Health Care Reform Bill Research Articles

The United States’ Health Care Reform Bill – A Translation

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APA Fights Hard Against Republican Health Care Bills

Back to table of contents Previous article Next article Government NewsFull AccessAPA Fights Hard Against Republican Health Care BillsK.J. HertzK.J. HertzSearch for more papers by this authorPublished Online:27 Jul 2017https://doi.org/10.1176/appi.pn.2017.8a27AbstractAPA is pulling out all the stops to protect Americans’ access to mental health/substance use care.APA leadership and staff of the Deparment of Government Relations (DGR) have been working tirelessly to protect mental health coverage in a highly unpredictable health care reform process that threatens to harm millions of Americans. Immediate Past APA President Maria A. Oquendo, M.D., Ph.D., joined physicians from five other medical organizations last month to meet with members of Congress and their staffs to voice opposition to the Better Care Reconciliation Act. Above, she shakes hands with Sen. Steve Daines (R-Mont.).David HathcoxIn the past few months, Republicans have issued two health care reform bills titled the Better Care Reconciliation Act and considered repealing the Affordable Care Act (ACA) without replacing it. Under these proposals anywhere from 22 million to 32 million people would be at risk of losing their coverage, including tens of millions of individuals on Medicaid—the largest provider of behavioral health services. Furthermore, states would be able to opt out of requiring mental health and substance abuse treatment coverage as an essential health benefit. APA has taken a leadership role in consistently opposing these efforts to repeal and replace the Affordable Care Act. APA leaders and staff have engaged Capitol Hill lawmakers and staffers; worked as a leader in coalitions, including the Mental Health Liaison Group (a group of medical and advocacy organizations that focuses on mental health issues); and facilitated “fly-ins” with leaders coming to Washington D.C. to advocate on Capitol Hill and participate in press conferences with other major medical specialty groups. On the Hill, APA leaders and staff have met with members of Congress and their staffs on both sides of the aisle, specifically targeting key Republican offices—leading up to the vote in the House as well as the vote in the Senate scheduled at press time. APA has also written numerous letters with five other frontline physician groups—American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians & Gynecologists, and American Osteopathic Association—to the House and Senate about the negative effects the Republican health care bills would have on patients across America. That same coalition worked over several months to host fly-ins with leadership from each organization participating in press conferences and meetings with the offices of key senators. During the fly-ins, APA Immediate Past President Maria A. Oquendo, M.D., Ph.D., and former APA President Renȳe Bender, M.D., expressed APA’s concerns and urged the senators to take a bipartisan approach to health care reform.In addition, APA has utilized the full force of its grassroots membership and social media to mobilize letter-writing and phone campaigns urging APA members to ask their members of Congress to vote no on any version of the bill that does not adequately protect people with mental illness and ensure access to mental health care as an essential health benefit.“APA believes that the health and mental health of the American people is paramount to its prosperity,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We urge Congress and the administration to work in a bipartisan manner to fix the ACA and improve it. We are willing to sit down with members of both parties and come up with a solution that puts patients first. Any health care plan needs to maintain mental health and substance use treatment as essential benefits. Mental health must be treated the same as physical illness in any bill moving forward.” ■K.J. Hertz is director of federal relations in APA’s Department of Government Relations. ISSUES NewArchived

Impact of tobacco industry and other corporations in the defeat of the 1994 Clinton health care plan

BackgroundThe primary reason cited by many scholars for the defeat of the Clinton Administration’s 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry’s role was in whole or part in defeating the Clinton health care bill.MethodsThis research occurred through crosschecking internal tobacco industry documents and Clinton White House documents.ResultsPrior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill.ConclusionsThe primary reason for the bill’s ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill’s defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.

