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In a push to encourage “personal responsibility,” the Centers for Medicare and Medicaid Services (CMS) has approved work requirements as a condition for receiving Medicaid benefits in four states - Kentucky, Indiana, Arkansas, and most recently New Hampshire, with applications from other states pending. In a new JAMA Viewpoint, Harald Schmidt and Allison Hoffman review the implications and ethics of Medicaid work requirements and other personal responsibility policies. They propose safeguards CMS should consider to minimize risk and protect beneficiaries’ health.
A new study in Health Affairs by Hilary Barnes, Matthew McHugh, and colleagues, demonstrates the increasingly important role nurse practitioners (NPs) have in primary care in the United States.
[Reposted: Jalpa A. Doshi, Justin Puckett, Michael S. Parmacek, and Daniel J. Rader. Balancing Affordability And Access: Lessons From New Cholesterol-Lowering Drugs, Health Affairs Blog, June 5, 2018. https://www.healthaffairs.org/do/10.1377/hblog20180604.549026/full: Copyright ©2018 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
PCSK9Is offer a fascinating case study in the intersections between pharmaceutical innovation, specialty drug pricing, real world budget concerns, and patient access. This is not the first time PCSK9Is have been the focus of media attention. They reignited national debate about the high cost of medications and the need to rein in prescription drug spending in the wake of their approval by the Food and Drug Administration (FDA) in the summer of 2015. Their efficacy in lowering stubbornly high LDL cholesterol was impressive; however, payers were concerned with their list price (approximately $14,000), as well as the absence of data at launch showing that the cholesterol reductions were accompanied by lower rates of cardiovascular events such as heart attacks and strokes.
June 7, 2018
Scott Halpern, Kevin Volpp Michael Harhay, and colleagues recently published results of a large smoking cessation trial in the New England Journal of Medicine. They tested the real-world effectiveness of offering five strategies for quitting smoking among all known smokers at 54 U.S. companies (over 6,000 employees). The results reflect what employers, insurers, or others offering similar programs might expect to see. Here, Scott Halpern shares some thoughts on the trial, including what we can and cannot conclude.
June 4, 2018
New research shows that young citizen children were more likely to receive important social services when their undocumented mothers became eligible for the Deferred Action for Childhood Arrivals (DACA) program. Providing evidence of the multi-generational spillover effects of immigration policy, this new analysis comes as the U.S. House of Representatives is on the brink of forcing a vote on a permanent solution for recipients of the DACA Program.
May 29, 2018
Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.
May 17, 2018
Several states, including some that reluctantly implemented Medicaid expansion and some contemplating it, have asked for federal permission to link Medicaid eligibility to labor force participation—working or looking for work. As with everything in health policy these days, this idea is controversial, with disagreement even about the facts but more fundamentally about subjective social values.
May 17, 2018
LDI Senior Fellow Julie A. Fairman, PhD, RN, FAAN made history last week as she became the first nurse to deliver the prestigious Garrison lecture at the American Association for the History of Medicine’s 91st annual meeting in Los Angeles.
May 15, 2018
Family caregivers of hospitalized patients will get much needed support and guidance in the 39 U.S. states and territories that have enacted versions of the Caregiver Advise, Record, Enable (CARE) Act. To achieve the intended public health outcomes, however, the needs of diverse communities, such as Latinos, immigrants, and other marginalized groups, must be considered as these policies are implemented.
May 6, 2018
On May 2 and 3, the School of Nursing sponsored a multidisciplinary “Think Tank” devoted to improving care for older adults with chronic illness. Led by Mary Naylor and Nancy Hodgson, it drew more than 40 external thought leaders, who joined Penn experts from across the University. You’ll be hearing much more in the coming weeks about the Think Tank’s recommendations, but from a policy perspective, it could not have come at a better time.
April 26, 2017
For the nearly 30 million people in the U.S. who have no health insurance, gaining access to care and paying for that care can be a challenge. A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price. To understand what it’s like to be uninsured, a new Bloomberg News project provides the personal stories behind the statistics, highlighting why and how some Americans are going without health insurance.
April 25, 2018
The American Dental Association (ADA) recently announced a new policy on opioid prescription. This is the latest in a series of ADA statements in response to the prominent role of dentistry in the opioid epidemic. In addition to mandatory continuing education and prescription limits, the ADA indicated its support for “dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.”
April 23, 2018
Engaging patients, families, and independent experts in policymaking is a laudable goal, but the process of doing so isn’t necessarily straightforward. If efforts to introduce patient and public perspectives also introduce bias, they may do more harm than good. In JAMA Internal Medicine, Matthew McCoy, Genevieve Kanter, and colleagues raise concerns that FDA public engagement is rife with conflicts of interest), which are frequently undisclosed.