA) and Amy Klobuchar (D-MN) have introduced legislation (S. 692) to repeal this tax permanently. The bill currently has 25 bipartisan cosponsors.

A Bipartisan Approach To Reducing Health Care Cost Growth

Barring any overnight developments that produce cures for major causes of mortality, such as heart disease and cancer, due to a steady growth in the overall population of the U.S. and accelerating increases in the number and proportion of the aged, health care costs will continue to increase. Recent years have witnessed considerable amounts of dissention and polarization in the political arena. Thus, it always is refreshing whenever spurts of bipartisanship occur. On March 1, eight prominent health economists from the Brookings Institution and the American Enterprise Institute, organizations seldom aligned ideologically, sent Lamar Alexander (R-TN), Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP), a list of 13 recommendations for the government to reduce the growth in health care costs. Recommendations include: passing legislation to expand mandatory bundled-payment programs and to end surprise out-of-network billing; and increasing Medicare payments for primary-care services and reducing them for other services.

Curtailing Fraud In Government Health Programs

Every year, billions of dollars in outlays and government program complexity combine to result in a susceptibility to improper payments, including fraud. Although there are no reliable estimates of fraud in Medicare, in fiscal year 2017 improper payments were estimated at about $52 billion, according to the Government Accountability Office (GAO). On February 25 of this year, the House passed H.R. 525, the Health Care Fraud Prevention Task Force Act, by voice vote. The bill would create the Health Care Fraud Prevention Task Force, a public-private partnership that would identify nationwide health care waste, fraud, and abuse and would supersede the Health Care Fraud Prevention Partnership (HFPP), which currently is operated by the Centers for Medicare & Medicaid Services (CMS). The newly established task force would contract with a third party to detect and prevent health care fraud through information sharing; streamline analytical tools and data; and provide a forum for government and industry experts to exchange successful anti-fraud practices. The task force also would be required to submit a report every two years to Congress showing any progress and cost savings attributable to the partnership.

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FEDERAL BUDGET RELEASE AND PROPOSED LEGISLATION

John Colbert

March 25, 2019

Trends Archives

The Trump Administration released its FY 2020 Federal Budget proposal on March 11. During the week of March 17, additional materials were released, including an appendix, analytical perspectives, and a Major Savings And Reforms Document that contains detailed information for use by the Appropriations Committees. An overall view reveals proposed savings of $48.4 billion in discretionary programs, including $25.8 billion in program eliminations and $22.6 billion in reductions. If history is any guide, legislators are unlikely to accept what the Administration has offered and will weigh in regarding what they consider to be more alternative ways of allocating federal dollars.

Immediate Congressional criticism of the Administration budget has focused on spending reductions on health programs that are considered too harsh. For example, the President’s proposal would cut hundreds of billions of dollars from Medicare. The budget also would slash funds for the National Institutes of Health by $5.5 billion in 2020, including a $897 million reduction in the National Cancer Institute's budget. The Administration also wants to provide $256 million to consolidate the Agency for Healthcare Research and Quality's work into the National Institute for Research in Safety and Quality, which is part of an attempt to streamline federal research.

Prior to taking action to pass 12 annual appropriations bills, lawmakers first will have to reach an agreement to raise spending caps under the Budget Control Act (BCA) so that appropriators have top-line spending limits with which to work. Absent a new agreement, discretionary spending caps will be cut to the levels outlined in the BCA for FY 2020, approximately $126 billion less than FY 2019.

Regarding other legislation, Senators Ron Wyden (D-OR), Marco Rubio (R-FL), and Mark Warner (D-VA) on March 6, 2019 reintroduced the Student Right to Know Before You Go Act (S. 681) to provide information through the U.S. Department of Education (USDE) on the costs and outcomes associated with higher education. Data focusing on graduation rates, debt levels, and earnings would be generated based on student information from institutions, along with loan and income information from USDE and the Internal Revenue Service. Versions of this bill have been introduced in every Congress since 2012. A companion bill (H.R. 1565) was introduced in the House by Duncan Hunter (R-CA).