Investigation of the Impact of the Massachusetts Health Care Reform on Hospital Costs and Quality of Care

In 2006, the Massachusetts legislature passed a landmark health care reform bill (the Reform) that has served as a model for the national health care reform. By aiming to provide “access to affordable, quality, accountable health care,” the goals of this reform were to reduce the number of uninsured Massachusetts residents while containing the growth of health care costs and improving the quality of health care services. The current paper examines the impact of the Reform on the quality of care in addition to hospital costs simultaneously from a perspective of efficiency analysis. We develop an integer-valued non-radial Russell data envelopment analysis (DEA) model, which is unit variant and calculate the hospitals’ efficiency directly. However, the proposed integer-valued model is non-linear. The current paper thus transforms this model into a parametric integer linear programming. We develop a method to derive its optimal solutions. We then use the new DEA model to calculate and compare the efficiency scores of hospitals in Massachusetts and Connecticut pre- and post-Reform. The analysis shows that the Reform has achieved its cost containment and quality improvement goals at the same time. These analyses provide potentially useful information to hospital regulators and government regulators, especially in light of the national interest on health care legislation.

Health Care Reform and Access to Hematopoietic Cell Transplantation

The landmark health care reform bill, the Affordable Care Act (ACA), was implemented on January 1, 2014. Among the changes to the United State's health care system are three main aspects: 1) creation of health insurance exchanges, 2) definition of essential health benefits and 3) Medicaid program expansion. The health insurance exchanges will act as marketplaces for people to shop for and compare health insurance plans in their state. There are three models of health insurance exchanges: federally facilitated, state run and partnership exchanges that have input from both the state and federal governments. Each state chose to create their own exchange or to have the federal government create and operate their state exchange. The exchanges present an opportunity for people to access affordable health insurance through federal tax credits that will subsidize premiums for individuals and families up to 400 percent of the federal poverty level (FPL). The exchanges are expected to enroll 7 million people in the first year of the ACA. Each exchange will offer a variety of qualified health plans (QHP) that are approved by the state and/or the US Department of Health and Human Services (HHS). Every QHP and non-grandfathered commercial health insurance plan is mandated to include a minimum level of coverage known as an essential health benefit (EHB) package selected by each state. Information was collected on each state's EHB plan to determine coverage of hematopoietic cell transplantation (HCT), and was analyzed for the level of HCT benefits with consideration of the Recommended Benefit Design For HCT developed by the National Marrow Donor Program (NMDP) (www.payor.bethematchclinical.org). States were then divided into three categories: poor coverage, fair coverage and excellent coverage. Eleven states had poor coverage, 12 states had fair coverage and 28 states had excellent coverage included in their EHBs. While access to health insurance is expanding, it is important that coverage of HCT meets levels prescribed in the Recommended Benefit Design For HCT. Additionally, states were able to expand their state Medicaid programs to include adults up to 138 percent of the FPL. To date, twenty-five states are expanding their Medicaid programs, resulting in increased access for low-income adults in their states. In states that expanded their Medicaid programs, 31,587,000 adults are now eligible to access to health insurance coverage through Medicaid (Kaiser Family Foundation). A study done by the NMDP provides HCT incidence rates that translates to a possible 2,148 Medicaid patients needing an allogeneic HCT following Medicaid expansion by states that have already voted to expand in the first year of ACA implementation. Transplant centers will need to understand how their state operates in each of these three aspects in order to provide patients with access to HCT in 2014 and beyond.

Destined for Failure? An Analysis of the Biologics Price Competition and Innovation Act of 2009

In 2010, Congress enacted the Biologics Price Competition and Innovation Act (“BPCIA”) as part of the large health care reform bill. The BPCIA creates a statutory pathway for FDA approval of “biosimilars”––which are generic versions of biologic drugs. Congress expects this new approval pathway for biosimilars to help lower biologics prices, just as generic drugs have significantly lowered pharmaceutical prices. This Note argues that, for three main reasons, the BPCIA will not succeed in lowering drug prices to the same degree that generic pharmaceuticals have. First, biosimilars are more expensive to develop than generic pharmaceutical drugs. Manufacturers will be hesitant to enter the biosimilars market, leading to less competition. Second, biosimilars will struggle more than generics to capture market share from the branded drug. Third, lengthy exclusivity periods awarded to the branded biologic and the first interchangeable biosimilar will substantially delay biosimilar market entry. This Note then concludes with suggestions for improving the BPCIA, both through potential amendments and regulatory process.

