Research Roundup - January 2016


California Regulators Urged to Scrutinize Health Insurance Mergers

By Chad Terhume | Los Angeles Times | Jan. 11, 2016

Consumer advocates are putting pressure on regulators in California and several other key states to examine proposed insurer mega-mergers between Anthem/Cigna and Aetna/Humana to prevent consumers from being left with fewer choices and higher costs, according to the Los Angeles Times.


Groups Urge Florida to Reject Health Insurance Mergers

By Carolina Bolado | Law360 | Dec. 17, 2015

A coalition of consumer groups, healthcare providers and unions urged Florida's insurance regulator Wednesday to reject the two proposed mergers among health insurance giants over concerns that less competition will mean higher rates, less choice and lower quality of care for Floridians.


Healthcare in Minnesota Not Always a Bargain, Study Finds

By Christopher Snowbeck | Minneapolis Star Tribune | Dec. 15, 2015

New research shows that while healthcare costs are lower than national average for Minnesota’s Medicare beneficiaries, the privately insured pay than in many other states. This research calls into question the long held belief that the region is one to be emulated due to relatively low costs.


1 In 6 Residents Put Off Healthcare to Avoid Costs, Survey Finds

WBUR News | Dec. 15, 2015

A new survey from the Massachusetts Center for Health Information and Analysis found that about one in six Massachusetts residents did not get healthcare they said they needed in 2015 because of the cost. The survey highlights a trend showing more people have high-deductible plans in which insurance covers less care and patients pay more out of pocket. 

New York

Is N.Y. Policy on Out-of-Network Medical Bills a Model for Other States?

By Drew Altman | The Wall Street Journal | Jan. 11, 2015

New York has one some of the most comprehensive surprise medical bill legislation. An analysis from Kaiser Family Foundation suggests that this legislation could be a potential model for other states or even federal policy makers looking to create such legislation.

Recent Reports

Even Insured Can Face Crushing Medical Debt, Study Finds

By Liz Hamel, et al. | Kaiser Family Foundation | Jan. 5, 2016

A new survey, the first detailed study of Americans struggling with medical bills, shows that insurance often fails as a safety net. In the new poll, conducted by The New York Times and the Kaiser Family Foundation, roughly 20 percent of people under age 65 with health insurance reported having problems paying their medical bills over the last year. By comparison, 53 percent of people without insurance said the same.

How High-Need Patients Experience the Healthcare System in Nine Countries

By Dana O. Sarnak and Jamie Ryan | The Commonwealth Fund | January 2016

High-need patients use a greater amount of healthcare services and also experience more coordination problems and financial barriers to care compared with other older adults. Focusing on these populations in the U.S. and effectively managing their care may improve their health status while reducing overall costs.The analysis uses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate healthcare use, quality and experiences among high-need patients in nine countries compared with other older adults.

Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss

By Mitesh S. Patel, et. al. | Health Affairs | January 2016

Employers often use adjustments to health insurance premiums as an incentive to encourage healthy behavior of their employees. According to a new study, workplace wellness programs that use financial incentives have not been successful  in spurring people to lose weight.The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.

How Much Do Marketplace and Other Nongroup Enrollees Spend on Healthcare Relative to Their Incomes?

By Linda Blumberg, et al. | Urban Institute | December 2015

New research examining household spending on healthcare shows that typical marketplace enrollees with incomes between 200 and 500 percent of the federal poverty level spend more than 10 percent of their income on insurance premiums and out-of-pocket costs, according to research from the Urban Institute and funded by the Robert Wood Johnson Foundation. Those with high expenditures can spend more than 20 percent of their income on medical care. 

Commentary/ News

Medicare Expands Coordinated Care for 8.9 Million Beneficiaries

By Ricardo Alonso-Zaldivar | Associated Press | Jan. 11, 2016

Medicare is expanding a major experiment that strives to keep seniors healthier by coordinating basic medical care to prevent common problems that often lead to hospitalization. Officials announced 121 new "accountable care organizations," networks of doctors and hospitals that collaborate to better serve patients with chronic medical conditions. A limited number will be able to directly recruit patients.

HHS Test Will Try Addressing Social Needs to Improve Health

By Steven Ross Johnson | Modern Healthcare | Jan. 5, 2016

In Jan. 2016,  the CMS Innovation Center announced that it would explicitly test whether addressing the social conditions that affect health can lower healthcare costs and improve the quality of care. The effort reflects an ambition to shift the industry toward value-based payment models as well as an acknowledgement that social factors, not just the quality of healthcare services, determine the health of a community.

How Pfizer Set the Cost of Its New Drug at $9,850 a Month

By Jonathan D. Rockoff | The Wall Street Journal | Dec. 9, 2015

Setting a new drug’s price is a process normally hidden from view. This article describes Pfizer’s path to setting the price of its new breast-cancer drug called Ibrance.  Its process yielded a price that bore little relation to the drug industry’s oft-cited justification for its prices, the cost of research and development.  Instead, the price that emerged was largely based on a complex analysis of the need for a new drug with this one’s particular set of benefits and risks, potential competing drugs, the sentiments of cancer doctors and a shrewd assessment of how health plans were likely to treat the product.

Even Talking About Reducing Drug Prices Can Reduce Drug Prices

By Austin Frakt | The New York Times | Jan 19, 2016

Debates about whether and how to reduce drug prices continue to be a popular area in health policy, but there has been little legislative success. However, new evidence suggests that even the threat of government price controls may have a moderating effect on drug prices.

What’s in the New Federal Guidance about 1332 State Innovation Waivers?

By Cheryl Fish-Parcham | Families USA Blog | January 2016

Beginning in 2017, the Affordable Care Act permits states to apply for waivers to begin experimenting with strategies to provide residents with access to high-quality, affordable health insurance. Known as 1332 state innovation waivers, this short piece from Families USA described how these waivers can be an important vehicle for the next round of state improvements in healthcare.