Senators Bill Cassidy (R-LA), Elizabeth Warren (D-MA), and 13 other Republicans and Democrats reintroduced the College Transparency Act (S. 800) on March 14, 2018. Initially introduced in the previous Congress, the bill would change the way the USDE collects information on postsecondary institutions, modifying the college reporting system to include student outcomes information, such as completion and post-college employment. Institutions would provide data for USDE to generate post-college outcome reports to be presented on a user-friendly Website. Currently, the Higher Education Act (HEA) prohibits a student unit record system. A companion bill (H.R. 1766) was introduced in the House by Mitchell Paul (R-MI).

A Medicare For All Act also was introduced in this session of Congress and will be discussed on the next page of the current newsletter.

return to march 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

March 25, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 11th of many profiles and the third in 2019 is presented as follows:

Name and Title: Curt Lox, Dean, Brooks College of Health

Place of birth: Harbor City, CA

University: University of North Florida

How long have you been in your position? Almost two years

What’s the value of a university education? Socioeconomic mobility, psychosocial development

What is the value of ASAHP? ASAHP brings together dedicated individuals who are all focused on health, broadly defined. Whenever a group of passionate, educated professionals congregate, great things can happen.

Your philosophy on education in seven words: Engaging, expanding, and challenging young minds (OK, that is only six words but perhaps I can get extra credit for efficiency?)

If I could teach in another field, which one and why? I enjoy talking about leadership so that would probably be my choice though I have no formal training in this area.

Before I retire I want to: See my unit become a nationally-recognized College of Health

What music is playing in my car/office? I will forever be a big fan of music from the 80’s.

The last book I read for fun was: The latest Lee Child (Jack Reacher) novel

My favorite trip was: Mediterranean cruise

If I could travel anywhere it would be: Australia/New Zealand

Four people I’d take to coffee or have a glass of wine with: There is much more I wish I knew about my family history so my first two selections would be my grandfather and grandmother (both deceased). As a Beatles fan, I’d love to visit with Paul McCartney. As a sports fan and student of leadership, I would have welcomed the opportunity to pick John Wooden’s brain if he were still with us.

The best advice I ever received was: From my dad. He said that it was critical to work hard in school so that I could find a job that I loved because it would occupy a large portion of my life. I’m glad I took his advice because I love what I do.

My hobby is: Outdoor activities and travel

My passion is: People (we’re social beings!)

A perfect day is: Exploring a geographical region I’ve never been before with family and/or friends.

Cats or dogs? Definitely dogs

E-book or hardback? Hardback

Beach or mountains? I love them both but given that I live three miles from the beach, I’d have to say the former.

I wish I could: Play a musical instrument

My favorite saying is: From former Notre Dame football coach Lou Holtz: “The only things that are going to change you from where you are today to where you are going to be five years from now are the people you meet and the books you read.”

Return to march 2019 trends

COSTS ASSOCIATED WITH NONADHERENCE

John Colbert

March 25, 2019

Trends Archives

Patients with physical and mental health ailments seek relief through interactions with a wide range of health care practitioners. Assuming that accurate diagnoses are made and effective forms of affordable treatment are available, then prescribing remedial and curative interventions should produce desired outcomes. A major problem is that some patients fail to adhere to recommendations and the result is the occurrence of highly significant kinds of costs that affect not only them as individuals, but also their caregivers and society as a whole.

An ongoing concern is the high cost of health care and what can be done to pay for it. According to the March 2019 issue of the journal Medical Care, medication nonadherence for diabetes, heart failure, hyperlipidemia, and hypertension resulted in billions of Medicare fee-for-service expenditures, millions in hospital days, and thousands of emergency department visits that could have been avoided. If the 25% of beneficiaries with hypertension who were nonadherent became adherent, it is estimated Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and seven million inpatient hospital days averted.

Patients and health professionals enter into a transaction at the point of care in which both sides are in a position to gain or lose in various ways. Clinicians benefit from the opportunity to practice their knowledge and skills while simultaneously being able to obtain a livelihood through payment for services rendered. The health status of recipients of care may improve by symptom reduction, pain relief, and contributions to enhancing overall wellbeing.

