Health Care Delivery

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the February issue, we turned to Gail Wilensky, PhD, an economist and senior fellow at Project HOPE.

The FDA gives marketing approval for a test that screens for Duchenne muscular dystrophy in newborns; acetaminophen is facing a possible statewide ban in California; the Supreme Court will not rush its decision on the Affordable Care Act.

The Supreme Court announced on January 17 it will hear a case regarding employers’ ability to limit access to free birth control under the Affordable Care Act. This marks the third instance the Court has looked at a case regarding applicability of the contraception mandate, but the first time with conservative Justices Neil Gorsuch and Brett Kavanaugh both on the bench.

Since 2016, racial and ethnic healthcare disparities have not improved; a new method of "reanimating" hearts from recently deceased donors for transplants is being tested; the new decade prompts concerns about an aging population.

Avalere Health broadcasted its annual Healthcare Industry Outlook for 2020 on January 9. The hour-long discussion included insights on some of the top healthcare topics predicted to have an impact in 2020. Although Medicare and drug pricing took center stage, artificial intelligence, the future of the Affordable Care Act, and 2020 presidential campaign platforms were among the subjects discussed.

AJMC® presents the results of our online poll of the top healthcare stories of 2019.

The FDA approved [fam-] trastuzumab deruxtecan-nxki, which will be marketed as Enhertu; preliminary CMS numbers show that 8.3 million people enrolled in coverage under the Affordable Care Act (ACA) from November 1 to December 17, about 2% fewer than last year; Sutter Health agreed to pay $575 million to settle claims of anticompetitive behavior brought by the California state attorney general as well as unions and employers.

A federal appeals court today struck down the individual mandate—the heart of the Affordable Care Act (ACA) that requires everyone to have health coverage and lays the groundwork for a risk pool that is more balanced between the sick and the healthy, the young and the old.

Open enrollment for ACA health plans is extended after glitches on Healthcare.gov; EPA watchdog found that the agency's health monitoring during Hurricane Harvey was lacking; Purdue Pharma splits ties with the lobbying organization PhRMA.

Governor Henry McMaster, a Republican, announced the waiver plan at an event in Greenville, South Carolina, with CMS Administrator Seema Verma by his side. Some observers see Verma’s promotion of Medicaid work rules in the face of court challenges as a key to her political survival in her feud with HHS Secretary Alex Azar.

Under the ACA, patients with HIV in Medicaid expansion states have greater access to care.

In a session at AMCP Nexus 2019, Melissa Andel, MPP, vice president of health policy, Applied Policy, covered the current state of health insurance coverage in the United States, major actions from the Trump administration impacting the Affordable Care Act (ACA), public sentiment around the ACA, and what stances presidential candidates have taken on healthcare.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included the average Affordable Care Act premiums falling 4%; the FDA approving a triple combination treatment for cystic fibrosis; House Republicans releasing part 1 of their healthcare plan.

HHS Secretary Alex Azar said his messaging about the Affordable Care Act (ACA) will be simple if the federal 5th Circuit Court of Appeals, in a decision that is expected any day now, sides with the administration in Texas vs Azar in finding the 2010 landmark health law unconstitutional. “Keep calm and carry on,” he said, as he and CMS Administrator Seema Verma released information about 2020 ACA premiums and health plan choices.

While the number of employers who reported they had self-insured at least one health plan had increased from 1999 to 2016, there was a sharp decrease by 38.7% in 2018, according to research from the Employee Benefit Research Institute.

According to a report from the US Census Bureau, the rising rate of the uninsured appears to be a result of a slump in Medicaid coverage. Health policy experts say the decline reflects efforts by the Trump administration to undermine the Affordable Care Act.

The nation’s community health centers, which serve patients who are largely low income and medically underserved, are facing a repeat of their 2017 funding crisis and are making contingency plans to lay off staff and reduce services, in case Congress does not pass a funding bill by September 30.

The Affordable Care Act’s reductions to Medicare Advantage plan payments were not significantly associated with healthcare access or affordability for enrollees.

An analysis of data from between 2010 and 2017 found that Medicaid expansion promoted HIV testing without increasing HIV risk behavior among nonelderly adults.

Health insurers are planning to expand their Affordable Care Act (ACA) plan offerings next year; a 4-in-1 pill can cut the risk of heart attacks and strokes; employers can see substantial savings with biosimilars if they implement a targeted effort to ecourage biosimilar use.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Health plans on the Affordable Care Act (ACA) exchanges will be required to display quality ratings starting with the 2020 plan year, according to an announcement from CMS, which is expanding the 5-star rating system it uses on Medicare plans to the health insurance exchanges.

This week, the top managed care stories included the Trump administration looking to bar legal immigrants from using public benefits; a study in The American Journal of Managed Care® finding that a law to limit surprise medical bills is working; data on Affordable Care Act enrollment showing the effect of subsidies.

A. Mark Fendrick, MD, professor of Medicine in the School of Medicine, professor of Health Management and Policy in the School of Public Health, and director of the VBID Center at the University of Michigan, discusses how low or no cost sharing for high-value services is particularly important for public health issues or epidemics, such as HIV.