Happy December! The holiday season is upon us and it is time to cozy up with a warm cup of tea to the latest health policy news.  This edition of the Source Roundup looks at articles on 1) healthcare market consolidation and provider network access, 2) increases in insurance premium contributions and deductibles, and 3) lessons from healthcare system reforms abroad.   Healthcare Markets Accountable care organizations (ACOs) have been lauded for providing higher quality medical care at lower costs.  In a recent Health Affairs research article, Changes in Physician Consolidation …

By: Hayden Soria, Student Fellow Hello September! As we see cooler days slowly roll in, there are still many sizzling topics in this month’s health policy literature. In this Roundup, we take a dive into article and reports that discuss 1) the prevalence of surprise billing, 2) the effects of California’s AB 72 on provider networks, 3) increasing hospital prices, 4) hospital quality ratings, 4) increasing insurance premiums and out-of-pocket costs, and 5) health plan profitability.   Surprise Billing and Provider Networks Eric C. Sun, Michelle Mello, and Jasmin Moshfegh explore …

By: Hayden Soria, Student Fellow Happy June! Summer is just around the corner and healthcare policy discussion is heating up. In this month’s Source Roundup, we highlight academic articles and studies that look at 1) the high costs of employer-sponsored insurance, 2) how much private insurers are paying hospitals compared to Medicare, and 3) implications of single payer system reform.   Increasing Employer-based Insurance Costs Present Difficulties to Many Americans In the last twelve years, annual deductibles in employer-based health plans have sky-rocketed and now average more than $1,300 annually. A …

It’s budget season, and this month kick-starts the discussion on whether California should re-implement the individual mandate, how much Affordable Care Act (ACA) subsidies should be increased, and whether Medi-Cal should be expanded to undocumented young adults and seniors. Back in January, Governor Newsom went quickly to work upon his inauguration, signing executive orders and sending a letter to Congress and President Trump. With his May Revise, we will examine, in three parts, the specifics of the Governor’s proposals, how the proposals have evolved, and the studies that evaluate those …

With the share of Gross Domestic Product spent on health care reaching crisis levels,[1] experts on both sides of the political spectrum are demanding better value for the dollars spent on health care. Programs that give patients incentive to choose better value health care get widespread support from both political parties. In the past few years, many states considered enabling or implementing right-to-shop or savings reward programs, in which an insurer creates an incentive program that gives patients financial rewards for choosing providers with lower than average costs.   How …

On Thursday, January 31, 2019, the Trump Administration announced a proposed rule to eliminate rebates from drug manufacturers to pharmacy benefit managers (PBMs) in the Medicaid managed care and Medicare Part D programs. The proposed rule accomplishes this aim by removing safe-harbor protection[1] under the federal Anti-Kickback Statute (AKS)[2] for these rebates. In addition, the administration proposed new safe-harbor protections for rebates and other price reductions that will reduce the cost-sharing for patients when they purchase prescriptions and protect some flat PBM service fees (i.e. fees that are not tied …

After considering 5,617 bills and resolutions, the two year California legislative cycle has come to a conclusion. As health care costs become more scrutinized, more bills than ever have emerged to target these costs. While not all of those bills passed, a significant amount of bills that did pass as well as the notable bills that failed coalesce around four themes: targeting high costs of prescription drugs, working towards a single payer system, regulating competition, and limiting high health costs. This post will focus on the first two themes: high …

Happy August! In this edition of the Source Roundup, we cover four academic articles and reports from June and July. The topics this month include: (1) price transparency as a means to affordable health care; (2) effect of state-based individual mandates; (3) Trump’s 5-Part Medicare Part D plan; and (4) Medicare’s experiment with bundled payments.   Price Transparency Goals to Achieve Affordable Health Care Skeptics have questioned whether consumer price transparency initiatives are an effective means of driving down healthcare costs. In the NEJM Catalyst article, “Defining the Goals of …

Year two of California’s 2017-2018 legislative session has been an active one. As lawmakers work diligently, The Source will take a brief look at some 2018 bills that can potentially change the California healthcare landscape.   SB 1021: This bill removes the sunset provision for AB 339 (2015), which was enacted to cap cost sharing for a covered outpatient prescription drug at $250/$500 per 30-day supply.[1] Furthermore, the bill codifies the regulation that “prohibits an enrollee or insured from being charged more than the retail price for a prescription drug …

Pharmaceutical litigation and enforcement actions took the spotlight in the news last month. In this edition, we highlight two high profile enforcement cases and continue to follow the Allergan patent saga. In enforcement, we saw developments in the FTC’s antitrust enforcement against generic drugmaker Impax and the DOJ’s anti-kickback enforcement against brand manufacturer Pfizer. These actions could set important precedents for similar cases and significantly impact price and competition in the pharmaceutical industry. Meanwhile, Allergan continues to defend against attacks of its tribal immunity maneuver in a seemingly losing battle. …