Both sides of the equation must function in responsible ways for outcomes to be of optimal worth. Caregivers need to go beyond the provision of hands-on care by educating patients about the purpose of an intervention and ascertaining that these individuals fully understand their personal roles in taking medications properly, following dietary recommendations, and achieving satisfactory levels of physical fitness. Many aspects of care are volitional on the part of patients. Whereas being treated with hot packs or receiving a massage tend not to require much active patient involvement, a considerable amount of health care entails patient consent from the perspective of their needing to know why certain procedures are warranted. These individuals also must demonstrate both resilience and a willingness to cooperate in what is being furnished.

Some patients may lack adherence because of the unaffordability of medications, but other factors, such as low health literacy may be more pertinent. It is common today for patients to receive telephone and text messages reminding them of an upcoming appointment with a health professional, but less seldom are messages aimed at determining follow-up levels of patient understanding and adherence to recommended protocols. Although it is relatively easy and comforting for practitioners to assume that adherence occurs, the truth may be otherwise. As a potential downside, it is worth noting that a failure by nonadherent patients to show improvement can result in increased dissatisfaction on the part of caregivers that possibly contributes to feelings of burnout, a major issue in health care today.

return to march 2019 trends

PUTTING PATIENTS FIRST AND DISPARITIES RESEARCH

John Colbert

February 19, 2019

Trends Archives

The Centers for Medicare & Medicaid Services (CMS) collaborated with a wide variety of partners to support work in all three areas of its path to equity: increasing the understanding and awareness of disparities and their causes, developing and disseminating solutions, and implementing sustainable actions. As a way of increasing understanding and awareness of disparities, CMS sponsored the February 2019 issue of the journal Health Services Research, with a goal of contributing to the discussion on health disparities and emphasizing the value of continuing research in this area. An aim is to underscore the importance of identifying groups of patients who do not benefit equally from the health system and also identifying root causes of such differences.

One study in the issue focused on inpatient care experiences that differ by preferred language within racial/ethnic groups. Six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within applicable subsets of five racial/ethnic groups (Hispanics, Asian/ Pacific Islanders, American Indian/Alaska Natives, Blacks, and Whites) were compared. Within each racial/ethnic group, mean reported experiences for non‐English‐preferring patients were almost always worse than their English‐preferring counterparts. Language differences were largest and most consistent for Care Coordination. Within‐hospital differences by language were often larger than between‐hospital differences and were largest for Care Coordination. Where between‐hospital differences existed, non‐English‐preferring patients usually attended hospitals whose average patient experience scores for all patients were lower than the average scores for the hospitals of their English‐preferring counterparts. The investigators concluded that efforts should be made to increase access to better hospitals for language minorities and improve care coordination and other facets of patient experience in hospitals with high proportions of non‐English‐preferring patients A focus should be on cultural competence and language‐ appropriate services.

Return to February 2019 trends

IDENTIFICATION, EVALUATION, AND COMPARISON OF HEALTH DEVICES

John Colbert

February 19, 2019

Trends Archives

The technology marketplace is a veritable paradise for entrepreneurs attracted to electronic devices that can be used by consumers to enhance their personal health status. For example, a patient who has undergone breast cancer surgery may want to engage in the use of wearable sensors and cloud-based apps so that upon returning home after being discharged from the clinical setting, this individual may want to provide daily information to the health care team about her conditions and successes experienced in self-care involving physical exercise, massage, and skin care.

An article published on February 14, 2019 in the journal npj Digital Medicine indicates that recent years have witnessed an explosion in the number of wearable sensing devices and associated apps that target a wide range of biomedical metrics, from actigraphy to glucose monitoring to lung function. It is estimated that the number of connected wearable devices worldwide will increase from 325 million in 2016 to 929 million by 2021. Similarly, the digital health consumer base is growing in tandem, and it is forecasted that by 2021, the number of individuals using remote monitoring programs will grow to 52 million globally. This increased availability and choice of sensors is accompanied by a great challenge to optimize the match between the sensor and a specific application context. A structured approach is needed first to refine the requirements for a specific application, and then to evaluate the available devices against those requirements.

