Research Roundup: Insurance Disparities; Medicare Beneficiaries’ Assets; Bariatric Surgery

Health Affairs: Uninsurance Disparities Have Narrowed For Black And Hispanic Adults Under The Affordable Care Act
Using early release data from the 2014 National Health Interview Survey (NHIS), we found that by the fourth quarter of 2014 the uninsurance rate for Hispanic adults, including both citizens and noncitizens, had fallen to 31.8 percent from 40.1 percent in the third quarter of 2013—which was just before the first ACA open enrollment period. Over the same period, non-Hispanic black adults ... saw a decline in uninsurance from 25.5 percent to 17.2 percent, and non-Hispanic white adults ... saw a smaller but still significant decline, from 14.8 percent to 10.5 percent. (McMorrow et al., 9/16)

The National Academies of Science: The Growing Gap In Life Expectancy By Income: Implications For Federal Programs And Policy Responses
Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. ... Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. ... Our major entitlement programs -- Medicare, Medicaid, Social Security, and Supplemental Security Income -- have come to deliver disproportionately larger lifetime benefits to higher-income people because, on average, they are increasingly collecting those benefits over more years than others. This report studies the impact the growing gap in life expectancy has on the present value of lifetime benefits that people with higher or lower earnings will receive from major entitlement programs. ... The report also explores, from a lifetime benefit perspective, how the growing gap in longevity affects traditional policy analyses of reforms to the nation's leading entitlement programs. (Lee, Orszag et al., 9/17)

Urban Institute: The Effect On States Of Increasing The Medicare Eligibility Age
Proposals to increase the eligibility age for Medicare may have unintended consequences for state government finances. Specifically, the medical care of some Americans who currently receive both Medicaid and Medicare benefits, also known as “dual eligibles,” could become the sole responsibility of Medicaid .... We estimate that the states’ share of Medicaid costs would increase $369 million per year if the Medicare eligibility age is increased to 67 and $1.9 billion per year if the eligibility age is increased to 70. ... the financial effect on an individual state depends on (1) its demographic composition, (2) the share of Medicaid expenditures for which the state is responsible, and most important, (3) whether the state has expanded the income eligibility threshold for Medicaid under the Affordable Care Act. (Waidmann and Lawton, 9/17)

The Kaiser Family Foundation: Income And Assets Of Medicare Beneficiaries, 2014 – 2030
While a small share of the Medicare population lives on relatively high incomes, most are of modest means, with half of people on Medicare living on less than $24,150 in 2014. ... the range of asset values among beneficiaries is wide and varies greatly across demographic characteristics. ... the income, assets and home equity values of Medicare beneficiaries overall are projected to be somewhat greater in 2030 than in 2014 after adjusting for inflation; yet, much of the growth is projected to be realized among those with relatively high incomes and assets. As policymakers consider options for decreasing federal Medicare spending ..., these findings raise questions about the extent to which the next generation of Medicare beneficiaries will be able to bear a larger share of costs. (Jacobson et al., 9/10)

Annals of Internal Medicine: A Cost Analysis Of The American Board Of Internal Medicine's Maintenance-Of-Certification Program
In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. ... [Researchers sought to] estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version. ... Internists will incur an average of $23 607 ... in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. (Sandhu, Dudley and Kazi, 9/15)

The Kaiser Family Foundation: Round 2 On The Legal Challenges To Contraceptive Coverage: Are Nonprofits “Substantially Burdened” By The “Accommodation”?
In the Burwell v. Hobby Lobby decision, the Supreme Court ruled that “closely held” for-profit corporations may be exempted from the [contraceptive coverage] requirement. This ruling, however, only settled part of the legal questions ... as there are ... other legal challenges brought by nonprofit corporations. The nonprofits are seeking an “exemption,” meaning their workers would not have coverage for some or all contraceptives, rather than an “accommodation,” which entitles their workers to full contraceptive coverage but releases the employer from paying for it. ... This brief explains the legal issues raised by the nonprofit litigation and discusses the impact of the Hobby Lobby decision on the current litigation. (Sobel and Salganicoff, 9/9)

