Allison Inserro

With the threat of another government shutdown looming next week, Sen. Lamar Alexander, R-Tennessee, formally asked his colleagues in the Senate to reinstate and expand cost sharing reductions (CSRs) in an effort to lower premiums for people who do not qualify for subsidies for insurance bought through the Affordable Care Act. However, it remains to be seen if the effort will work, as a new fight over abortion funding threatens to derail any efforts to stabilize insurance markets.

New health statistics from the US government paint a picture of a population that is more obese and more prone to diabetes than it was 20 years ago. On the bright side, however, more people have health insurance.

Nine physician groups sent a letter to HHS Secretary Alex Azar Wednesday expressing concern about drug pricing proposals related to Medicare Part B and Medicare Part D that they said would hurt patient care.

The authors write that an emphasis must be put on constraining drug prices and administrative costs if the United States desires to bring healthcare spending more in line with other countries, which not only spend less but have better health outcomes. The report found that the differences were driven mainly by prices for labor and goods, including physician and hospital services, pharmaceuticals, diagnostic tests, devices, and administrative costs.

A revamped “right-to-try” bill was defeated in the House of Representatives 259-140 Tuesday night. Advocates had said the bill would give desperate, dying patients a last chance at experimental treatments. Earlier, The American Journal of Managed Care® sought reaction from Marjorie A. Speers, PhD, executive director of the WCG Foundation, a public charity which works to ensure experimental medicines to very ill patients under the FDA's current expanded access and compassionate use programs.

According to the latest report arising out of the Gallup–Sharecare State of American Well-Being series, 186 communities were ranked based on their Well-Being Index scores for 2016-2017. The index is a metric that measures areas of physical health, financial security, community pride, social connections, and purpose. For the third consecutive year, Naples-Immokalee-Marco Island, Florida, came in first.

The Great Recession was associated with increased blood pressure and glucose levels, especially among groups of older homeowners and individuals younger than 65 years still employed, according to new research published in Proceedings of the National Academy of Sciences. Medication use fell after the Great Recession, and the results provide strong evidence that economic crises can have measurable effects on public health.

In another sign of the worsening opioid crisis, a recently released CDC report found that emergency department (ED) visits for opioid overdoses rose 30% in all parts of the country from July 2016 through September 2017.

Does meaningful competition currently exist in the pharmaceutical industry and is there enough transparency on price? This was the crux of the discussion at the 2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC.

If healthcare is a human right, how do you pay for it in the United States so that no one is left behind? In a session called “Single-Payer Healthcare: Is It the Right Approach for the US?” at the 2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC, a panel tried to come up with an answer to that question.

In a keynote address at the 2018 National Health Policy Conference of America’s Health Insurance Plans (AHIP) in Washington, DC, HHS Secretary Alex Azar asked his audience to consider 4 areas that he said are key to “accelerating value-based transformation, and creating a true market for healthcare” through means of some sort of federal intervention that puts patients in control of their own health records.

A reimbursement system that relies on rebates passed between pharmaceutical companies and pharmacy benefit managers is holding back development and competition in the biosilimar market, FDA Commissioner Scott Gottlieb, MD, said in the opening session of the 2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC.

Amid a rising uproar over drug prices, UnitedHealthcare said Tuesday it will pass along to consumers in employer-based plans the rebates it receives from pharmaceutical companies.

Three House Democratic leaders introduced a healthcare bill aimed at reversing some of the actions taken by the Trump administration regarding the Affordable Care Act (ACA). Because Republicans currently control Congress, however, the legislation may largely be moot for now.

A new study from the Yale School of Public Health finds that states that did not expand Medicaid appeared to have a chilling effect on the participation of eligible adults who could have enrolled in the program, but did not, because of undocumented immigrants living in the same household.

Next week, America’s Health Insurance Plans (AHIP) holds its annual National Health Policy Conference in Washington, DC. The American Journal of Managed Care® spoke to David Merritt, its executive vice president of public affairs, about possible things to watch for during this event.

