Unbiased Analysis of Today's Healthcare Issues
The number of hospitals owned by private equity (PE) firms has increased in recent years. One key question is how increased PE ownership has impact quality of care. To answer the question, a Jiao 2025 Health Services Research paper used claims Medicaid claims data–specifically data from the Transformed Medicaid Statistical Information System (T-MSIS) and Medicaid…
The Trump administration has introduced three most-favored-nation (MFN) drug pricing initiatives designed to link U.S. pharmaceutical costs to prices paid in economically comparable countries. Most-favored-nation pricing requires manufacturers to provide rebates when U.S. prices exceed those in reference nations—a direct response to the persistent gap between U.S. drug prices and those in other developed economies.…
How did Medicaid expansion under the Affordable Care Act impact health insurance coverage, cost and mental health? That is the question asked by Andreyeva, Rochford and Marthey (2025). They use 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine outcomes for Americans aged 26–54 with at least one child living in the…
One reason are the administrative obstacles and frictions that eligible individuals have to overcome to receive the public services. A paper by Herd and Moynihan (2025) in the Journal of Economic Perspectives provides an overview of the literature. Such burdens are the experience of policy implementation as onerous, and arise via learning costs (knowing about…
In a statement today, CMS confirmed that Elon Musk and the Department of Government Efficiency (DOGE) has been given access to CMS payment systems: CMS has two senior Agency veterans – one focused on policy and one focused on operations – who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems…
One reason is that reimbursement rates for Medicaid are lower than for Medicare or commercial insurance. Another (often overlooked) factor, however, is physician’s risk of payment denials and the administrative hassle they face trying to get reimbursed by Medicaid. A paper by Dunn et al. (2024)–cleverly named “A Denial a Day Keeps the Doctor Away“–shows…
Medicaid policies vary from state-to-state. With the advent of new, GLP-1 medications (and others) to treat obesity and overweight, there are potentially significant health benefits to be gained. However, are State Medicaid Agencies actually covering these medications? This is the question asked by Liu et al. (2024). They use data from public state Medicaid formulary…
The Biden Administration promised more access to Medicare data. Then the reverse happened. ProPublica explains: In January, the Biden administration pledged to increase public access to a wide array of Medicare information to improve health care for America’s most sick and vulnerable. Some Medicare plans’ lack of transparency “deprives researchers and doctors of critical data…
One approach CMS has is the Cell and Gene Therapy (CGT) Access Model. Under the CGT Access Model, CMS (at the federal level) will negotiates outcomes based agreements (OBAs) with manufacturers, which will include pricing terms and outcomes to be evaluated. Then states can elect to participate in the contract terms negotiated by CMS or…
New cell and gene therapies offer the promise of revolutionizing care for patients with genetic diseases. Many of these diseases impact kids and about a third of children in the US are insured by Medicaid or the Children’s Health Insurance Program (CHIP). The government faces a challenge: cell and gene therapies are potential breakthrough therapies…