BCM HPJC (MEERM 628)

Medicare Part D has no cap on beneficiaries' out-of-pocket spending for outpatient prescription drugs, and, unlike Medicare Parts A and B, beneficiaries are prohibited from purchasing supplemental insurance that could provide such a cap. Historically, most beneficiaries whose annual Part D spending reached the catastrophic level were protected from unlimited personal liability by the Low-Income Subsidy (LIS). However, we found that the proportion of beneficiaries whose spending reached that level but did not qualify for the subsidy-and therefore remained liable for coinsurance-increased rapidly, from 18 percent in 2007 to 28 percent in 2015...

The 2020 presidential election will be consequential for the future of health reform, with the two major-party nominees taking very different views on the future of the Affordable Care Act (ACA), as well as the policies needed to lower health costs and continue to expand access to coverage. The Republican nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation-based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017...

Democratic candidates for president in 2020 will likely include some type of public plan in their health care reform platforms. Existing public plans take many forms and often incorporate private elements, as do most proposals to extend such plans. We review the types of public plans in the current system. We describe and assess the range of proposals to extend these plans or elements of them to additional populations. We suggest questions that candidates could use to guide their decisions about the scope and content of their health policy proposals...

OBJECTIVES: To examine the person-level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups. DATA SOURCE: Medical Expenditure Panel Survey, 2008-2014. STUDY DESIGN: We pooled multiple 2-year waves of data to examine the direct impact of Medicaid enrollment among uninsured Americans. We compared changes in outcomes among nonpregnant, uninsured individuals who gained Medicaid (N = 963) to those who remained uninsured (N = 9784) using a difference-in-differences analysis...

While the Affordable Care Act has expanded health insurance to millions of Americans through the expansion of eligibility for Medicaid and the health insurance Marketplaces, concerns about Marketplace stability persist-given increasing premiums and multiple insurers exiting selected markets. Yet there has been little investigation of what factors underlie this pattern. We assessed the county-level prevalence of limited insurer participation (defined as having two or fewer distinct participating insurers) in Marketplaces in the period 2014-18...

BACKGROUND: E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments. METHODS: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice...

Importance: In 40 of 50 US states, scheduled dialysis is withheld from undocumented immigrants with end-stage renal disease (ESRD); instead, they receive intermittent emergency-only dialysis to treat life-threatening manifestations of ESRD. However, the comparative effectiveness of scheduled dialysis vs emergency-only dialysis and the influence of treatment on health outcomes, utilization, and costs is uncertain. Objective: To compare the effectiveness of scheduled vs emergency-only dialysis with regard to health outcomes, utilization, and costs in undocumented immigrants with ESRD...

BACKGROUND: Over the last 30 years, public opinion and state level legislation regarding the concealed-carry of firearms have shifted dramatically. Previous studies of potential effects have yielded mixed results, making policy recommendations difficult. We investigated whether liberalization of state level concealed-carry legislation was associated with a change in the rates of homicide or other violent crime. STUDY DESIGN: Data on violent crime and homicide rates were collected from the US Department of Justice Uniform Crime Reporting Program (UCR) and the Centers for Disease Control and Prevention (CDC) over 30 years, from 1986 to 2015...

The outcome of the 2018 midterm congressional election is important to the future of health care in the United States. Since 1994, the division between those who identify as Republicans and those who identify as Democrats has grown on a range of domestic policy issues, including many major health..

There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan-which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way...

BACKGROUND: The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS: We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage...

OBJECTIVES: To evaluate the cost-effectiveness of electronic consultations (eConsults) for cardiology compared with traditional face-to-face consults. STUDY DESIGN: Cost-effectiveness analysis for a subset of Medicaid-insured patients in a cluster-randomized trial of eConsults versus the traditional face-to-face consultation process in a statewide federally qualified health center. METHODS: A total of 369 Medicaid patients were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process...

OBJECTIVES: To assess the impact of New York City's (NYC's) 2014 increase of the minimum legal purchase age (MLPA) for tobacco and e-cigarettes from 18 to 21 years. METHODS: We performed a difference-in-differences analysis comparing NYC to the rest of New York State by using repeated cross-sections of the New York Youth Tobacco Survey (2008-2016) and to 4 Florida cities by using the Youth Risk Behavior Surveys (2007-2015). RESULTS: Adolescent tobacco use declined slightly in NYC after the policy change...

Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending...

BACKGROUND: The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. OBJECTIVE: To identify changes in physician reimbursements associated with RUC rotating seat representation. DATA SOURCES: Relative Value Scale Update Committee members 1994-2013; Medicare Part B Relative Value Scale 1994-2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000-2011...

OBJECTIVES: To examine the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. STUDY DESIGN: We used observational data from the Center for Consumer Information and Insurance Oversight on the annual premiums and other characteristics of plans, matched to measures of physician, hospital, and insurer market competitiveness and other characteristics of 411 rating areas in the 37 FFMs...

OBJECTIVES: To examine the impact of the Affordable Care Act's (ACA's) 2010 parental insurance coverage extension to young adults aged 19 to 25 years on health insurance coverage and access to care, including racial/ethnic disparities. METHODS: We pooled data from the Behavioral Risk Factor Surveillance System for the periods 2007 to 2009 and 2011 to 2013 (n = 402 777). We constructed quasiexperimental difference-in-differences models in which adults aged 26 to 35 years served as a control group...

OBJECTIVES: A substantial portion of healthcare spending is wasted on services that do not directly improve patient health and that cause harm in some cases. Features of health insurance coverage, including enrollment in high-deductible health plans (HDHPs) or health maintenance organizations (HMOs), may provide financial and nonfinancial mechanisms to potentially reduce overuse of low-value healthcare services. STUDY DESIGN: Using 2009 to 2013 administrative data from 3 large commercial insurers, we examined patient characteristics and health insurance plan types associated with overuse of 6 healthcare services identified by the Choosing Wisely campaign...

Importance: Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. Objective: To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics...

Choosing Wisely was launched by the American Board of Internal Medicine in April 2012 as a patient- and clinician-targeted campaign to reduce potentially unnecessary "low-value" medical services. The campaign's impact on low- and high-value care beyond its first year is unknown; furthermore, it is unknown whether some patients such as members of consumer-directed health plans and people residing in different US regions have responded more than others. To evaluate the impact of Choosing Wisely, we used commercial insurance claims to track changes in the use of low-value imaging (x-ray, computed tomography, and magnetic resonance imaging) for back pain before and after the campaign began, a period running from 2010 to 2014...