Thirty-six percent of Americans who have health coverage through the Affordable Care Act and 27% of those with Medicaid are pessimistic they will be able to keep their future coverage, according to a new Commonwealth Fund survey of 2410 adults. In addition, most believed all Americans should have the right to affordable healthcare. Those agreeing with that sentiment included 99% of Democrats, 92% of independent voters, and 82% of Republicans.

A proposed rule by the Trump administration to allow association health plans to sell insurance across state lines would shift 3.2 million enrollees out of the Affordable Care Act (ACA)'s individual and small group markets by 2022 and increase premiums, according to a new analysis from Avalere.

CMS should use its Innovation Center to pilot a proposal from the Medicare Payment Advisory Commission (MedPAC) to reform the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a senior fellow at Project HOPE. Gail Wilensky, PhD, writing in The New England Journal of Medicine, said a pilot based on the proposal that MedPAC submitted to Congress would provide “real-world evidence” as to whether or not its idea to eliminate the Merit-Based Incentive Payment System (MIPS) is an improvement.

An opinion piece in the Annals of Internal Medicine makes the case for shifting value-based payment models to address the issue of healthcare disparities directly into hospitals’ financial calculations, incentivizing institutions to address the issue head-on without sacrificing quality.

Twenty states are suing the federal government challenging the constitutionality of the Affordable Care Act (ACA), since the individual mandate was abolished in the tax reform law signed last December by President Donald Trump. The Tax Cuts and Jobs Act eliminated the tax penalty of the ACA, without eliminating the individual mandate itself, according to the lawsuit filed Monday in US District Court in the Northern District of Texas.

A new report questions what metrics policy makers are using to evaluate whether or not children enrolled in Medicaid managed care organizations are receiving quality care, given the public investment these programs receive. The report, from the nonpartisan Georgetown University Center for Children and Families, said that state Medicaid agencies and CMS do not use 1 common measurement for measuring quality of care.

A new policy report from the Urban Institute examining the effects of the Trump administration’s changes to the Affordable Care Act (ACA) finds that premiums will rise in ACA insurance plans and more people will be without insurance in certain states.

The FDA is expected to release guidance to phamarceutical companies about expanding medication-assisted treatment (MAT) to help combat substance use disorder; the National Governors Association meeting featured a number of healthcare discussions, including HHS Secretary Azar meeting with Idaho officials about their plan to sell insurance not compliant with the Affordable Care Act; the CDC has requested $350 million for a new laboratory to work on dangerous pathogens.

A study of adults in Canada found that primary care doctors were usually able to correctly identify patients with attention-deficit/hyperactivity disorder (ADHD), with the diagnosis being confirmed by a specialist in most cases.

Pediatric patients from low-income neighborhoods died at rates 18% higher while hospitalized, and had higher hospital costs after cardiac surgery, compared with those from higher-income neighborhoods, according to results of a national study that the lead investigator called “shocking.” The NIH-supported study was published Friday in Pediatrics.

The FDA is warning healthcare providers about prescribing the antibiotic clarithromycin (Biaxin) to patients with heart disease because of a potential increased risk of heart problems or death that can occur years later. FDA's recommendation is based on a review of the results of a 10-year follow-up study of patients with coronary heart disease from a large clinical trial that first observed the issue.

A liberal think tank released a universal healthcare plan modeled on Medicare that would also preserve employer-based insurance coverage as an option for those who are satisfied with their current plans. The Center for American Progress (CAP) is calling its program “Medicare Extra for All” and said it would be available to everyone regardless of income, health status, age, or insurance status.

Medicaid became a leading payer for inpatient hospital stays among certain age groups between 2000 and 2015, a brief from the Agency for Healthcare Research and Quality (AHRQ) recently reported. AHRQ’s Healthcare Cost and Utilization Project Statistical Brief presents data on hospital inpatient stays from 2000 through 2015 by age group and primary payer.

The Trump administration on Tuesday proposed extending the time period that Americans can stay in short-term, limited-duration insurance plans from 3 months to 12 months. The administration claims that the proposed changes are intended to provide affordable coverage options for individuals and families that cannot afford premiums for policies that meet the full requirements set by the Affordable Care Act, such as 10 essential health benefits and other care.