Legislative Activity On Medicaid

A report from the Commonwealth Fund discusses how the 2018 election of Democratic governors and passage of ballot initiatives to expand Medicaid in conservative states laid the groundwork for serious debates about Medicaid expansion in some states. Also considered are still-unresolved questions surrounding pending federal and state efforts to expand, or restrict, a program created to provide health coverage to low incomes beneficiaries. 

The report can be obtained at https://www.commonwealthfund.org/blog/2019/up-close-legislative-activity-medicaid-heating-up-across-country.

Centers for Medicare & Medicaid Services Podcast

The Centers for Medicare & Medicaid Services (CMS) released the latest episode of a podcast, CMS: Beyond the Policy, featuring highlights from the 2019 CMS Quality Conference.  An annual event attracting over 3,000 participants, this year’s meeting had a strong focus on reducing clinician burden so they can focus on patients, promoting health care choice and driving value-based care.   

The podcast can be obtained at https://www.cms.gov/podcast/episode-2-2019-cms-quality-conference.

Senate Appropriations HHS FY 20 Budget Hearing

The Senate Appropriations Committee, Labor, Health and Human Services and Education Subcommittee Hearing on “FY 2020 Budget Request for the Health and Human Services Department” in which HHS Secretary Azar testified on behalf of the Department’s budget request.

Both parties supported the fight against opioid addiction, and Sec. Azar expressed his willingness to work with Congress to develop legislation, such as including Jessie’s Law in the SUPPORT Act. With increasing rates of e-cigarette usage among youth, Sec. Azar committed to address tobacco use by potentially adding more regulation but called upon manufacturers to better control the sale of their products. A majority of the hearing focused on how HHS is handling unaccompanied minors at the border, health coverage for those with pre-existing conditions, and Title X family planning funds.

Read ASAHP’s full memo here.

Innovations To Meet The Needs Of High-Need, High-Cost Populations

One way to improve care for high-need, high-cost patients and make the health system more effective is to identify promising care delivery and payment innovations from accountable care models around the world. A publication from the Commonwealth Fund explores best practices from a global innovation database to improve health outcomes and reduce the total cost of care for high-need, high-cost populations in the U.S.

It can be obtained at https://www.commonwealthfund.org/blog/2019/adapting-promising-innovations-meet-needs-high-need-high-cost-populations.

Addressing Campus Sexual Assault And Ensuring Student Safety And Rights

Related to reauthorizing the Higher Education Act (HEA), the U.S. Senate Health, Education, Labor And Pensions (HELP) Committee conducted a hearing on April 2, 2019 on Addressing Campus Sexual Assault And Ensuring Student Safety And Rights.  

A video of the event and copies of testimony by witnesses can be obtained at https://www.help.senate.gov/hearings/reauthorizing-hea-addressing-campus-sexual-assault-and-ensuring-student-safety-and-rights.

House Department of Labor FY 20 Budget Hearing

The House Appropriations Committee, Labor, Health and Human Services, Education and Related Agencies Hearing on “Department of Labor Budget Request for FY 2020” in which Labor Secretary Acosta testified on behalf of the Department’s budget request.

Both Republicans and Democrats supported the expansion of registered apprenticeships; Republicans additionally supported the Administration’s industry recognized apprenticeship program (IRAP) that would include intermediaries to help industries expand and scale their apprenticeship programs.

Democrats repeatedly asked Secretary Acosta how he could cut funding for workforce development and Job Corps when he says both are priorities for the Department. Sec. Acosta discussed how tough decisions had to be made, but that Governors are coming up with innovative ideas to make Job Corps centers more effective through partnerships with community colleges or the National Guard.

Read ASAHP’s full memo here.

House Education & Labor Committee Hearing on Higher Education Accountability

The House Education and Labor Committee, Higher Education and Workforce Investment Subcommittee Hearing on “Strengthening Accountability in Higher Education to Better Serve Students and Taxpayers” to discuss the current roles and necessary reforms to the accountability triad: the federal government, states, and accreditors.

Both Republicans and Democrats believed that student success should be a metric measured by accreditors to determine a college or university’s success. Republicans further encouraged the use of performance-based funding, which pushes for student completion and alignment to college mission, and also for colleges to share more in the risk of financing a student’s education through innovative practices. Democrats believed that performance-based funding could lead to inequities, where colleges may not admit underrepresented, more at- risk individuals.

Read ASAHP’s full memo here.

Integrating Health Care And Social Services For Patients With Serious Illness

As a way of better understanding and facilitating discussions about challenges and opportunities related to integrating health care and social services for patients with serious illness, the National Academies of Sciences, Engineering, and Medicine held a full-day public workshop on July 19, 2018 in Washington, DC. A new publication summarizes presentations and discussions from the workshop. 

It can be obtained at https://www.nap.edu/read/25350/chapter/1.

The Failings Of Online For-Profit Colleges

A report from the Brookings Institution addresses the trend of for-profit colleges going exclusively online or contracting with nonprofit (mostly public) colleges to run their online programs. Using results from focus groups of for-profit student borrowers, the report explores the risks that this rapid shift entails for students already vulnerable to poor outcomes. 

