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New From the GAO

October 31, 2014 Comments off

New GAO Report
Source: Government Accountability Office

Government Efficiency and Effectiveness: Inconsistent Definitions and Information Limit the Usefulness of Federal Program Inventories. GAO-15-83, October 31.
http://www.gao.gov/products/GAO-15-83
Highlights – http://www.gao.gov/assets/670/666734.pdf

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Voters and the Affordable Care Act in the 2014 Election

October 31, 2014 Comments off

Voters and the Affordable Care Act in the 2014 Election
Source: New England Journal of Medicine

As we approach the 2014 election, we are witnessing an unusual situation. Poll results suggest a low level of public interest and a low projected voter turnout in this election. Only about half (52%) of the public say they are currently paying attention to the election (CBS News–New York Times [CBS-NYT] poll, 2014). On the basis of past nonpresidential-year elections, less than half of U.S. adults are expected to vote.1 At the same time, congressional candidates are raising a number of important national issues, including what should be the future of the Affordable Care Act (ACA) in the years ahead.

Most Democratic candidates hold positions in favor of continuing the next phase of the ACA’s implementation mostly in its current form, whereas most Republican candidates have positions favoring some sort of major scaling back, repeal, or replacement of the legislation. For a number of different reasons, political forecasters see this election’s outcome as being very close. They give at least an even chance that the Republican Party will win majorities in both the House of Representatives and the Senate. The uncertain outcome of this election has importance for health care because of the polarized views held by each party’s candidates on the future of the ACA, federal health spending, and policies regarding federal health care regulation.

This article, which is based on an analysis of data from 27 public opinion polls by 14 organizations, seeks to examine the role of the ACA in the 2014 election and the potential implications for health care depending on the outcome. It examines the following six questions: How important is health care, and specifically the ACA, as an issue in the 2014 election? If a congressional candidate supports the ACA, are voters more or less likely to vote for him or her? What is the current level of voter support for the ACA? How does this support vary according to voters’ partisan affiliation? Do voters currently support a core principle of the ACA that it is the responsibility of the federal government to make sure that all Americans have health care coverage? What do voters want the next Congress to do with the ACA?

Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (October 23, 2014)

October 31, 2014 Comments off

Can the President Bar Foreign Travelers from Ebola-Stricken Countries from Entering the United States?, CRS Legal Sidebar (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The recent outbreak of the Ebola virus in West Africa has prompted concern over the risk that foreign travelers may carry the virus to the United States — a concern that has grown since an infected Liberian national who traveled to the United States infected two nurses who cared for him at a Dallas hospital. On Monday, October 21, the Department of Homeland Security announced new screening procedures at U.S. ports of entry for travelers from Ebola-stricken countries in West Africa. Several Members of Congress have gone further and suggested a blanket ban on the admission into the United States of foreign nationals who reside in or have recently traveled to Ebola-stricken countries – a suggestion that the Obama Administration has thus far opposed. Although it has never been used for such purposes, section 212(f) of the Immigration and Nationality Act (INA) seems to confer the President with authority to bar foreign travelers from Ebolastricken countries from entering the United States, if he deems such a restriction necessary to protect U.S. interests, regardless of whether there is a reason to believe that a particular traveler is infected with the Ebola virus.

The Federal Civil Service Workforce: Assessing the Effects on Retention of Pay Freezes, Unpaid Furloughs, and Other Federal-Employee Compensation Changes in the Department of Defense

October 31, 2014 Comments off

The Federal Civil Service Workforce: Assessing the Effects on Retention of Pay Freezes, Unpaid Furloughs, and Other Federal-Employee Compensation Changes in the Department of Defense
Source: RAND Corporation

Planners and policymakers must be able to assess how compensation policy, including pay freezes and unpaid furloughs, affects retention. This study begins to extend the dynamic retention model (DRM) — a structural, stochastic, dynamic, discrete-choice model of individual behavior — to federal civil service employment. Models are developed and estimated,using 24 years of data, and then used to simulate the effects of pay freezes and unpaid furloughs. A permanent three-year pay freeze decreases the size of the retained General Service (GS) workforce with at least a baccalaureate degree by 7.3 percent in the steady state. A temporary pay freeze with pay immediately restored has virtually no impact on retention. When pay is restored after ten years, the retained GS workforce falls by 2.8 percent five years after the pay freeze and 3.5 percent ten years after it. An unpaid furlough, similar to the six-day federal furlough in 2013, has no discernible effect on retention. For all subgroups of GS employees for which the model is estimated, the model fit to the actual data is excellent, and all of the model parameter estimates are statistically significant. In future work, the DRM could be extended to provide empirically based simulations of the impact of other policies on retention; to estimate effects on other occupational areas, other pay systems, or specific demographic groups; or to create a “total force” model (military and civilian) of DoD retention dynamics and the effects of compensation on those dynamics.