JAMA Surgery: Variation In Hospital Episode Costs With Bariatric Surgery
Under bundled payment programs, hospitals receive a single payment for all services provided surrounding an episode of care. Because health care providers, such as hospitals and physicians, accept more financial risk under these programs, they will need a better understanding of episode costs to identify areas to target improvements in quality and cost-efficiency. ... we used national Medicare claims data and identified patients undergoing bariatric procedures in 2011-2012 [for 24,647 patients at 463 hospitals]. ... Mean total payments for bariatric procedures varied from $11 086 to $13 073 per episode of care, resulting in a mean difference of $1987 (16.5% difference) per episode of care between the lowest and highest hospital quartiles. The index hospitalization was responsible for the largest portion of total payments (75%), followed by physician services (21%). (Grenda et al., 9/16)

Health Affairs: Rebalancing Medicaid Long-Term Services And Supports
In 2013 the majority of Medicaid LTSS [long-term services and supports] spending was for the first time focused on home and community-based settings instead of institutional care, and the Centers for Medicare and Medicaid Services (CMS) projects that community-based spending will reach 63 percent of all Medicaid LTSS spending by 2020. However, the fundamental structure of the Medicaid statute continues to promote an "institutional bias." ... state progress in providing choice of home and community-based alternatives ... has been uneven, and expenditures for certain population groups continue to be largely institutionally based. ... CMS enacted final HCBS [home and community-based services] regulations in January 2015 that, for the first time, attempt to create a national standard regarding the characteristics of home and community-based care settings. (Ryan, 9/17)

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

Medscape: Longer Nursing Shifts Tied To More Burnout
For hospital nurses, working 12 hours or longer is associated with adverse outcomes, including nurse burnout, that may endanger patients and nurses, a new study has shown. Chiara Dall'Ora, MSc, from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, United Kingdom, and colleagues present their findings in an article published online August 23 in BMJ Open. (Brown, 9/14)

Reuters: Blacks Fare Worse Than Whites After Heart Attacks
After a heart attack, black patients typically don’t live as long as whites – a racial difference that is starkest among the affluent – according to a new U.S. study. Researchers evaluated data on more than 132,000 white heart attack patients and almost 9,000 black patients covered by Medicare, the government health program for the elderly and disabled. They used postal codes to assess income levels in patients’ communities. After 17 years of follow-up, the overall survival rate was 7.4 percent for white patients and 5.7 percent for black patients, according to the results published in Circulation, the journal of the American Heart Association. (Rapaport, 9/14)

Reuters: Cancer Remains Leading Cause Of Death Among U.S. Hispanics
Cancer remains the leading cause of death among Hispanics in the U.S., driven in large part by lung malignancies in men and breast tumors in women, a new report finds. ... Every three years, the American Cancer Society reports cancer statistics for Hispanics based on data from U.S. health agencies and national cancer registries. For all cancers combined, Hispanics have 20 percent lower incidence rates and 30 percent lower death rates than white people in the U.S., [researcher Rebecca] Siegel and her colleagues report in CA: A Cancer Journal for Clinicians. (Rapaport, 9/16)

Reuters: Black Children Less Likely To Get Pain Drugs For Appendicitis
Race appears to affect the odds that a child or teen with appendicitis, a painful condition requiring surgery, will get pain medication, particularly opioid medication, according to a new study. ... Previous studies have documented racial disparities in emergency department treatment or management of adult patients, but these results specifically among children are particularly striking, [Dr. Monika K. Goyal] said. (Doyle, 9/14)

NPR: Mediterranean Diet With Extra Olive Oil May Lower Breast Cancer Risk
[R]esearchers say that eating a Mediterranean diet supplemented with four tablespoons per day of extra-virgin olive oil reduces the risk of breast cancer. "We found a strong reduction in the risk of breast cancer," says Miguel Martinez Gonzalez, an author of the study and a leading researcher on the preventive health effects of the Mediterranean diet at the University of Navarra in Spain. (Aubrey, 9/14)