The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now This past May 4, US House or Representative Republicans passed the American Health Care Act (AHCA).  The bill, defined by Republicans as a repeal of the Affordable Care Act (ACA), is now under debate among Senate Republicans. (Neither any House Democrat voted for the AHCA nor are there any Senate Democrats expected to vote for related Senate bill should it make the Senate floor.)  Per t...

Listen Now Considering the debate over the past five months about repealing the ACA (and more generally reforming the Medicare program via premium support),  it is worth remembering that approximately 55% of non-elderly Americans, or 155 million, still receive their health care coverage via their employer.   In addition, as of 2016 the ACA requires employers with over 50 employees to either offer...

Listen Now  As former DHHS Secretary Louis Sullivan wrote in support of this work, "Mary Otto brings history, policy and painful personal realities together in this compelling and engaging book about our nation's highly preventable epidemic of oral disease.  Teeth should be read by every policy maker and health professional who believes we can and must ace to reduce the current barriers to dental...

Listen Now In mid-January the CDC abruptly canceled a three-day "Climate and Health Summit" the Center had been planning for months.  The meeting was intended to discuss public health risks caused by the climate crisis and steps being taken to reduce the emissions of carbon dioxide and other greenhouse gases or its adverse consequences on human health.   (It was speculated the meeting was canceled...

Listen Now Over approximately the past decade the health care industry has become increasingly committed to financially incenting physicians and other clinicians, or tying performance to reimbursement.  Commonly termed "pay for performance"(P4P), these arrangements are increasingly employed in the Medicare (i.e., under the Medicare Access and CHIP Reauthorization Act, or MACRA) and Medicaid progra...

Listen Now Late today, or within a few hours after this interview was completed, the House Republicans proposed ACA repeal or reconciliation legislation.  The legislation includes repealing Medicaid expansion under the Affordable Care Act (ACA).  More specifically, House Republicans propose repealing the  federal enhanced match rate for eligible beneficiaries on December 31, 2019 though states can...

Listen Now In his recent work, The Case Against Sugar , Gary Taubes argues not all calories are alike.  Sugar, or the consumption of sugar, causes elevated levels of insulin, or hyperinsulenema, and high levels of insulin drives fat accumulation.  Rather than obesity causing diabetes, Taubes argues, hyperinsulinemia causes both.   That there's been an 800% increase since 1960 in the consumption of...

Listen Now This past November, voters in seven states legalized marijuana either for medical or for recreational use.  Twenty-nine states have now legalized cannabis for medicinal use (and of these eight, along with the District of Columbia, for recreational use).   Despite growing state legalization, the debate concerning marijuana's health effects continues.  Recently, the National Academy of Sc...

Listen Now While there is evidence noise-induced hearing loss among adolescents has increased due to the use of smartphones and other mobile devices, the evidence to date is not compelling or is still the subject of scientific debate.  Nevertheless, noise induced-hearing loss is a legitimate concern and therefore a topic in need of health education to combat, particularly since exposure is frequen...

Listen Now On any given day US prisons and jails hold between 80,000 and 120,000 men, women and children in solitary confinement.   A significant percent of these individuals enter solitary with a mental disease and a similar percent of those held in isolation for extended periods of time develop severe psychiatric illnesses that include self amputation and suicidality.  (US prisons and jails cons...

Listen Now With the election of Donald Trump Congressional Republicans are poised to repeal the Affordable Care Act (ACA) within the first 100 days of the 115th Congress via the budget reconciliation process.  (At some future date they are pledging to draft ACA replacement language or legislation.)  The expectation is repeal would have an effective date of 2018 or 2019, or after the mid-term Congr...

Listen Now Though comparatively late to adopt quality ratings, many health care products and services are today quality rated.  For example, CMS rates hospital, nursing home and home health care care quality along with Medicare Advantage insurance and prescription drug, or Part D plans.  Quality performance is a factor in calculating rewards and penalties in Medicare pay for performance agreements...

Listen Now As has been widely reported the US has faced an opioid addiction epidemic over the past decade.  Opioid-related overdose deaths have quadrupled in recent years.  (Drug overdose deaths, in sum, now equal or exceed auto accident fatalities.)   What explains the dramatic increase use and addiction to these medicines?  In Drug Dealer, MD, recently published by Johns Hopkins University Press...

Listen Now Section 1332 of the Affordable Car Act allows states to propose Affordable Care Act-comparable state insurance programs.   Programs would need to meet certain criteria in order to win federal waiver authority.   One state currently considering a wavier is Colorado, i.e., Colorado voters will be asked to approve a state constitutional amendment that would create in part, a financing plan...

Listen Now UnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable.  Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider.  For example, in 2016 30 percent of counties throu...

Listen Now For this, my 101st interview, I discuss with the author, Daniel L. Hatcher, his new work, "The Poverty Industry, The Exploitation of America's Most Vulnerable Citizens."  The work is aptly summarized by Columbia University Professor Jane Spinak.  She notes on the book's dust jacket, "In the tradition of great muckracking, Hatcher has exposed how states and localities misdirected and mis...

Listen Now Since the passage of the Affordable Care Act in 2010 CMS has been working to reform Medicare reimbursements from "fee for service" to "fee for value."  (Earlier this year Secretary Burwell noted 30% of traditional or "fee for service" Medicare reimbursements are now tied to quality or value.)  The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 accelerates this trans...

Listen Now Excluding from taxable income the moneys employers spend in providing employees with health insurance dates back to WWII-era wage and price controls.  Today, this tax policy, that amounts to over $250 billion in lost federal tax revenue, effectively constitutes the third largest federal government expenditure on health care after Medicare and Medicaid.  Few tax experts would disagree th...

Listen Now The 2015 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will sunset three current Medicare performance measurement and incentive payment programs in 2018.  (This year, 2016, will be the last year these programs will be measuring and rewarding Medicare physician performance.)  These are: the Physician Quality Reporting System (PQRS); the HIT Meaningful Use (MU) program; and...

Listen Now Measuring health care quality and outcomes effectively and efficiently remains a daunting task.  Quality measures are largely seen as too process versus outcome focused, substantially irrelevant to patients and insufficiently aligned between and among payers.  Measuring care or care quality, ironically, can and does detract from actual care delivery, can have no relationship to spending...

Listen Now In an extremely busy year for Medicare delivery and payment reform,  regulatory implementation of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) stands out.   This past April CMS published the agency's 960-page proposed rule to implement the law.  The proposed rule, that will go final this fall, will change the way Medicare physician payments (Medicare Part B) are annuall...

Listen Now What accounts for so called patient compliance or adherence or why is it the case physicians and other providers are frequently unable to successfully engage their patients.  Why is it the case, for example, that patients adhere to highly toxic regimens of such as chemo therapy and not to more tolerable drugs such as statins.  What explains adherence or non-adherence?          During th...

Listen Now Since, in part, April is recognized by DHHS as National Minority Health Month (this year's theme is "Accelerating Health Equity in the Nation") it is thoroughly appropriate to discuss Professor Daniel Dawes's recent work, "150 Years of Obamacare."  Professor Dawes's work begins with a discussion of efforts since the Civil War to reform national health care policy beginning with the 1865...

Listen Now As a follow up to my April 1st conversation with Jim Gera concerning bundled payments, during this podcast Dr. Richard Morel discusses Medicare's other major payment reform program, Accountable Care Organizations (ACOs), or WESTMED Medical Group's three year experience as a Track 1 ACO.   The Medicare ACO program is a creation of the 2010 Accountable Care Act and participation in the pr...

Listen Now Today, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surg...