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AbstractSAMHSA Issues Final Rule Allowing OTPs to Dispense Take‐Home BuprenorphineVt. Hospital Program Manages Planned and Unexpected GrowthProgram to Screen Staff for Relapse Risk after DUI TragedyWhere Recovery Residences Fit in Health Care ReformBill White ‘Retiring’ but Will Continue Work in the FieldStudy: Binge Eating in Teens Associated with Initiating Drug UseResourcesObituaryComing up

Strategic politicians, partisan roll calls, and the Tea Party: Evaluating the 2010 midterm elections

The 2010 midterm elections were politically and historically significant in several respects. This article offers a concise narrative of the congressional elections beginning with a discussion of the factors influencing the outcome of the historic election. We briefly consider established research on congressional elections and analyze the degree to which these theories apply to the specific circumstances in 2010. Throughout the article, we compare the 2010 midterms to two other recent elections, 2006 and 2008. We also examine several idiosyncratic aspects of the 2010 elections, relative to the historic midterm elections of 1994 and 2006, as well as the effects of the stimulus and healthcare reform bills and the Tea Party movement. We find strong effects for member votes on the individual roll calls, but little evidence of Tea Party influence on electoral outcomes.

An adapted F‐test for homogeneity of variability in follow‐on biological products

In recent years, follow-on biological products (biosimilars) have received much attention from both the biotechnology industry and the regulatory agencies, especially after the passage of the 2010 healthcare reform bill. Unlike the traditional small-molecule drug products, the development of biological products is not only more complicated but also sensitive to small changes (both mean and variation) in procedure/environment during the manufacturing process because of some fundamental differences between drug products and biological products. A small change will have an impact on the quality of the product and consequently the treatment effect. Thus, in addition to the assessment of biosimilarity in average, it was suggested that biosimilarity in variability between biological products should be assessed. In this article, we propose an adapted F-test for homogeneity of variances to assess biosimilarity in variability. We study the performance and concordance of the proposed adapted F-test and compare it with probability-based method by extensive Monte Carlo simulations.

Landmark US healthcare reform bill upheld by Supreme Court

Landmark US healthcare reform bill upheld by Supreme Court

The Retreat From Advanced Care Planning

THE SPECTER OF DEATH PANELS LIVES. 1 AS A REMINDER of their origin, the House of Representatives version of what eventually became the Affordable Care Act (ie, the health care reform bill passed in 2010) included a provision authorizing Medicare to reimburse physicians for the time they spend discussing with patients their goals and preferences surrounding end-of-life care. “Advanced care planning” is the term used for the process of patients’ thinking about and communicating their values and preferences, whereas the term “advanced directive” refers to the related legal document. The advanced care planning process helps ensure that individuals receive the health care they desire at the end of their lives. The provision had widespread bipartisan support until the summer of 2009, when Sarah Palin morphed talk of providing support for patients who wanted to have a discussion with their physicians concerning their priorities into rhetoric alluding to “death panels.” The provision was removed from the pending legislation in reaction to the ensuing maelstrom. In the fall of 2010, voluntary advanced care planning was included in the draft regulation covering the new annual wellness visit that provides Medicare coverage for preventive services that have a compelling evidence base. Evidence shows that patients who talk with their physicians about their preferences for end-of-life care felt they had more ability to influence their medical care, believed their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion. Families also reported less stress after the patients died. The public comments on the draft of the annual wellness visit including advanced care planning were positive. But media commentators again discovered the issue, and the controversy was rekindled. Despite the positive public comments and the compelling evidence base that advanced care planning improves patient-centered care, provision for advanced care planning was removed from the annual wellness visit, presumably at the behest of members of the administration. Over the past year, the Centers for Medicare & Medicaid Services (CMS) has published several additional rules and regulations including new payment rules and the Hospital Conditions of Participation, the conditions that hospitals must meet to participate in the Medicare and Medicaid programs. None of these rules or regulations included mention of voluntary advanced care planning. Given the support of CMS for patient-centered care and value-based purchasing, it was reasonable to expect that advanced care planning–related measures would be included in at least some of the new CMS rules, regulations, and programs. Their absence is notable. Almost 2 and a half million people in the United States die every year, making death the most common health event in the United States. Clinical decision-making predicated on meeting an individual’s health priorities is the cornerstone of patient-centered care. When faced with advanced illness and the end of life, patients vary in what care and outcomes they prioritize. Some want aggressive treatment focused on prolonging life as long as possible; others want care focused on comfort, function, and quality of life. Patientcentered care dictates that physicians offer care consistent with the individual priorities and preferences of patients. Physicians cannot provide care consistent with patient wishes, goals, and priorities, however, if they do not know them. Even without CMS provisions covering advance care planning, physicians are not prohibited from engaging in advanced care planning discussions with their patients. Media misrepresentation and the absence of endorsement of advance care planning by the administration and CMS, nevertheless, affects the relationship between physicians and patients. The administration’s acquiescence, as much as the “death panel” falsehood, compromises the openness and trust between patient and physician that is needed to elicit patients’ priorities and preferences. By not forcefully reacting to the misleading statements, the administration has unwittingly created an aura of doubt. By its unwillingness to make the case for the centrality of advanced care planning to health care, the administration lends credence to the no-

