Policy

The health policy implications and ballot measures in the wake of the presidential election, new trends in physician compensation, lessons from the Medicaid unwinding, disparities in cancer mortality, and privately negotiated hospital fees.

Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.”

Physician reimbursement stands to be affected by the consolidation of medical systems and changes in Medicare enrollment affecting their pay, which may lead to shifts in medical training and hiring.

Relying on a 2-stage secret shopper survey, the authors found that inaccuracies in provider directories often persisted for well over 1 year.

Former President Donald J. Trump’s return to the White House portends a significant shakeup of health policy.

As Cigna and Humana pick back up on the potential for a megamerger, executives will be keeping a close eye on the outcomes of the presidential election.

Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).

Financial toxicity is a burden many patients and their families unfortunately are forced to shoulder, leading some to delay or skip care and incur bills related to their care that they lack the financial capacity to pay off.

As presidential candidates Kamala Harris and Donald Trump diverge on health care reform paths, contrasting futures hinge on the outcome of the presidential election.

This week’s Center on Health Equity & Access highlights emphasize the role of social determinants of health in policy-making and underscore the importance of addressing rising costs and challenges employers face.

CMS is creating infrastructure to improve coverage of prescription digital therapeutics (PDTs), and new legislation would also drive uptake of PDTs.

In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering.

Report reveals growing divide between subsidized and unsubsidized enrollees.

Program yields largest savings in its history of more than $2.1 billion in 2023.

The authors detail how artificial intelligence could be used in primary, secondary, and tertiary prevention to improve health outcomes and provide better value-based care.

As the US charts its course through the next political era, it is crucial that we boldly allocate resources and prioritize what truly impacts patients. When faced with complexity, feasibility concerns, or entrenched norms, we must proclaim: “It’s the outcomes, stupid.”

Here are 10 concrete, immediately implementable, and highly impactful measures that could significantly improve the US health care system by expanding access and reducing costs.

There are 3 ways to make the US health care system more efficient and sustainable: address its burdensome complexity, emphasize primary care reimbursement, and regulate drug pricing.

The author highlights reasons why we have not seen substantial cost savings in the health care industry and why future efforts are likely to continue to see forceful pushback, as well as offers potential solutions.

The US should consider reducing or eliminating employer-sponsored insurance. Here are some ways to do it efficiently.

The policy community should consider these concrete suggestions to address the challenges presented by social determinants of health.

As health care moves toward a value-based payment model, the pharmacy benefit is going in the opposite direction, one that places unit cost over clinical appropriateness.

Of the 10% of women contacted for this survey who said that they or their partner had ever sought fertility assistance, only 7% were able to get the necessary care; cost was cited as the top reason for not being able to access fertility services.

Medicaid expansion is associated with improved care and increased survival rates for patients with certain breast cancers, but future studies should focus on whether Medicaid expansion mitigates the disparities between Black and non-White patients.

Kimberly Westrich, MA, of National Pharmaceutical Council, and Adam Colborn, JD, of AMCP, run through the current status of lawsuits and lawmaking at the federal and state levels related to pharmacy benefit managers and cost-shifting programs.

Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.

Among near-poor Black and Hispanic individuals, Medicare Advantage was associated with increased vision care and some, although not uniform, reductions in access disparities vs traditional Medicare.

Groundbreaking proposal to expand contraception coverage under the ACA marks the most significant update in over 10 years.

The AMCP Nexus 2024 annual meeting covered a variety of hot health care topics impacting managed care pharmacy in the present and future.

Many women remain unaware that the Affordable Care Act (ACA) mandates cost-free preventive services; however, ongoing legal challenges threaten the future of this coverage.