Research Roundup: Medicaid Expansion, Health Law Repeal And Medicare Advantage Plans

Commonwealth Fund: Role Of Medicaid Expansion Care Delivery Community Health Centers
Community health centers provide comprehensive primary care to medically underserved communities, regardless of patients’ insurance status or ability to pay. Health centers have enjoyed bipartisan support for decades, because they provide affordable, cost-effective care for millions of Americans while saving the overall health care system money.1 When people gained insurance coverage under the Affordable Care Act (ACA), it was expected that reliance on health centers would increase. As a result, Congress doubled federal grant funding for centers and created incentives for clinicians to practice in them. (Lewis, 4/4)

Urban Institute: State-By-State Estimates Of The Coverage And Funding Consequences Of Full Repeal Of The ACA
This analysis provides information on some of the consequences should a case pending before the US Court of Appeals for the 5th Circuit be decided in favor of the plaintiffs. The plaintiffs argue that the entire Affordable Care Act be eliminated due to the fact that he individual mandate penalties were set to $0 beginning with plan year 2019. We estimate the state-by-state implications of full ACA repeal for insurance coverage and government funding of health care in 2019. Our estimates take into account 2019 marketplace enrollment and premiums as well as recent Medicaid data. (Blumberg et al, 3/26)

Health Affairs: Primary Care Physician Networks In Medicare Advantage
Medicare Advantage (MA) plans often establish restrictive networks of covered providers. Some policy makers have raised concerns that networks may have become excessively restrictive over time, potentially interfering with patients’ access to providers. Because of data limitations, little is known about the breadth of MA networks. Taking a novel approach, we used Medicare Part D claims data for 2011–15 to examine how primary care physician networks have changed over time and what demographic and plan characteristics are associated with varying levels of network breadth. (Feyman et al, 4/1)

The Henry J. Kaiser Family Foundation: How Much Does Medicare Spend On Insulin?
The rising cost of prescription drugs is currently a major focus for policymakers. One medication that has come under increasing scrutiny over its price increases is insulin, used by people with both Type 1 and Type 2 diabetes to control blood glucose levels. Among people with Medicare, one third (33%) had diabetes in 2016, up from 18% in 2000. The rate of diabetes is higher among certain groups, including more than 40% of black and Hispanic beneficiaries. Although not all people with diabetes take insulin, for many it is a life-saving medication and essential to maintaining good health. Three companies—Eli Lilly, Novo Nordisk, and Sanofi—manufacture most insulin products, and there are no generic insulin products currently available, despite the fact that insulin was discovered in the 1920s. Committees in both the House and the Senate recently convened hearings on prescription drug costs that focused on rising insulin prices and affordability concerns for patients, and congressional investigations are underway. (Cubanski et al, 4/1)

JAMA Internal Medicine: Prognosis Reconsidered In Light Of Ancient Insights—From Hippocrates To Modern Medicine.
Whereas modern clinicians are often reluctant to discuss prognosis with their patients, such discussions were central to medical practice in ancient Greece. A historical analysis has the potential to explain the reasons for this difference in prognostic practices and provide insights into overcoming current challenges. Many scholars consider prognosis to be the principal scientific achievement of the Hippocratic tradition. The earliest treatise on the subject, On Prognostics, defines prognosis broadly as “foreseeing and foretelling, by the side of the sick, the present, the past, and the future.” (Thomas et al, 4/8)