#6things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research. This week’s edition includes contributions from Yevgeniy Feyman (@YFeyman) and Anthony Moccia (@Anthony_Moccia).

POLITICO New York: State moves to protect smaller insurers from federal risk adjustment program

  • New York’s Governor, Andrew Cuomo, announced late last week changes to the risk adjustment program in the state.
    • Risk adjustment, one of the ACA’s “Three Rs,” is a permanent program designed to transfer money from insurers with relatively low-risk population, to those with high-risk.
    • States can either operate their own risk adjustment program, or allow the federal program to run in the state.
    • The new regulations permit the state’s Department of Financial Services (which is responsible for overseeing the state’s insurance market) to return money paid into the program if regulators feel that the payments might “hurt insurers in the market.”
  • In recent months, insurers have raised concerns that the risk adjustment program may not be functioning as intended.
    • In New York, for instance, UnitedHealthCare controls 70 percent of the small-group market, but is receiving $315 million.
    • On the flipside, CareConnect, a new insurer started by Northwell Health owes about $13 million into the program.
  • Importantly, these changes only apply to the state’s small group market.

Bloomberg BNA: Census: Uninsured Rate Dips Below 10 Percent

  • Updated numbers from the Census Bureau reveal that the uninsured rate has declined to 9.1 percent – about 29 million people – in 2015.
    • Since 2010, when the ACA took effect, the uninsured rate has fallen from 16 percent
  • According to the Center for Budget and Policy Priorities, a left-leaning think tank, that number is the lowest on record.
  • David Waddington, a division chief at the Census Bureau noted in a conference call with reporters that states that haven’t expanded their Medicaid programs under the law saw the smallest declines in uninsured rates.
    • The four states with the highest uninsured rates in 2015, for instance, all did not expand their Medicaid programs.
  • Republicans pushed back, calling the ACA a “disaster” due to increases in premiums and market concentration.
    • A recent study from Avalere Health, for instance, found that more than half of exchange markets may have two or fewer insurers in 2017.

KHN: Studies Link Cancer Patient’s Survival Time To Insurance Status

  • Two new studies in the journal Cancer have found that for two types of cancers, privately insured tend to be diagnosed earlier and live longer than those with Medicaid or who are uninsured.
  • One study looked at data on over 13,000 patients with a malignant brain tumor called glioblastoma multiforme. The other examined data for over 10,000 patients with testicular cancer.
    • The five-year survival rate is less than five percent for glioblastoma, which tends to be very aggressive.
    • Testicular cancer, on the other hand, responds well to chemotherapy and has a 5-year survival rate of 95 percent.
  • For testicular cancer, uninsured patients were 26 percent more likely than the privately insured to have the cancer metastasize; Medicaid patients were 62 percent more likely. Similarly, the uninsured were 88 percent more likely to die, and Medicaid patients were 51 percent more likely.
    • The study notes that there may be confounders with the Medicaid population – in many states, people can qualify for Medicaid upon receiving a cancer diagnosis.
  • For glioblastoma, the uninsured were 14 percent more likely to have shorter survival than the privately insured; Medicaid patients were 10 percent more likely.

KHN: Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar

  • The Average deductible, since 2011, has increased 63% while worker’s wages have only increased by 11%
    • Premiums for employer-sponsored family coverage rose only 4% in 2016 which is lower than the usual increases as seen in 2011 and the early 2000’s
    • Steady premiums are manifesting themselves in increased out-of-pocket costs for employees in the form of high deductibles and copayments
  • One way consumers are responding to high deductible plans is by using fewer medical services
    • High-deductible plan consumers from 2010-2014 used 13% less inpatient hospital care, 10% less outpatient care, and 13% fewer prescriptions compared to those with conventional insurance
  • Amanda Frost, an HCCI researcher says that, “If the intention is lower utilization will lead to lower spending, we are seeing that” she goes on to conclude that the effect this has on patient health is not understood

NIH: HHS take steps to provide more information about clinical trials to the public

  • The Department of Health and Human Services issued a “Final Rule” that includes requirements for registering certain clinical trials and submitting summary results to ClinicalTrials.gov
    • This rule increases legal requirements for submitting registration and results information for clinical trials involving the U.S. FDA regulated drug, biological and device products
  • By Expanding registration information, people will be able to find clinical trials more easily, while also helping to inform healthcare providers and patients regarding medical decisions
  • FDA Commissioner Robert Califf, M.D., in regards to the Final Rule, says “The FDA will help ensure compliance with these new requirements so that patients and providers can have confidence in and access to significantly more clinical trial information and researchers can improve clinical trial focus and design.”

Modern Healthcare: CMS says 49 states have reduced avoidable hospital readmissions

  • Data released by the CMS Show, shows readmission rates, since 2010, have been reduced in every state in the U.S. except for Vermont
    • Reductions trail the implementation various CMS programs, like Hospital Readmissions Reduction Program (HRRP)
  • In 2015 100,000 hospital readmissions have been avoided by Medicare beneficiaries, and 565,000 readmissions since 2010
  • Vermont saw an increase in readmission rates from 15.3% to 15.4% over the study period of 2010-2015
  • CMS is predicting penalizing about 2,500 hospitals because of excess readmissions in the coming year
    • $538 million is expected to be saved based on expanding criteria for readmissions penalties

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