An Overview of the Intentions of Health Care Reform

If upheld as constitutional, the Patient Protection and Affordable Care Act that passed in 2010 promises to change health care delivery systems in the United States, partly by shifting focus from disease treatment to disease prevention. Registered dietitians (RDs) have already taken an active role in health care areas that stand to be directly affected by provisions in the health care reform bill. However, nutrition's vital role in preventing diseases and conditions potentially could translate to additional opportunities for RDs as a result of this reform. Specific dietetics-related areas targeted by health care reform include medical nutrition therapy for chronic conditions and employee wellness incentive programs. However, dietetics practitioners are not necessarily established in the language of the bill as the essential providers of specific services or as reimbursable practitioners. Thus, although it is possible health care reform could affect demand-and, in turn, supply-of RDs, the actual effect of this legislation is difficult to predict.

Public Health Cuts Threaten Preparedness, Preventive Health Services

CONTINUING CUTS TO LOCAL PUBlic health departments’ budgets and staff, as well as proposed cuts to the US Prevention and Public Health Fund, are leading to reduced local preventive services and straining the ability of departments to respond to emerging crises, public health leaders and advocates say. A new report from the National Association of County and City Health Officials (NACCHO) found that nearly half of local public health departments cut staff in the first half of 2011 and more than half cut programs during the past year (http://tiny.cc /snu7t). The cuts compound previous losses to such agencies that have occurred in the years since the economic crisis began. Moreover, proposed cuts to the $15 billion in expected funding for prevention efforts included in the health care reform bill may further dampen planned prevention activities, warn more than 100 organizations, including clinician organizations and public interest groups.

Rewarding Family Medicine While Penalizing Comprehensiveness? Primary Care Payment Incentives and Health Reform: the Patient Protection and Affordable Care Act (PPACA)

Family physicians' scope of work is exceptionally broad, particularly with increasing rurality. Provisions for Medicare bonus payment specified in the health care reform bill (the Patient Protection and Affordable Care Act) used a narrow definition of primary care that inadvertently offers family physicians disincentives to delivering comprehensive primary care.

