Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.

This compilation is produced by the HPSA Education Committee: Sharoni Bandyopadhyay, Matthew Dunn, Payton Watt and Courtney Zott.

Medicaid Expansion Continues to Improve Outcomes, Reduce Costs

Health care has been one of the most important topics of the government debates this year, and recent studies showing the benefits of Medicaid expansion will likely change voters’ perspectives on Medicaid. It has been found that Medicaid expansion has resulted in net savings and improved health outcomes. More specifically, states that have expanded Medicaid have seen decreases in admissions, hospital stays, and hospital costs . In addition, states have seen an overall reduction in their costs . For example, Michigan has had a net decrease of $1 billion. These decreases are largely attributed to the fact that individuals with chronic conditions can now manage their health through a primary care physician, rather than delaying care until an emergency visit is needed.

On the contrary, states that have not expanded Medicaid have had increased costs and have created a coverage gap among its residents. Studies have found that two million currently uninsured adults in the U.S. would have been eligible for Medicaid if their state had expanded eligibility. This expansion would have been particularly beneficial for residents who live in rural areas . Unfortunately, there are not many other coverage options for these individuals whose incomes are below the poverty line. 

There is increasing evidence that Democrats and Republicans alike support Medicaid expansion , but they are taking different approaches. Many Democrats support a single-payer system, and Republicans— including Trump— are currently trying to impose work requirements for Medicaid recipients. Some states, like Tennessee, are considering block grants that would put a cap on the amount of spending that the state can use toward Medicaid. Overall, the 2018 midterm elections that showed that most states are choosing Medicaid expansion in order to improve health care outcomes— a total of 37 states and the District of Columbia . In 2019’s midterm election, voters asserted their concerns with healthcare coverage, with voters in Kentucky, Virginia and Mississippi favoring candidates who supported the expansion of Medicaid. 

Sources: Modern Healthcare , Center on Budget and Policy Priorities , Kaiser Family Foundation , Kaiser Family Foundation , Kaiser Family Foundation , NBC News , The Wall Street Journal , Tennessean , Healthcare.gov , Kaiser Family Foundation

HMP Spotlight: New Study Finds that CMS Effort to Reduce Hospital-Acquired Injuries and Infections Adds Little Value

New research from Dr. Andrew Ryan in UM’s Health Management and Policy Department raises questions about the efficacy of a federal effort to reduce hospital-acquired injury and infection rates.

 

The study , published Monday in Health Affairs, found that the Hospital-Acquired Condition Reduction Program did not lead to improvements in Michigan beyond what was expected based on the state’s existing trends. The Hospital-Acquired Condition Reduction Program launched with the passage of the Affordable Care Act and penalizes hospitals financially for performing in the bottom 25% of their peers on conditions such as pressure injuries, central line-associated blood stream infections, surgical-site infections and catheter-associated urinary tract infections. This study is the first to independently evaluate its efficacy.

 

Dr. Ryan told Modern Healthcare that the penalty—a 1% reduction in Medicare payment—could be inadequate to motivate significant change in hospital performance. Additionally, hospitals argue that it does not account for progress. Hospitals within the bottom quartile are penalized the same each year regardless if their performance represents an improvement.

 

Interestingly, the study also found that hospitals may be under-reporting patient injuries and infections to avoid penalties. The researchers used data from the Michigan Surgical Quality Collaborative rather than Medicare claims data and discovered much higher rates than are found in the program.

 

Sources: Modern Healthcare

Wildfires Continue to Devastate California, Raising Questions on Effective Policy Interventions to Reduce Impact

After a relatively calm start to the 2019 wildfire season, large fires have broken out over the past few weeks in Southern California. As of October 29th, there were 17 major fires actively burning across California. Consequently, approximately 130 million trees were lost, millions of people lost power or were forced to evacuate their homes, and dozens of schools were closed. Although the state was better prepared this year to combat the fires, there is still a large threat to public health. 

A large portion of the danger is due to the smoke released by wildfires. Particulate matter is the main pollutant, which is associated with the development of heart disease, lung disease, and cancer . Children, the elderly, and people with certain pre-existing health conditions are considered to be most at-risk. Also, smoke can become trapped by land features or weather, extending the health risks for weeks after the wildfire occurs. A major problem is that some people are unable to evacuate unsafe areas. For instance, low-income California farm workers often have to choose between working in toxic conditions or losing their pay. Government relief programs are available, but many of the workers are undocumented and fear that applying to these programs would jeopardize their safety. 

There is no silver-bullet solution to these challenges, but there are policy proposals that may help. Intensive climate interventions to reduce emissions, such as strict cap and trade policies, can reduce the frequency of major wildfires over time. Building affordable housing units in California cities would also protect forests, which are strained when working-class people are locked out of developed areas and pushed toward the wilderness. Finally, it is important that utility companies update their infrastructure and grid-lines to the highest standard of fire resistance. 

Sources: Health Affairs , California Air Resources Board , Vox

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