Increased device availability is leading to greater research and commercial opportunity, but it also can create significant confusion, especially for professionals who are attempting to select appropriate technologies that meet the requirements of their specific application for a clinical trial, research study, or a digital health service. The authors posit that there are no standardized methods to help professionals identify, evaluate, and compare the numerous human performance devices available. Consequently, they describe a framework that provides a comprehensive tool to enable users to define their specific requirements, conduct a systematic Web search and complete a holistic desk-based evaluation, to determine whether one or more devices are fit for purpose and worthy of field testing.

Return to February 2019 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

February 19, 2019

Trends Archives

Adoption Of A National System For Electronic Use And Exchange Of Health Information

The Office of the National Coordinator for Health Information Technology (ONC) has released its 2018 Report to Congress. As of 2015, 96% of nonfederal acute care hospitals and 78% of office-based physicians adopted certified health IT, however, hurdles to progress still remain. For example, many certified health IT products lack capabilities that allow for greater innovation in how health information can be securely accessed and easily shared with appropriate members of the care team. Such innovation is more common in other industries. Also, lack of transparent expectations for data sharing and burdensome experiences for health care providers limit the return on investment for health care providers and the value patients are able to gain from using certified health IT. Information not always is accessible across systems and by all end users, such as patients, health care providers, and payers, in the market in productive ways. For example, despite the individual right to access health information about themselves established by the HIPAA Privacy Rule, patients often lack access to their own health information, which hinders their ability to manage their health and shop for medical care at lower prices. Health care providers often lack access to patient data at the point of care, particularly when multiple health care providers maintain different pieces of data, own different systems, or use health IT solutions purchased from different developers. Also, payers often lack access to clinical data on groups of covered individuals to assess the value of services provided to their customers. The report can be obtained here.

Current Status And Response To The Global Obesity Pandemic

On October 9, 2018, the Roundtable on Obesity Solutions, held a public workshop in Washington, DC entitled Current Status and Response to the Global Obesity Pandemic.” The workshop examined the status of the global obesity pandemic and explored approaches used to manage the problem in different settings around the world. The “Proceedings of a Workshop In Brief” highlights presentations that discussed the importance of understanding the obesity epidemic in global context and shared perspectives on the implications of obesity as a global problem for prevention and treatment efforts in the United States, with an emphasis on reducing disparities.

A report was released on January 11, 2019. It can be obtained here.

How Innovation Will Blur Traditional Health Care Boundaries

According to the firm Deloitte, by 2040, health care as known today will no longer exist. A shift will occur from “health care” to “health.” Disease never will be completely eliminated, but through science, data, and technology, it can be identified earlier, proactive interventions can be implemented, and its progression can be understood better. The future will be focused on wellness and managed by companies that assume new roles to drive value in the transformed health ecosystem. Driven by greater data connectivity; interoperable and open, secure platforms; and increasing consumer engagement, 10 archetypes are likely to emerge and will replace and redefine today’s traditional life sciences and health care roles to power the future of health. The 10 archetypes will fall into three distinct, but interconnected, categories: Data and platforms will be the foundational infrastructure that will generate the insights for decision making. Care enablement will be connectors, financers, and regulators that help make the industry’s “engine” run. Well-being and care delivery will be the most health-focused of the three groupings, consisting of care facilities and health communities, both virtual and physical. The report can be obtained here.

Return to February 2019 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

February 19, 2019

Trends Archives

Record Number Of Novel Medical Devices Approved By The FDA In 2018
According to Scott Gottlieb, Commissioner of the U.S. Food & Drug Administration, a record 106 novel medical devices were approved in 2018, surpassing the 40-year approval record set in 2017, which was 99. Innovative new products that have come to market in 2018 as a result of an efficient, risk-based approach to total product life-cycle regulation include: expanded approval of an automated insulin dosing system to include patients with diabetes who are as young as age seven; the world’s smallest heart valve for newborns; the first blood test in the world to evaluate mild traumatic brain injury (“concussion”); the first mobile medical app to help treat substance abuse disorders; technologies using artificial intelligence to detect diabetic retinopathy in adults with diabetes and for aiding providers in the detection of wrist fractures. Additional approvals included the first artificial iris in the U.S. and permitted marketing of a new prescription medical device that measures eye movement as an aid in the diagnosis of concussion.