Emerging Subspecialties in Neurology: Public policy fellowships

“Now, more than ever, American science must enlighten American statecraft.” This statement made by former Secretary of State Colin Powell eloquently describes the dynamic that exists between physicians and policy makers. The importance of policy-making and its effects on the field of neurology recently became evident with the passage of the health care reform bill. The controversial Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, enacts the most significant health care reform since the creation of Medicare in 1965. Neurologists can interface with the legislative branch of the US government and participate in the law-making process through a number of advocacy opportunities and fellowships which we describe here. There are a number of public policy fellowships available to physicians including one available exclusively to adult and child neurologists. Many organizations offer fellowships, several of which have a long history of training physicians and scientists for careers in public policy and advocacy. One of the largest of these organizations is the American Association for the Advancement of Science (AAAS). The AAAS manages and administers a number of science and technology policy fellowships with the goal of enabling physicians, scientists, and engineers to participate in and contribute to the federal policy-making process. There are 2 types of fellowships available through AAAS: congressional fellowships and executive branch fellowships. Approximately 30 partner societies fund Congressional fellowships that place fellows in either the US House of Representatives or the US Senate. This includes the Viste Neurology Public Policy Fellowship (NPPF) sponsored jointly by the American Academy of Neurology (AAN), the Child Neurology Society, and the American Neurological Association (ANA). Congressional fellowships, in particular, are highly competitive as they allow neurologists to draft and shape legislation of interest to members of Congress. Fellows are often allowed to take the lead …

Investigation of the Impact of the Massachusetts Health Care Reform on Hospital Costs and Quality of Care

In 2006, the Massachusetts legislature passed a landmark health care reform bill (the Reform) that has served as a model for the national health care reform. By aiming to provide “access to affordable, quality, accountable health care,” the goals of this reform were to reduce the number of uninsured Massachusetts residents while containing health care costs and improving the quality of health care services.This bill has been the subject of much controversy at both the national and state level. Although most agree that the Reform has improved the insurance coverage rate of Massachusetts residents, the financial impact of the Reform has been of special concern with critics arguing that the Reform has increased the overall cost of health care. Despite this scrutiny, it is still unclear whether the goals of the Reform have been achieved. We propose to test a subset of the Reform’s goals by examining at the hospital level whether the Massachusetts Health Care Reform has achieved its cost containment and quality improvement goals. We use Centers for Medicare & Medicaid Services (CMS) and Hospital Compare (HC) data to investigate this issue and study hospital costs and quality for the period spanning 2003 to 2009. To assess the impact of the Reform on costs and quality, we compare the change in Massachusetts hospital costs and quality pre- and post-Reform to changes in two states that provide a similar level of health care quality for the same period (namely, Connecticut and Wisconsin). Data from acute care hospitals show that there is no evidence that Massachusetts total hospital costs or salaries of departments providing clinical services were adversely affected by the Reform. Moreover, we find that quality of care improved for several quality measures post-Reform to a greater extent in Massachusetts than in our control states. In sum, our evidence is consistent with the claim that Massachusetts hospital costs were contained and quality improved subsequent to the Reform. Thus, this study provides preliminary support for the argument that the Reform achieved some of its financial and quality goals.

Next on the Menu: Labeling Law Could Mean New Career Opportunities for RDs

This article is reprinted from the August 2010 issue of the Journal (2010;110:1144-1147). Next on the Menu: Labeling Law Could Mean New Career Opportunities for RDsJournal of the American Dietetic AssociationVol. 110Issue 8PreviewThe registered dietitians (RDs) of the American Dietetic Association (ADA) are always alert to new ways to improve the health of Americans and enhance the profile of the dietetics profession. So when President Obama signed the Health Care Reform bill into law, RDs—particularly those with an entrepreneurial spirit—saw an opportunity. Full-Text PDF

Palliative Care: A Case-based Guide.

