Unbiased Analysis of Today's Healthcare Issues
What price does Medicaid pay for drugs? The answer is, the “best price”. What is “best price?” The 1990 Omnibus Reconciliation Act (OBRA) codified that pharmaceutical manufacturers must give Medicaid steep discounts in order to receive coverage by state Medicaid agency. How big are the discounts? The answer is the larger of a fixed percentage of the…
The Research Data Assistance Center (ResDAC) has announced that individuals and firms will now be able to get access to more CMS data. They describe their “Innovator Research” program as follows: Innovators and entrepreneurs may now access CMS data as part of a research study to create products or tools that they intend to sell…
There is a belief that providing better care can reduce cost, at least somewhat. For instance, some claim that better primary care can avoid unnecessary hospitalizations. But can increased use of prescription drugs lead to decreased medical spending? This is exactly what a paper by Roebuck et al. (2015) find. They write: We found that a 1…
Most previous research into Medicaid expansions focus on extending coverage to pregnant women or children. However, a recent Section 1115 waiver allows for researcher to examine what happens when Medicaid coverage is extended to a larger share of adults. This is exactly what a paper by Atherly et al. (2015) examines: …prior to ACA adults…
It has long been posited that increased used of home health care will decrease the use of long-term care. Clearly, there are some patients who need assistance, but for whom long-term care is not needed. If most of these people who would use home health care would otherwise be in long-term care, home health care…
A recent RWJF Issue Brief notes that states that expanded Medicaid received more revenue from the federal government and had less state-level spending on programs that support the uninsured. In examining Medicaid expansion across eight states—Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia—it is clear that states are realizing savings and revenue…
Medicare’s Shared Savings Program (MSSP) contracts with accountable care organizations (ACOs) to provide care for Medicare beneficiaries. Reimbursement levels for these ACOs depends on quality and their ability to generate cost savings relative to the non-ACO national trend. The goal is to align provider and payer incentives in improving quality and reducing cost. Would such a…
The Affordable Care Act (ACA) contained the provision requiring States to significantly expand Medicaid eligibility. The Supreme Court, however, ruled that states had the option of implementing this provision. Thus, the change in Medicaid eligibility and subsequent enrollment varied significantly across states based largely on whether or not they were an expansion state. A recent…
One part of the Affordable Care Act extended Medicaid benefits to millions of Americans. One problem, however, is that patients with Medicaid insurance often have trouble finding doctors who will treat them. The New York Times reports: Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal…
Which states have decided to receive additional federal funds to expand the share of people they cover under Medicaid? The Kaiser Family Foundation has the answer. Alabama Not Moving Forward at this Time Alaska Not Moving Forward at this Time Arizona Implementing the Medicaid Expansion Arkansas Implementing the Medicaid Expansion California Implementing the Medicaid Expansion Colorado Implementing the Medicaid Expansion…