Research Roundup: Health Cost Burdens; Calif.’s Fair Price Law; Possible Effect Of Court Ruling

Health Affairs: The Share Of People With High Medical Costs Increased Prior To Implementation Of The Affordable Care Act
The percentage of Americans with high medical cost burdens—those who spend more than 10 percent of their family income on out-of-pocket expenses for health care—increased to 19.2 percent in 2011, after having stabilized at 18.2 percent during the Great Recession of 2007–09. The increase was driven primarily by growth in premium expenses in 2009–11 for people with employer-sponsored coverage. Out-of-pocket spending on health services, especially for prescription drugs, continued to decrease between 2007–09 and 2011. Medical cost burdens were highest for income groups most likely to benefit from the Affordable Care Act’s coverage expansions, including people with private insurance coverage. (Cunningham, 1/5)

Health Affairs: California’s Hospital Fair Pricing Act Reduced The Prices Actually Paid By Uninsured Patients
California’s Hospital Fair Pricing Act, passed in 2006, aims to protect uninsured patients from paying hospital gross charges: the full, undiscounted prices based on each hospital’s chargemaster. ... I examined how the law affects the net price actually paid by uninsured patients .... I found that from 2004 to 2012 the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices; the adjusted collection ratio, essentially the amount the hospital actually collected for every dollar in gross price charged, for uninsured patients dropped from 32 percent to 11 percent. (Bai, 1/5)

The Rand Corp.: The Effect Of Eliminating The Affordable Care Act's Tax Credits In Federally Facilitated Marketplaces
In this research report, we assess the expected change in enrollment and premiums in the ACA compliant individual market in FFM [federally facilitated marketplace] states if the Supreme Court eliminates subsidies in those states .... Key findings of our analysis include the following: 1. Enrollment in the ACA-compliant individual market, including plans sold in the marketplaces and those sold outside of the marketplaces that comply with ACA regulations, would decline by 9.6 million, or 70 percent, in FFM states. 2. Unsubsidized premiums in the ACA-compliant individual market would increase 47 percent in FFM states. This corresponds to a $1,610 annual increase for a 40-year-old nonsmoker purchasing a silver plan. (Saltzman and Eibner, 1/8)

JAMA Internal Medicine: Effect Of Medicare’s Nonpayment For Hospital-Acquired Conditions
In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. [This study measured] the association between Medicare’s nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. ... The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends. (Waters et al., 1/5)

JAMA: Effect Of An Enhanced Medical Home On Serious Illness And Cost Of Care Among High-Risk Children With Chronic Illness
We conducted a randomized clinical trial to assess whether an enhanced medical home providing comprehensive care for high-risk children with chronic illness would reduce serious illnesses, medical costs, or both, from a health system perspective. ... Access to care and parent satisfaction were substantially increased, the number of high-risk children with a serious illness was decreased by 55%, and total clinic and hospital costs (assessed from a health system perspective) were reduced by $10 258 per child-year. (Mosquera et al., 12/24)

The Kaiser Family Foundation: Visualizing Health Policy: Medicare Spending: A Look At Present, Short-Term And Long-Term Trends
This Visualizing Health Policy infographic provides an overview of Medicare spending, including information on current federal spending relative to other government programs (e.g., Social Security) and percent-share of spending across Medicare services, as well as projected Medicare spending over the next decade and beyond. Recent federal spending on Medicare is about a third of Defense and Social Security spending combined. In the short term, Medicare spending per person is expected to be lower relative to previous projections and to grow more slowly than private health insurance. In the long term, Medicare spending as a share of the economy is projected to grow, and Medicare is projected to lack sufficient funds to pay all hospital bills beginning in 2030. (Cubanski, Neuman et al., 1/6)

The Kaiser Family Foundation: Medical Debt Among Insured Consumers: The Role Of Cost Sharing, Transparency, And Consumer Assistance
Increasing deductibles and other cost sharing have helped to make insurance premiums more affordable, but the flip side has been to expose even people with insurance to risk of medical debt. When cost-sharing under health insurance exceeds the ability of consumers to pay their medical bills, cases of health-related bankruptcy and credit problems are inevitable. Greater transparency in the details of health insurance plans cannot eliminate medical debt, but they can help consumers distinguish plan differences to make more informed choices and to plan ahead financially. Greater transparency, as well as consumer assistance, can also help consumers use their coverage more effectively and resolve billing questions and disputes when they arise. (Pollitz, 1/8)

The Heritage Foundation: Reforming Graduate Medical Education In The U.S.
[T]here is increasing concern that the current system for training doctors following graduation from medical school falls short in terms of producing an adequate workforce to meet the nation’s changing health care needs. Reforming the graduate medical education system will require accurate data on the true costs of training physicians, greater oversight and accountability, and a transition from the current outdated financing system that is based mainly on federal support to a system that is more equitably distributed among stakeholders and where the funding is controlled by the states and follows the trainee. (O'Shea, 12/29)

JAMA Dermatology: Trends In Indoor Tanning Among US High School Students, 2009-2013
In 2009, the World Health Organization classified indoor tanning devices as carcinogenic to humans .... Furthermore, 40 states implemented new laws or strengthened existing laws between 2009 and 2013; of those, 11 states prohibited indoor tanning among those younger than 18 years. Evidence suggests that such laws are associated with lower rates of indoor tanning. In addition, a 10% excise tax on indoor tanning services was implemented in 2010, the effects of which are largely unknown. Despite these reductions, indoor tanning remains common among youth. The 2013 national Youth Risk Behavior Survey data suggest that an estimated 1.5 million female and 0.4 million male high school students engage in indoor tanning. (Guy et al., 12/24)

Center on Budget and Policy Priorities: Geographic Pattern Of Disability Receipt Largely Reflects Economic And Demographic Factors
About 6 percent of the nation’s working-age population receives disability payments from Social Security Disability Insurance (DI) or Supplemental Security Income (SSI), and people who depend on those benefits live in every state, county, and congressional district. Nevertheless, there’s a distinct “geography of disability.” Some states, chiefly in the South and Appalachia, have much higher rates of receipt — nearly twice the national average. ... In a nutshell, states with high rates of disability receipt tend to have populations that are less educated, older, and more blue-collar than other states; they also have fewer immigrants. ... In fact, those four factors alone are associated with about 85 percent of the variation in disability receipt rates across states. (Ruffing, 1/8)

The New England Journal of Medicine: The Proposed Rule For U.S. Clinical Trial Registration And Results Submission
Broad access to information about clinical trials and their findings is critical for advancing medicine .... Traditional methods of information dissemination ... may nevertheless leave ... gaps in the knowledge base because the results of many trials are not published. Title VIII of the Food and Drug Administration (FDA) Amendments Act of 2007 (FDAAA) addressed some of these concerns .... (HHS) recently published for public comment a proposed rule (or “Notice of Proposed Rulemaking [NPRM] for Clinical Trials Registration and Results Submission”) to clarify and expand (as permitted) the FDAAA requirements and ultimately facilitate compliance with the law. ... In this article, we provide information about the FDAAA and NPRM. (Zarin, Tse and Sheehan, 1/8)

Here is a selection of news coverage of other recent research:

Reuters: Food And Medication Insecurity Tied To Poor Diabetes Control
People without reliable sources of food and medicine are more likely to have poor control over their diabetes, compared to those without such concerns, according to a new study. Researchers found the likelihood of a person having poorly controlled diabetes increased by about 39 percent for each of the so-called economic insecurities they reported [in JAMA Internal Medicine]. (Seamon, 12/29)

Reuters: End Of Life Planning Does Not Make Cancer Patients Hopeless Or Anxious
For a small group of advanced cancer patients, using an online tool for learning about end-of-life medical decisions and developing an advance directive document did not lead to psychological distress, according to a new study. ... For the study, the researchers divided 200 advanced-stage cancer patients with anticipated life expectancy of two years or less into two groups. One engaged in advanced care planning with the online tool, while the other used only a state-approved advance directive form and American Hospital Association educational materials. ... Neither group had a decrease in hope or an increase in hopelessness after their advance care planning sessions, according to results in the Journal of Pain and Symptom Management. (Doyle, 1/2)

The Washington Post's Wonkblog: Why You Shouldn’t Count On Your Family Members To Take Care Of You When You’re Old
Americans are strongly underestimating their future needs for long-term care, a potentially costly oversight that could hurt them in their retirement years. About 60 percent of adults between 40 and 65 years old don't think they'll need need long-term care services, according to a new Health Affairs study. That's much less than the 70 percent of people at least 65 years old who will need long-term care services at some point either in their home or at a facility, according to a widely cited earlier study from the Georgetown University Long-Term Care Financing Project. That includes 20 percent who will need between two to five years of long-term care and 20 percent who'll need more than five years. (Millman, 1/6)

Reuters: Health Problems Can Lead To Loss Of Home
People who develop a debilitating or chronic illness could be at least twice as likely to default on their homes or risk foreclosure, a recent U.S. study suggests. Most research on links between financial troubles and illness has focused on poverty or declining income as a cause of poor health, rather than the other way around, the study team notes. That work is important, said Danya Keene, an author of the new report, but “it tends to miss that there can be huge social consequences of becoming sick, disabled, or more generally having poor health.” (Neumann, 1/7)