Nearly One-Quarter Of Antibiotic Prescriptions Filled Are Unnecessary

Of the 15.5 million antibiotic prescriptions filled in 2016 by a population of 19.2 million privately insured children and adults under age 65, nearly one-quarter were unnecessary, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ). Published on January 17, 2019 in the journal BMJ, the results indicate that an additional 36% of antibiotic prescriptions in 2016 were only "potentially appropriate." The analysis provides the most comprehensive estimates to date of inappropriate prescribing of antibiotics among individuals with private, employer-sponsored insurance. Appropriate antibiotic prescribing means that the medication is recommended for the patient's condition. Researchers conducted a combined analysis of a U.S. medical claims database and the 2016 version of an international system for categorizing diseases (ICD-10-CM). The analysis provides the most comprehensive estimates to date of inappropriate prescribing of antibiotics among individuals with private, employer-sponsored insurance.

HEALTH TECHNOLOGY CORNER

Enhanced Toy Dog Robot Includes An Ability To Learn From Its Owners

According to the January 2019 issue of the journal Science Robotics, the return of Aibo, Sony’s toy dog first introduced nearly 20 years ago, is welcomed by many, and not just because of its new appearance, enhanced voice understanding, and its improved ability to learn from its owners. In the new addition, the robot has been developed with Sony’s increasing awareness of the role that robots can play in childhood learning or as a companion for the aged, particularly those with neurodegenerative diseases. Understanding the perception, interaction, and expectations of humans around the robot and developing robot behavior and personality that are context aware (not dependent on pre-scripted programs and with personalization and adaptation) are interesting topics in social robotics. The device was highlighted in the journal as one of 10 Robotic Technologies Of The Year.

Electrical Stimulation Of The Brain During Surgery Produces Immediate Laughter And Calm

Neuroscientists at Emory University School of Medicine have discovered a focal pathway in the brain of a patient that when electrically stimulated causes immediate laughter, followed by a sense of calm and happiness, even during awake brain surgery. The behavioral effects of direct electrical stimulation of the cingulum bundle, a white matter tract in the brain, were confirmed in two other epilepsy patients undergoing diagnostic monitoring. The findings were published on February 11, 2019 in the Journal of Clinical Investigation. The technique is viewed as a potentially transformative way to calm some patients during awake brain surgery, even for individuals who are not especially anxious. For optimal protection of critical brain functions during surgery, patients may need to be awake and not sedated, so that doctors can talk with them, assess their language skills, and detect impairments that may arise from resection. Outside of use during awake surgery, understanding how cingulum bundle stimulation works also could inform efforts to treat depression, anxiety disorders, or chronic pain more effectively via deep brain stimulation.

Return to Feb 2019 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

February 19, 2019

Trends Archives

The start of the 116th Congress in January 2019 is the first one in which the House and Senate are controlled by different parties since the 113th Congress (2013-2015). A long overdue reauthorization of the Higher Education Act may be one piece of major legislation that could be addressed this year. If so, the following kinds of changes might be considered in the context of making some needed improvements: simplifying the federal student aid application, creating a new income-based repayment plan for borrowers, building a new accountability system for colleges based on whether borrowers actually are repaying their loans, expanding competency-based education programs, requiring colleges to use clearer language in letters telling students about the aid they're receiving, and collecting better data on how much students borrow and how much they earn after graduation. Other possibilities include allowing incarcerated individuals to access Pell Grants and making grants available for shorter academic programs.

More than 104,000 responses recently were generated to comment on proposed Title IX rules by the U.S. Department of Education regarding how schools handle sexual assault allegations. Acknowledging that some would-be respondents may have experienced technical issues involving the website that could have preventing the submission of comments, the site was reopened for the single day of February 15, 2019. Examples of what the controversy entails also are described below:

Reducing Student College Debt

During the last four years, the U.S. Senate Committee on Health, Education Labor & Pensions (HELP) has held 27 hearings on the Higher Education Act. A concern expressed at many of these sessions is the problem of the significant burden of student debt. Approximately 43 million individuals, one in six adult Americans, have federal student loan debt and the federal student loan portfolio currently is approaching $1.5 trillion. A key aspect of the situation is applying for financial aid, a process that may be a suitable candidate for implementing some beneficial modifications.

