HEALTHCARE COSTS
California Budget Watch 2019 (Part 1 of 4): Governor Newsom’s May Revise Ups the Ante to Increase Healthcare Coverage and Affordability
Sammy Chang, Health Policy Researcher May 31, 2019
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 …
Continue Reading Download PDF
The Source Roundup: May 2019 Edition
Tiffany Wang, Student Fellow May 1, 2019
Happy May! We hope you’re enjoying the longer, sunnier days of spring. In this edition of The Source Roundup, we survey articles and reports that discuss 1) health system consolidation’s impact on healthcare prices and quality, 2) the new federal price transparency rule, and 3) cost-containment strategies from various fronts. More Evidence of Hospital Market Concentration’s Negative Impact on Competition and Healthcare Costs Two articles this month reinforced the principle that protecting access to affordable healthcare requires strong antitrust enforcement policies to ensure adequate competition among hospitals and hospital systems. …
Continue Reading Download PDF
Better Data for Better Results: AB 1122’s Super User Pilot Project and Other 2019 Bills That Improve Health Care Transparency
Sammy Chang, Health Policy Researcher April 30, 2019
As California continues its implementation of an all-payer claims database, we take a look at other bills the Legislature introduced to further the aim of better understanding the factors and activities that drive health care costs and quality. SB 343 subjects the Kaiser Permanente system to the same reporting requirements as other plans and hospitals. SB 612 and AB 929 mandate public disclosure of cost reduction and quality improvement activities. Additionally, AB 1122 proposes a pilot project that utilizes existing data sets to identify a new data set: high health …
Continue Reading Download PDF
The Source Roundup: April 2019 Edition
Source Fellow April 1, 2019
By: Erin Sclar, Student Fellow Spring is finally here! With it, we review articles and reports about 1) single payer health plans and universal health care, 2) the causes, effects, and possible solutions to rising prescription drug pricing, and 3) health care costs and price transparency. Single Payer Health Plans and Universal Health Care The terms “single payer health plans” and “universal health care” are becoming increasingly familiar as the 2020 elections approach. But the meanings of these terms, and the specific policies and proposals associated with them, are often …
Continue Reading Download PDF
Innovations in State Medicaid Programs to Control Prescription Drug Costs
Katie Gudiksen, Senior Health Policy Researcher March 7, 2019
Medicaid serves nearly one in five Americans, including many with chronic conditions, and purchases about 10% of total prescription medications dispensed in the U.S.[1] From 2013 to 2016, Medicaid’s nationwide drug spending increased almost 50%, from $22.4 billion to $33.4 billion.[2] Medicaid programs consume an increasing percentage of state budgets and threaten to overtake funding for other programs like education and infrastructure.[3] In 2018, the National Association of State Budget Officers (NASBO) estimated that Medicaid accounted for nearly 30% of total state spending and is the fastest growing component of …
Continue Reading Download PDF
The Source Roundup: March 2019 Edition
Source Fellow March 1, 2019
By: Leah S. Gray, Student Fellow Happy March! This month we take a look at articles that examine 1) state health system reform efforts, 2) protections against surprise medical bills, 3) effects of market concentration on cost and quality, and 4) ways to control rising costs for health care and pharmaceuticals. States are taking the lead in health system reform While the federal health policy debate has remained rather stagnant, states have stepped up protect their citizens from rising health care costs. North Carolina is poised to make rapid, unprecedented …
Continue Reading Download PDF
The Issues with Prior Authorization and Why Reform Is Needed
Source Fellow February 25, 2019
By: Swaja Khanna, Student Fellow Late last year, in the middle of the holiday season, I needed a prescription medication urgently. My physician prescribed it on December 13th. I received the medication on December 20th. It took a whole week to get a medication that I should have long finished by the time I actually received it. I was deeply frustrated not only because I was physically ill, but also because I was dealing with a great deal of uncertainty. When I attempted to pick up my medication from the …
Continue Reading Download PDF
Right-to-Shop Programs: Encouraging Patients to Shop for High-Value Health Care
Katie Gudiksen, Senior Health Policy Researcher February 11, 2019
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 …
Continue Reading Download PDF
Trump Administration Issues Proposed Rule to Dramatically Change Drug Rebates
Katie Gudiksen, Senior Health Policy Researcher February 4, 2019
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 …
Continue Reading Download PDF
The Source Roundup: February 2019 Edition
Source Fellow February 1, 2019
By: Erin Sclar, Student Fellow Happy February! As we eagerly await this year’s health policy valentines on Twitter, we review recent academic articles that examine a variety of issues related to health care costs, including 1) the effect of vertical integration in health care, 2) health reform and theories of cost control, 3) why the US spends so much on health care, 4) how ACOs use population segmentation to care for high-cost patients, 5) characteristics and spending patterns of high-cost Medicare patients, and 6) an evaluation of bundled payments for joint …
Continue Reading Download PDF