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.
The failure of the House Republican proposal to repeal and replace Obamacare has turned the attention of Republican members of the Senate to devising an alternative that captures their somewhat more moderate preferences but still sticks to Republican promises to repeal the objectionable parts of the ACA. The most well developed version is the Patient Freedom Act (PFA), introduced by Senators Cassidy and Collins. While there is, in my opinion, much merit in the core idea of the bill—to turn back to the states the difficult job of finding a plan to cover many uninsured people at a cost to insurance buyers and taxpayers that will not blow their respective budgets—the problem as usual is the details. And the problem is that, despite persuasive criticism that the ACA was weighted down with far too many unneeded, controversial, or partisan regulations, the PFA takes much the same strategy, with prespecified insurance designs and rules for what qualifies for subsidies.
The drafters of the Orphan Drug Act did not likely foresee a world of precision medicine, in which many common diseases could be transformed into orphan ones by molecularly characterizing subsets that can be targeted with a specific drug. They did not foresee a time when seven of the top ten best-selling drugs had orphan designations. And they did not foresee a drug development product cycle in which more than 40% of all new approved drugs would have the orphan designation.
The goal of mandatory reporting is to identify children at risk of abuse, not to create more reports. Evidence is mounting that increasing mandatory reporting requirements is not an effective policy to improve detection of at-risk children.
In a recent Knowledge@Whartonblog post, LDI Senior Fellows Daniel Polsky and Scott Harrington weigh in on the fate of “Big Pharma” under the Trump Administration. This issue will take center stage as the confirmation hearings begin for Scott Gottlieb, the nominee to head the Food and Drug Administration (FDA).
New evidence supports the adoption of mandates of registration in all states as an effective and relatively low-cost strategy to enhance prescriber participation in PDMPs. The added value of mandating use needs further evaluation as more states adopt stronger and more comprehensive mandates of use in recent years.
What if health systems provided rides for elderly patients with limited transportation options or poor patients unable to access public transportation? We might applaud them for a creative strategy to improve access for vulnerable populations. However, their actions might be illegal. We navigated these legal challenges as we designed a rideshare-based medical transportation service using Lyft to help Medicaid patients get to their primary care appointment.
Penn’s third annual Martin Luther King Health Equity Symposium featured a keynote address by Antonia Novello, 14th Surgeon General of the United States, who had a hopeful, yet challenging message: “Had Martin Luther King been here today, he would see that we are doing much better, but he would he would still be fighting. He would feel pride, disappointment, sadness, and he would be appalled that blacks and whites are still segregated.”
A new study points to nursing as a key to achieving value in health care. The researchers ask whether investing in an intervention aimed at supporting direct care nurses – Magnet recognition – influences hospitals’ performance on Medicare’s Hospital Value Based Purchasing (VBP) measures. Indeed, Magnet recognition is associated with better performance on VBP measures.
A new study finds that the reformulated, abuse-deterrent version of OxyContin led to short-term substitution toward heroin. The overall effectiveness of abuse-deterrent formulations will become more evident over time as we observe whether reductions in new initiation eventually offset short-term substitution to heroin.