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The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies

March 18, 2015 Comments off

The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies
Source: Kaiser Family Foundation

This fact sheet summarizes the major statutory requirements and policies pertaining to U.S. global family planning/reproductive health (FP/RH) efforts over time and identifies those currently in effect. These laws and policies collectively serve to direct how U.S. funds are spent, to where and which organizations funds are provided, and generally shape the implementation and define the scope of U.S. global FP/RH activities. It includes U.S. laws and annual requirements enacted by Congress through appropriations bills (statutory provisions) as well as executive branch policies and guidance specific to FP/RH (policy provisions). Each category lists provisions in chronological order.

Consumer Assets and Patient Cost Sharing

March 12, 2015 Comments off

Consumer Assets and Patient Cost Sharing
Source: Kaiser Family Foundation

Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. Plans with higher deductibles and other point of service costs provide health plan enrollees with incentives to make more cost conscious health care choices. For families with limited resources, however, high cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. Many current policies expose individual enrollees to thousands of dollars in cost sharing expenses and family expenses can easily top ten thousand dollars when someone becomes seriously ill.

While concerns about cost sharing are not new, the recent coverage expansions under the ACA put a new focus on what it means for coverage to be affordable. The goal of the law was to cover more of the uninsured, many of whom have limited means. The law requires most people to have health insurance, if they can afford to pay the premium, or to pay a penalty. The issue for some families, however, is that the policies with affordable premiums may have cost sharing requirements that would be difficult for them to meet when they access services. Many of the policies in the state and federal marketplaces have significant cost sharing, as do many policies provided to people at work [here]. The ACA provides cost-sharing assistance to some, primarily to those with incomes below 200 percent of poverty purchasing through a state or the federal marketplace (see sidebar). Others potentially face much higher out-of-pocket expenses.

We use information from the 2013 Survey of Consumer Finances to look at how household resources match up against potential cost-sharing requirements. We assume that households pay premiums out of current income, but that they may need to use savings or other assets if they become seriously ill in order to meet the deductible or the out-of-pocket limit under their health insurance policies. We show that many households, in particular those with lower incomes or where someone lacks insurance, have low levels of resources that would make it difficult for them to meet health insurance cost sharing demands.

See also: The Cost of Care with Marketplace Coverage

Trends in Medicaid Spending Leading up to ACA Implementation

March 3, 2015 Comments off

Trends in Medicaid Spending Leading up to ACA Implementation
Source: Kaiser Family Foundation

In the years leading up to the Affordable Care Act (ACA), Medicaid programs were influenced by several factors, including enrollment growth related to the Great Recession, fiscal pressures and changes in program financing, and preparation and early implementation of some ACA provisions. This paper presents data on Medicaid spending during the period of these changes, the first half of which we refer to as the “recessionary period”, and the second half of which we refer to as the “post-recessionary period”. We use administrative data to first examine overall spending trends and trends by service type. We then draw on additional data to analyze per enrollee spending growth during this period, both by service type and by eligibility group, to understand what drove Medicaid spending.

Tapping Nurse Practitioners to Meet Rising Demand for Primary Care

February 17, 2015 Comments off

Tapping Nurse Practitioners to Meet Rising Demand for Primary Care
Source: Kaiser Family Foundation

Over 58 million Americans reside in geographic areas or belong to population groups that are considered primary care shortage areas. In these areas, known officially as primary care Health Professional Shortage Areas (HPSAs), the supply of primary care physicians relative to the population falls below federally defined standards.1 The proportion of Americans living in HPSAs varies widely by state, from 1.4% (Nebraska) to 57.3% (Mississippi), but in almost half the states, it is at least 20%, including six states (including DC) where it exceeds 30%.

The demand for primary care is projected to rise over the next five years, due largely to population growth and aging, and to a smaller extent, to expanded health insurance.2 The Health Resources and Services Administration (HRSA), the federal agency focused on improving access to care and strengthening the health care workforce, projects a shortage of 20,400 primary care physicians in 2020, and other experts, too, have projected a large shortfall in the coming years.3 4 However, a recent Institute of Medicine (IOM) report on shaping the health care workforce for the future noted that such projections of primary care physician shortages are generally based on traditional health care delivery models and do not consider the potential of an expanded primary care role for physician assistants and advanced-practice nurses, redesign of health care, telehealth, and other innovations.5 This brief focuses on the untapped potential of one type of advanced-practice nurses – nurse practitioners – to increase access to primary care.