One possible remedy is reducing the 108 questions to a much smaller number (e.g., 15-25) in the Free Application for Federal Student Aid (FAFSA) that 20 million families must fill out each year if they want a federal grant or loan to help pay for college. Not only does providing answers involve a significant amount of effort, a related issue is that some applicants may be intimidated by the complexity of the required information, making them wary of giving the Education Department data they already have provided to the IRS. Another impediment is that a verification process can suspend Pell Grant payments while a family has to resubmit tax information and wait for the government to check to ensure that the information is correct. To the extent that some students may be unable to attend college because of an inability to obtain financial aid, a solution involving the FAFSA is warranted.

Title IX Proposed Rule Involving Sexual Assault Allegations

Academic institutions are not equivalent to courts of law, yet they are responsible under Title IX to respond to allegations of sexual harassment, including sexual assault. Cases of this nature can be quite difficult to resolve because of differing accounts of what transpired and time lapses between when an event occurred and when it is reported. The challenge in such instances is to adopt processes to ensure that the parties involved are treated fairly and equitably. Depending on one’s perspective, the proposed rule consists of provisions that may be considered:

Helpful (e.g., requires institutions to provide both parties with reasonable time to prepare for any interview or disciplinary hearing).

Not Helpful (e.g., a requirement for a live hearing with cross-examination, which in effect is viewed as the same as legalistic, court-like processes that should not be the responsibility of educational institutions).

Lack Of Clarity (e.g., the term “due process” basically adds to an existing level of confusion).

Return to Feb 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

February 19, 2019

Trends Archives

Although other aspects of health reform occasionally crop up, the Affordable Care Act continues to represent the centerpiece of efforts to transform the delivery of health care, reduce costs, and increase the number of individuals who have an adequate amount of insurance coverage. As the years have gone by, Republicans through legislation introduced in Congress and in law suits filed by Attorneys General in several states have been successful in making some changes, such as eliminating the individual mandate, but they have not been able to repeal and replace this law.

As discussed below, with the passage of time it is relatively easy to lose sight of some of ACA’s elements. An example is the so-called “Cadillac tax.” Originally scheduled for implementation in 2018, postponements have occurred. More recently involving a separate matter, the U.S. Department of Labor in June 2018 was successful in having a rule finalized to expand the ability of employers to join together to offer health coverage through Association Health Plans, which provide short-term limited insurance coverage that may be less adequate in comparison to consumer protections in the ACA. Opposition by Democrats continues to be expressed to making these plans available. Meanwhile, the U.S. Senate maintains an interest in supporting primary care to lower health costs and improve patient outcomes.

The Cadillac Tax As A Means Of Offsetting Health Care Costs

The Cadillac tax is a provision in the ACA that affects high-cost employment-based health plans. It consists of a non-deductible 40% excise tax imposed on the portion of health coverage costs that exceeds $10,200 for single coverage and $27,500 for family coverage. Initially scheduled to become effective last year, it since has been delayed twice and presently is scheduled to take effect in 2022. By that year, the amounts will change to $11,200 for single coverage and $30,150 for family coverage. The original plan was to generate tax revenues that could help mitigate increasing health care costs and assist in financing other ACA provisions. If and when it ever becomes operational, nothing can be known until then regarding whether this tax can lead to the achievement of financial objectives.

Short-Term Association Health Plans And State Regulations

The Commonwealth Fund has issued concerns that short-term policies may be deceptively marketed, with some sellers leading consumers to believe they are buying a comprehensive policy when they are not. Efforts by the states to regulate these plans may be undermined by a loophole that limits their ability to perform basic consumer protection functions because many short-term plans are being sold through out-of-state associations that are exempt from state regulation. These entities are able to file insurance products for approval in one state and then sell the same policies in other states that have exempted policies, such as benefit mandates. In those jurisdictions, the association is then regulated by the state of approval, rather than the state in which the coverage is purchased.