Federal Funds for Research and Development: Fiscal Years 2011-13

October 31, 2014 Comments off

Federal Funds for Research and Development: Fiscal Years 2011-13
Source: National Science Foundation

This report is volume 61 of the Federal Funds series of detailed statistical tables. It presents data collected by the Survey of Federal Funds for Research and Development for FYs 2011–13. In May 2012, the survey was sent to all federal agencies identified as conducting R&D programs, and 27 agencies reported R&D funding levels. The basis for reporting is determined by fiscal year.
• FY 2011 data are completed transactions
• FY 2012 data are estimates of congressional appropriation actions and apportionment and reprogramming decisions
• FY 2013 data are estimates of administration budget proposals not yet acted on

Subsequent volumes in this series will show authorization, appropriation, deferral, and apportionment actions completed after these data were collected.

The data tables provide R&D totals as outlays and obligations. Obligations data are sorted as follows:
• Character of work (basic research, applied research, development, and R&D plant)
• Federal agency
• Field of science or engineering (for research but not for development)
• Geographical area
• Performer

Each year, agencies report obligations or outlays incurred or expected to be incurred in that year, no matter when the agencies’ funds were authorized, appropriated, or received. Agencies report R&D funding whether or not their budgets itemize funds for research, development, and R&D plant.

HHS OIG — Medicare Paid for HIV Drugs for Deceased Beneficiaries

October 31, 2014 Comments off

Medicare Paid for HIV Drugs for Deceased Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. OIG has had ongoing concerns about Medicare paying for drugs and services after a beneficiary has died.
Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive. Although this report focuses on HIV drugs, the issues raised are relevant to all Part D drugs.

HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012. Part D sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the drug, beneficiary, pharmacy, and prescriber. We used the Beneficiary Enrollment Database, the Social Security Administration’s Death Master File, and Accurint’s Death Records to identify beneficiaries’ dates of death.

WHAT WE FOUND
Medicare paid for HIV drugs for over 150 deceased beneficiaries. CMS’s current practices allowed most of these payments to occur. Specifically, CMS has edits (i.e., systems processes) in place that reject PDE records for drugs with dates of service more than 32 days after death. CMS’s practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies.
This review looked only at HIV drugs, which account for one-quarter of one percent of all Part D drugs in 2012. However, our findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers.

WHAT WE RECOMMEND
We recommend that CMS change its practice of paying for drugs that have a date of service within 32 days after the beneficiary’s death. CMS should eliminate or-if necessary for administrative processing issues-shorten the window in which it accepts PDE records for drugs dispensed after a beneficiary’s death. Such a change would prevent inappropriate payments for drugs for deceased beneficiaries and lead to cost savings for the program and for taxpayers. CMS concurred with our recommendation.

ACA Advertising in 2014 – Insurance and Political Ads

October 31, 2014 Comments off

ACA Advertising in 2014 – Insurance and Political Ads
Source: Kaiser Family Foundation

Since the passage of the Affordable Care Act (ACA) in 2010, the law has been an often potent and divisive political issue, and has sparked an unprecedented amount of political and campaign advertising, particularly from candidates and groups that oppose the law. According to Kantar Media’s Campaign Media Analysis Group (CMAG), no other federal program or policy has resulted in the kind of advertising the ACA has caused, namely the combination of new insurance “product” advertising and sustained political advertising across multiple election cycles.

This year, Americans saw the launch of the ACA’s insurance market reforms, the implementation of the state and federal exchanges where people can shop for coverage and access subsidies, and the expansion of Medicaid in many states. Alongside these policy changes, new stakeholders began to advertise to encourage participation in the new coverage options, including state and federal governments, non-profit groups looking to boost enrollment, and health insurance companies seeking new customers. The mid-term elections have also brought a new collection of political advertising with ACA messaging. These two distinct types of advertising have different goals and aims; some encourage people to take advantage of new options under the ACA, while others encourage people to vote a certain way. With both of these types of advertising making their way into American living rooms in 2014, this analysis describes the full spectrum of ads that the American public is being exposed to regarding health care, both in the context of health insurance coverage, and as a political issue in the mid-term elections.

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