Health Policy Updates: January 14 2018

The Trump administration is moving ahead with enabling states to impose work requirements for Medicaid.

“‘This policy is about helping people achieve the American dream,’ Verma told reporters on Thursday. ‘People moving off of Medicaid is a good outcome because we hope that means they don’t need the program anymore.'”

The conventional wisdom on the impact of the ACA/Obamacare is that it has helped improve hospitals’ bottom lines – particularly in states that expanded Medicaid. Since fewer patients would be showing up for care uninsured, hospitals would not have to dole out as much “charity care” and would instead get reimbursed for this patient population.

The authors of a recent article in health affairs found a new way to measure this effect – by comparing the numbers of hospital closures between Medicaid expansion and non-expansion states. The found that Medicaid expansion had a positive impact and reduced the likelihood of hospital closure, especially among those treating rural populations.

“We found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals.”

This week saw a sobering report on childhood mortality in the USA. US children are 1.7 times as likely to die before reaching adulthood compared to other developed countries.

“Thakrar and his co-authors found that the United States is especially far off from its peer countries when it comes to infants and teenagers. Thakrar argues that some of this most likely has to do with America’s fragmented health care system. A new mother may go without health insurance before becoming pregnant — when she would usually qualify for Medicaid — and that could lead to untreated health issues ultimately affecting the child.”

Editorial in this week’s New England Journal argued against the “right to try” law currently before Congress, which would allow patients to have access to drugs that have not yet undergone FDA approval.

“If a federal right-to-try bill becomes law, the long-standing principle that broad access to medical products should await evidence of safety and efficacy will contend with the principle that patients with life-threatening diseases should have unfettered access to agents that have passed a bare minimum of safety testing…Are we prepared to abandon the FDA’s gatekeeping role in favor of unfettered patient autonomy and market forces, risking precisely the problems that prompted Congress to grant the FDA its present authority?”

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