How Primary Care Can Affect Health Care Costs And Outcomes

The U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on February 5, 2019 in Washington, DC to discuss the role of primary care in influencing health care costs and patient outcomes. Individuals offering testimony included:

Tracy Watts, a Senior Partner and U.S. Healthcare Reform Leader at Mercer. Her remarks focused on ways employers are working to improve employee health and manage healthcare costs through onsite clinics and other innovative strategies.
Katherine Bennett, Assistant Professor of Medicine and Program Director of the Geriatric Medicine Fellowship at the University of Washington, described Project ECHO, the Extension for Community Health Outcomes, an effort launched in more than 160 locations in the U.S. to address complex conditions, such as HIV, tuberculosis, and mental illness.
Sapna Kripalani, Assistant Professor of Medicine at Vanderbilt University Medical Center, provided an example of the value of primary care for an obese patient with complex conditions involving diabetes, hypertension, seizure disorder, and bipolar disorder.

Return to February 2019 trends

OPEN SEASON FOR LEGISLATION

John Colbert

February 19, 2019

Trends Archives

The 1st Session of the 116th Congress is off to a brisk start. Given the fact that 2020 will involve an election to determine who will occupy the White House beginning in 2021, Congressional activity can be assessed within that context. Several Capitol Hill Democrats already have announced officially that they are in the race to decide which of them will be that party’s representative in the November election next year. A portion of the appeal of these candidates to voters will rest on legislative proposals that they endorse. Another venue where Congressional officials can operate effectively is as participants in hearings that highlight either defects in current Administration policies or alternative courses of action to adopt, which they espouse.

During his State of the Union Address to Congress on February 5, President Donald Trump served up a menu of examples of bipartisan cooperation that produced meaningful results, while also identifying areas where a reduction in partisan wrangling could lead to even more dramatic improvements in addressing topics of great importance to the nation’s welfare. Clearly, politics will provide a backdrop for what unfolds or fails to materialize between now and next year’s election. Not too surprisingly, the party in power always wants to be in the position of boasting of its enormous achievements, thereby furnishing a rationale why its leadership should be retained. The party out of power cannot be expected to cooperate in the passage of legislation that will burnish their opponents’ claims. Instead, it will redound more to their advantage to focus on the inadequacies of the other party and illustrate to voters in compelling terms why they would be better equipped to achieve more positive results once elected.

The President reminded his listeners on that occasion that both parties in the previous two years had come together: to pass unprecedented legislation to confront the opioid crisis, produce a sweeping new Farm Bill, and achieve historic Veterans Administration reforms. He said that as recently as only weeks ago, Democrats and Republicans united for groundbreaking criminal justice reform. Working closely with both groups, the Administration was able to sign the First Step Act into law, legislation that reformed previous sentencing laws that wrongly and disproportionately have harmed the African-American community. The Act gives non-violent offenders the chance to re-enter society as productive, law-abiding citizens.

Assuming that same cooperative spirit can prevail in the current session of Congress, then it may be possible to pass an infrastructure bill, including investments in cutting edge industries of the future. Along with proposing a nationwide paid family leave so that every new parent has the chance to bond with newborn children, the President identified the following objectives pertaining to health: (1) increase investments in HIV prevention programs, such as the Ryan White HIV/AIDS Program, and direct funding to launch new programs through community health centers to provide preventive medication to high-risk individuals, (2) allocate more than $500 million over the next 10 years to fund research for childhood cancer, (3) lower the cost of healthcare and prescription drugs and protect patients with pre- existing conditions, and (4) expand efforts to reduce “surprise billing” where patients are billed for care that is much more expensive than anticipated or is not covered by their insurance.

It is unclear whether any of these initiatives will see the light of day prior to November 2020. What is certain is that the 116th Congress will be worth monitoring to see what eventually unfolds.

Return to Dec 2018 - Jan 2019 trends

Provision Of Non-Medical Services For Social Needs That Affect Health

House Reaction To A Lawsuit To Invalidate The Affordable Care Act

More Articles from TRENDS April 2019

VARIETIES OF PLAGUES BOTH OLD AND NEW

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

100TH DAY OF THE 116TH CONGRESS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

PER SCIENTIAM AD SAPIENTIAM: SOME KEY STEPS IN THE JOURNEY

PLACING A MAN ON THE MOON AND SOME RELATED MUSINGS

More Articles from TRENDS April 2019

VARIETIES OF PLAGUES BOTH OLD AND NEW

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS