Research Roundup: Hospitals’ Tax Status; States’ Influence On ACA Views; Wellness Programs

Health Affairs: The Value Of The Nonprofit Hospital Tax Exemption Was $24.6 Billion In 2011
[Tax-exempt] hospitals must engage in community benefit activities, such as providing care to indigent patients and participating in Medicaid. The congressional Joint Committee on Taxation estimated the value of the nonprofit hospital tax exemption at $12.6 billion in 2002—a number that included forgone taxes, public contributions, and the value of tax-exempt bond financing. In this article we estimate that the size of the exemption reached $24.6 billion in 2011. The Affordable Care Act (ACA) brings a new focus on community benefit activities by requiring tax-exempt hospitals to engage in communitywide planning efforts to improve community health. (Rosenbaum et al., 6/17)

Health Affairs: The Impact Of State Policies On ACA Applications And Enrollment Among Low-Income Adults In Arkansas, Kentucky, And Texas
We surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies: Kentucky, which expanded Medicaid, created a successful state Marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership Marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators. We found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. ... Fewer than half of adults had heard some or a lot about the coverage expansions. ... Twice as many respondents felt that the ACA had helped them as hurt them (although the majority reported no direct impact). (Sommers et al., 6/11)

Urban Institute: Overview Of The Potential Effects Of A Supreme Court Finding For The Plaintiffs In The Pending King V. Burwell Case
[If the Supreme Court strikes down premium subsidies in federal insurance marketplaces and states and the federal government fail] to re-instate the assistance, our analyses indicate that: In 2016, the number of uninsured people would be 8.2 million higher than it otherwise would have been. ... The size of the private nongroup insurance markets in the affected states would drop by about 70 percent. ... Of those losing nongroup insurance and becoming uninsured, three-fourths are low or middle income, but are not poor; over 60 percent are white, non-Hispanic; over 60 percent live in the south; two-thirds have at least one family member employed by a small firm; and more than three fourths of the adults are workers. ... Health care spending on behalf of those becoming uninsured would fall by 35 percent, (Blumberg, Buettgens and Holahan, 6/16)

Health Affairs: Future Demand For Long-Term Care Workers Will Be Influenced By Demographic And Utilization Changes
A looming question for policy makers is how growing diversity of the US elderly population and greater use of home and community-based services will affect demand for long-term care workers. We used national surveys to analyze current use and staffing of long-term care, project demand for long-term care services and workers through 2030, and assess how projections varied if we changed assumptions about utilization patterns. If current trends continue, the occupations anticipated to grow the most over the period are counselors and social workers (94 percent), community and social services workers (93 percent), and home health and personal care aides (88 percent). ... Policy makers and educators should redouble efforts to create and sustainably fund programs to recruit, train, and retain long-term care workers. (Spetz, Trupin, Bates and Coffman, 6/11)

Brookings: Implementing Value-Based Insurance Products: A Collaborative Approach To Health Care Transformation
[H]ealth plans and providers have begun to develop, implement and evaluate a range of financing reforms. These new models use reimbursement that seeks to reward value rather than volume in order to give providers greater support for delivering care that promotes higher quality and lower costs. ... the adoption of these value-based payment models appears to be accelerating. The Catalyst for Payment Reform estimates that 40% (a 29% increase from 2013) of payments are tied to quality or financial performance or intended to reduce waste. Of these value-based payments, slightly more than half (53%) put providers at risk for costs going up (downside risk) ... To accelerate this transformation, we have described ways to address the obstacles, and to bring these steps together in the concept of a value-based insurance product. (McClellan, Patel, Latts and Dang-Vu, 6/16)

Georgetown University Center on Health Insurance Reforms/Robert Wood Johnson Foundation: Balance Billing: How Are States Protecting Consumers From Unexpected Charges?
Large bills from an out-of-network health care provider can be an unexpected surprise to consumers who did not knowingly decide to obtain health care outside the plan’s provider network. ... Several states have acted to protect consumers from the need to pay balance bills, at least in emergency situations. ... But the approaches have different levels of effectiveness. The most effective protections appear to share two common elements. First, they do not require active intervention by the consumer. Second, they have a mechanism, acceptable to both plans and providers, for determining the amount of payment. (Hoadley, Ahn and Lucia, June, 2015)

The Kaiser Family Foundation: Workplace Wellness Programs Characteristics And Requirements
Most employers that offer health benefits today also offer at least some wellness programs in an effort to promote employee health and productivity and reduce health related costs. Workplace wellness programs vary in the services and activities they include, and about one-in-five use financial incentives to encourage employees to participate. ... A proposed regulation recently issued by the Equal Employment Opportunity Commission (EEOC) would change standards applicable to certain workplace wellness programs ... These new rules are intended to be more consistent with other standards implementing requirements in the Affordable Care Act (ACA) ... Both rules seek to balance employer interest in incentivizing workers to participate in wellness programs against requirements that prohibit discrimination ... This brief summarizes key regulatory standards. (Pollitz and Rae, 6/15)

The Kaiser Family Foundation: Children’s Coverage: What Matters Most To Parents Results From Focus Groups In 6 Cities
Congress has extended funding for [the Children's Health Insurance Program] CHIP for two years (through 2017), but longer-term there will be additional debate about how best to ensure coverage to children in low and moderate income families. ... This study examined what parents value in children’s coverage. Affordability was a primary concern often followed by broad coverage. Most thought the costs of private coverage were too high and often unpredictable and that CHIP was affordable. Across private and CHIP coverage, families valued comprehensive benefits (including dental and vision coverage) and were generally satisfied with providers available through their coverage. ... parents often reported gaps in coverage and periods of being uninsured when they were in between jobs. Coverage under the same plan with their children was not a priority for parents. (Rudowitz, 6/15)

The Kaiser Family Foundation: 10 FAQs: Medicare’s Role In End-Of-Life Care
About three-quarters of the 2.5 million people who die during the year in the US are ages 65 and older, making Medicare the largest insurer of health care provided during the last year of life. In fact, roughly one-quarter of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life—a proportion that has remained steady for decades. ... In recent years, Medicare’s role with respect to end-of-life care has come to the forefront as policymakers and the Administration grapple with whether or not physicians and other health professionals should be reimbursed for talking to patients about their options. ... In addition to defining relevant terms, and explaining Medicare coverage for end-of-life care, these FAQs also describe policy proposals being considered by the Administration and Congress. (6/18)

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

Medscape: Drug Overdose Now Leading Cause Of Injury-Related Deaths
Drug overdose deaths continue to increase in the United States and are now the leading cause of deaths from injury in the United States, a new report shows. Every year, nearly 44,000 people die from drug overdoses. Deaths due to drug overdose have more than doubled in the past 14 years, and half of them are related to prescription drugs (22,000 per year), the report shows. During the past 4 years, the number of overdose deaths rose significantly in 26 states and Washington, DC, and decreased in only six states. In 36 states and Washington, DC, overdose deaths now exceed motor vehicle–related deaths. (Brooks, 6/17)

Medscape: Physicians Are Biggest Influencer Of Hospice Enrollment
Hospice enrollment may depend more on the physician than on the individual circumstances of the patient. A new study published in the June issue of Health Affairs found that physician characteristics are the strongest predictor of whether a patient will be referred to hospice care, outweighing other known drivers, such as geographic location, patient age, race, sex, and comorbidities. (Nelson, 6/17)

Reuters: Public Rarely Knows Full Reason FDA Rejects New Drugs
Drug companies generally don’t disclose all the reasons new medicines fail to win U.S. marketing approval, even though regulators often reject treatments over concerns about safety or effectiveness, a study finds. Researchers compared the details companies made public in press releases with confidential documents from the U.S. Food and Drug Administration known as complete response letters, which explain why a new medicine can’t be sold. Often, companies made no announcement when a drug was rejected, or omitted most of the reasons the FDA cited for denying approval, the study found. (Rapaport, 6/16)

Reuters: Few U.S. Stroke Patients Get Clot-Busting Treatment
Not all U.S. stroke patients eligible for a clot-busting treatment actually receive it -- and the odds of getting this therapy may depend on where they live, a large study finds. Researchers found wide variation in treatment for ischemic stroke, which results from an obstruction in a blood vessel supplying the brain. (Rapaport, 6/17)

Reuters: Training Clinic Staff About Birth Control Options Reduces Pregnancies
Training staffers at reproductive health clinics to educate women about birth control options ultimately cut pregnancy rates in half, according to a new study. "Our impetus for doing this study is that unintended pregnancy has been extremely high in the U.S. for decades," said Cynthia Harper, the study's lead author from the Bixby Center for Global Reproductive Health at the University of California, San Francisco. (Seaman, 6/16)

Reuters: Low-Fat Milk Is Scarce In Poor Neighborhoods
Less than half of U.S. shops where milk is sold carry lower-fat or skim varieties, and this healthier option is most scarce in poor and minority communities that tend to have higher rates of obesity, a large study found. Part of the problem, researchers say, is a lack of supermarkets in poor communities, leaving residents reliant on smaller convenience stores and drugstores, where any milk is more expensive and low-fat varieties are less often available. (Rapaport, 6/15)