Research Roundup: Work Requirements; Reference Pricing; And Medicare Beneficiaries

JAMA Internal Medicine: Analysis Of Work Requirement Exemptions And Medicaid Spending
To date, 4 states (Arkansas, Indiana, Kentucky, and New Hampshire) have federal waivers to impose work requirements as a condition of eligibility for Medicaid (although a judge recently stayed Kentucky’s waiver), and 7 other states (Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin) have submitted waiver applications. The governor of Kentucky claimed that excluding “able-bodied” adults will reduce Medicaid enrollment by 16%, ensuring the program’s “fiscal sustainability.” However, such claims may be overstated because many Medicaid enrollees already work, and waivers have specified that many others (eg, people with disabilities and caregivers of young children) will be exempted. To our knowledge, no studies have quantified the potential influence of work requirements on Medicaid spending. We estimated the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented with the exemptions specified in approved waiver applications, and we calculated current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers. (Goldman et al, 9/10)

Commonwealth Fund: Does Pharmaceutical Reference Pricing Have A Future In The U.S.?
Reference pricing is an emerging health insurance benefit design aimed at reducing health costs. In this model, an insurer establishes a maximum payment that it will contribute toward covering the price of a product or service in situations where there is wide price variation for therapeutically similar drugs, diagnostics, or procedures. Experiences to date indicate that reference pricing can influence patients and physicians to switch to less costly options within each therapeutic class, reducing overall drug prices. (Robinson, 9/10)

Commonwealth Fund: Policy Option To Enhance Access Medicare Low-Income Beneficiaries
An estimated 40 percent of low-income Medicare beneficiaries spend 20 percent or more of their incomes on premiums and health care costs. Low-income beneficiaries with multiple chronic conditions or high need are at particular risk of financial hardship. High cost burdens reflect Medicare premiums and cost-sharing, gaps in benefits, and limited assistance. Existing policies to help people with low incomes are fragmented — meaning that beneficiaries apply separately, sometimes to different offices — and require Medicare beneficiaries to navigate complex applications. (Schoen et al, 9/12)

Health Affairs: California’s Efforts To Cover The Uninsured: Successes, Building Blocks, And Challenges
During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts. More immediate success was achieved with incremental reforms, such as child health insurance, Medicaid section 1115 waivers, and the creation of purchasing pools. These reforms, as well as the experience derived from the broader coverage expansion efforts, contributed to the intellectual and policy frameworks that underlay major national reforms and created building blocks for the state’s successful implementation of the Affordable Care Act. That act allowed California to meet its greatest need: the financing required to make a truly sizable dent in the numbers of uninsured Californians. (9/4)

JAMA Internal Medicine: Factors Associated With Long-Term Benzodiazepine Use Among Older Adults
Benzodiazepine use among older adults is common despite evidence for many potential risks. While treatment guidelines recommend short-term use of benzodiazepines, up to one-third of use is long term, which is most common among older adults. To reduce benzodiazepine prescribing to older adults, one potential point for intervention is at the transition from new to long-term use, yet little is known about the factors that predict conversion to long-term use. (Gerlach et al, 9/10)

Urban Institute: Five Ways Households Are Left Behind In The Disaster Recovery And Data Supply Chain
As a potentially catastrophic Hurricane Florence barrels toward the Carolinas, an extensive disaster recovery is likely no longer an “if” but a “when.”  Yet many flaws with our disaster preparation and recovery remain unaddressed, even after the wake-up call of  last year’s devastating natural disasters. The Urban Institute partnered with the Texas Low Income Housing Information Service to explore the chain of disaster recovery and data collection to identify areas where people might get left behind. (Martin, 9/11)