Northwestern Memorial Hospital, Chicago, Illinois. aogunsei@nmh.orgEdited by Jane E. Loitman, M.D., M.S., Christian T. Sinclair, M.D., Michael J. Fisch, M.D., M.P.H. New York, Humana Press, 2010. Price: $59.95.In the summer of 2009, as the healthcare debate heated up, a new phrase was thrust into the American lexicon: death panels .Credited to the former governor of Alaska, Sarah Palin, the term was used to describe a section in the healthcare reform bill that would have funded doctors to have discussions about end-of-life planning with patients. To the horror of many practitioners, this was for many Americans, the first introduction to the concept of palliative care. The falsehoods and misconceptions that began circulating at that time were regarded to have set back the cause of palliative care at least a decade.Another year, another summer, and this time the practice of palliative care has cause to hope that it is no longer associated with “rationing” of care and administrative judgments of life versus death. The reasons for this change are two-fold. First was the publication in The New Yorker of Atul Gawande's1thoughtful treatise on end-of-life care in the United States and the struggles of patients, families, and healthcare providers faced with incurable illnesses in a system that can always offer one more intervention aimed solely at staving off the inevitable. In the article, Gawande1narrates his own journey of discovery that hospice and palliative care help patients “live their fullest lives now.”This essay was followed by the publication of a study a few weeks later in the New England Journal of Medicine 2that showed lung cancer patients receiving traditional curative care and early palliative care had a better quality of life and outlived patients that received standard care alone.These two publications—more than any others in recent memory—have helped shift the perception of palliative care from that of Grim Reaper to life-affirming holistic medicine that should be standard practice for people with advanced illness.It is into this new, nurturing climate that the book Palliative Care : A Case -based Guide is delivered. The book is a slim volume in a glossy, everglade green that is small enough to fit into a laboratory coat pocket. Palliative Care is aimed at general clinicians who are caring for patients with life-threatening or life-limiting illness.There are 10 chapters, spanning topics that range from global palliative issues to issues in the last hours of life. Each chapter is written by experts in the field and is presented as case-based problems realistic enough to be encountered in any medical practice. The cases work through scenarios from initial presentation and diagnosis to management, follow up, and handling of complications. In addition, Palliative Care provides a framework for dealing with the many associated psychosocial challenges that arise for patients and their families.Palliative care is a relatively young field with a budding evidence base and growing research to support many of its practices. The authors provide literature references at the end of each chapter for people inclined to seek out the data behind the recommendations.Overall the book is well written and edited, with scant editorial glitches. Included are the expected topics, such as communication; symptom management, including pain, dyspnea, nausea, vomiting, diarrhea, and constipation; as well as caring for patients and families when death is imminent.The chapters on nutrition and psychiatric palliative issues stand out for their insightful, thorough, yet concise handling of topics that are frequently challenging for patients, families, and healthcare providers. Also welcome are the chapters on cardiac issues and palliative skin and wound care.Because the book is aimed at general clinicians, an introductory chapter that defines palliative care and hospice, why this approach is important, who provides it, and where it is provided (inpatient, ambulatory, home) would have been beneficial. Also missing is a chapter on pediatric palliative care, as well as discussion of the challenges faced by families with young children when a sibling or parent is dealing with a life-threatening illness. However, these omissions do not take away from the value and utility of this book. It is a book that belongs on the desk, if not in the pocket, of every physician.Northwestern Memorial Hospital, Chicago, Illinois. aogunsei@nmh.org

Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System and Still Broken: Understanding the U.S. Health Care System

Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System and Still Broken: Understanding the U.S. Health Care System

Breastfeeding‐friendly workplace:are employers ready?

Currently over 50% of mothers with infants are in the labor force in the U.S. The recent Health Care Reform Bill requires employers to provide reasonable breastfeeding support in the workplace for lactating mothers. A qualitative study explored employers' readiness to provide breastfeeding accommodation in the workplace. Personal interviews were conducted with human resource managers (N=20) of companies with 500 or more employees in New York metropolitan area. Content analyses identified recurrent concepts in responses and determined employers' salient beliefs on consequences, supporters, and facilitating/challenging circumstances for implementing breastfeeding support in workplace. “Happy employees” and “high retention rate and improved loyalty” were most frequently mentioned (95%) benefits to the company. Supporters of breastfeeding-friendly environment in the workplace included “mothers and expectant mothers (70%),” and “managers supervising women and new mothers (55%).” Most frequently mentioned company drawbacks were “not cost effective (65%),” “time consuming (65%),” followed by “perception of special favors for some (50%).” Challenges for implementation included cost-effectiveness, and perceived fear of the negative impact on employee dynamics. The modal beliefs can be addressed in awareness campaigns and in planning strategies to implement breastfeeding friendly workplace.