How Health Expenditures Vary Across the Population (Slideshow)

January 5, 2015 Comments off

How Health Expenditures Vary Across the Population
Sourvce: Kaiser Family Foundation

In a given year, a small portion of the population is responsible for a very large percentage of total health spending. This slideshow explores the variation in health spending across the population through an analysis of the 2012 Medical Expenditure Panel Survey (MEPS) data. The analysis shows that the 1% of the population with the highest spending accounted for almost one quarter of health spending (23%) and that the top 5% of the population is responsible for almost half of all spending. It also examines spending variation across different demographic and health factors, including age, gender, race, insurance status and presence of certain health conditions.

The slideshow is part of the Peterson-Kaiser Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system. More information about the analysis leading to the slideshow is available through the tracker.

Coverage of Preventive Services for Adults in Medicaid

January 4, 2015 Comments off

Coverage of Preventive Services for Adults in Medicaid
Source: Kaiser Family Foundation

The Affordable Care Act (ACA) added emphasis to the importance of preventive services in improving lives. As of January 1, 2013, per Section 4106 of the ACA, states can receive a one percentage point increase in their federal Medicaid match rate for preventive services if they cover without cost sharing all the adult preventive services (see Table A1) recommended by the federally-convened U.S. Preventive Services Task Force (USPSTF) and Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). As of the time of the survey, four states had submitted state plan amendments (SPAs) to receive the 1% increase and since then, 4 additional states (8 total) have submitted SPAs for the enhanced match. States must cover preventive services for adults newly eligible for Medicaid under the ACA, but this is not required for the group of adults enrolled in or eligible for traditional Medicaid prior to the ACA’s expansion of the program.This brief highlights data from a survey of state Medicaid programs conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) on coverage of preventive services recommended for non-elderly adults before the ACA was enacted.1,2 The survey asked states about coverage and cost sharing in their fee-for-service Medicaid programs as of January 1, 2013 for 40 adult preventive services rated grade “A” or “B” by the USPSTF and immunizations recommended by the ACIP. The survey also asked about coverage for seven additional preventive services for women that are recommended by the Health Resources and Services Administration (HRSA) (see Table A2).3 In total, 39 states and the District of Columbia replied to the survey.

What Drives Spending and Utilization on Medicaid Drug Benefits in States?

December 20, 2014 Comments off

What Drives Spending and Utilization on Medicaid Drug Benefits in States?
Source: Kaiser Family Foundation

Medicaid is one of the country’s biggest payers for prescription drugs, but because prescription drugs have accounted for a small share of total Medicaid spending, Medicaid’s pharmacy benefit policies have not been at the top of mainstream healthcare policy debate. However, with the approval of new specialty drugs, such as the Hepatitis C treatment Sovaldi, states are mindful that the price tag for the Medicaid drug program could increase significantly. While states have implemented many cost-saving policies targeting their Medicaid prescription drug benefits, there remains room for additional cost savings, better management, and improved health outcomes. To ensure appropriate policy for this central benefit and achieve these goals, it is important to understand which drugs are most frequently prescribed and which drive spending.

Using state drug utilization data, as well as an industry drug database, this issue brief examines trends in Medicaid drug prescriptions and drug spending before rebates from 2010 through 2012.1 As part of the Medicaid drug benefit, manufacturers provide rebates to the state and federal government. However, rebates are based on proprietary data and they are not available to the public at the drug level. As a result we are unable to include them, or use this data to calculate total Medicaid drug spending. After presenting this analysis, we place these findings in the context of policy discussions. Key findings of the analysis include:

  • Comprising 35% of prescriptions and 34% of spending before rebates in 2012, Central Nervous System Agents, a class of drugs that include pain killers, antidepressants, and antipsychotics, constitute the largest share of Medicaid drug utilization and spending. Within this drug class, pain killers and fever reducers represent a third of utilization.
  • Specialty drugs account for just two percent of drug utilization in 2012, but they comprise 28% of drug spending. This share increased from 2010 when they totaled 24% of drug spending before rebates. The specialty drug share of total drug spending varies at the state level.
  • Brand-name drugs account for a disproportionate amount of drug spending. In 2012, they accounted for 20% of Medicaid drug prescriptions but 76% of spending. In the past three years, the share of Medicaid drugs that are generic has risen slightly, possibly due to a number of blockbuster brand drugs losing their exclusivity and facing generic competition in the past several years.
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