The report can be obtained at https://www.brookings.edu/wp-content/uploads/2019/03/The-Failings-of-Online-For-profit-Colleges.pdf.

Senate Hearing on Dept of Education FY 20 Budget

The Senate Committee on Appropriations, Labor, Health and Human Services, Education, and Related Agencies Subcommittee held a hearing on “Review of the FY2020 budget request for the U.S. Department of Education” in which Education Secretary DeVos testified on behalf of the Department’s budget request.

Bipartisan support surrounded funding for the Special Olympics, CTE awareness for high school students and families, apprenticeships, and short-term Pell grants. Ranking Member Patty Murray (D-WA) expressed concern about the Department issuing higher education regulations for accreditation and distance learning as she and Sen. Lamar Alexander (R-TN) work on reauthorizing the Higher Education Act.

Democrats expressed frustration with the Department’s slow progress to approve borrower defense claims (especially for students defrauded by for-profit colleges), proposal to cut PSLF, and cuts to GEAR UP and TRIO. Republicans supported the Department’s proposals for teacher professional development vouchers and the Education Freedom scholarships.

Read ASAHP’s full memo here.

Possible Consequences Of A Full Repeal Of The Affordable Care Act

A brief from the Urban Institute discusses a case before the US Court of Appeals for the 5th Circuit, which if decided in favor of the plaintiffs, would eliminate the entire Affordable Care Act. State-by-state implications of full ACA repeal for insurance coverage and government funding of health care in 2019 are estimated. 

The brief can be obtained at https://www.urban.org/sites/default/files/publication/100000/repeal_of_the_aca_by_state_0.pdf.

House Education & Labor Committee Hearing on Registered Apprenticeships

The House Committee on Education and Labor, Higher Education and Workforce Investment Subcommittee held a Hearing on “Innovations in Expanding Registered Apprenticeship Programs” to discuss expansion of apprenticeships through the current registered model or through Industry Recognized Apprenticeship Programs (IRAPs).

Democrats continued to emphasize their support Registered Apprenticeship programs that they believe ensure high quality programming with portable credentials. With the current skills gap, Republicans believe more needs to be done and that the Administration’s Industry Recognized Apprenticeship programs (IRAPs) provide curriculum flexibility for employers in high demand professions without the lengthy approval process included with Registered Apprenticeship programs. Democrats raised concerns that IRAPs could take away taxpayer dollars from the Registered Apprenticeship program, which has a proven, standardized model.

Community colleges were also highlighted for their partnerships and work as intermediaries between high schools, 4-year institutions, and businesses, to create programs that meet the needs of the community.

Read ASAHP’s full memo here.

FY20 Department of Education Budget Hearing

The House Committee on Appropriations, Labor, Health and Human Services, Education, and Related Agencies Subcommittee held a hearing on “Department of Education Budget Request for FY 2020” in which Education Secretary DeVos testified on behalf of the Department’s budget request.

Among the issues that received bipartisan support were funding for CTE and the expansion of Pell grants for short-term programs. Democrats emphasized the importance of guardrails with short term Pell and DeVos supported working with Congress for this expansion of Pell.

Public charter schools were a hot button issue throughout the hearing, with Republicans supporting charter schools as a mechanism to find the best type of education for students, while Democrats were concerned about a recent report showing up to $1 billion in misuse of charter school funding and they also reiterated their belief that charter schools are largely a means to privatize education. Subcommittee Chairwoman Rosa DeLauro (D-CT) stated their focus is on the 90% of students who are in public schools, not charters.

There was bipartisan support to continue funding TRIO and GEAR UP, rejecting the Department’s proposal to eliminate these programs. Democrats continued to raise concerns about the lack of transparency and oversight of loan servicers along with concerns about potential equity issues for low-income individuals if the Department implemented an institutional risk-sharing program.  

DeLauro emphasized in her closing statement, “I look forward to working with my colleague across the aisle to reject the cuts…and we won’t be reviewing what has been proposed.”

Read ASAHP’s full memo here.

2019 Exchange Open Enrollment Period Final Report

The Centers for Medicare & Medicaid Services (CMS) today released the Health Insurance Exchanges 2019 Open Enrollment Report. It shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million, representing a minimal decline of around 300,000 plan selections from the same time last year. Also, average total premiums for plans dropped by 1.5% from the prior year, the first decline since the Exchanges began operations in 2014.  

The report can be obtained at https://www.cms.gov/newsroom/fact-sheets/health-insurance-exchanges-2019-open-enrollment-report.

Framework For Improving End-Of-Life Care

The Institute for Healthcare Improvement has published the second edition of its white paper, "Conversation Ready: A Framework for Improving End-of-Life Care." The paper presents a framework relevant to any health care professional and organization to provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.  

The white paper can be obtained at http://www.ihi.org/resources/Pages/IHIWhitePapers/ConversationReadyEndofLifeCare.aspx.

The Value Of A College Degree

The House Committee on Education and Labor issued a report entitled Don’t Stop Believin’: The Value of a College Degree. It states that a college degree is still well worth the cost, noting that bachelor’s degree holders earn up to $1 million more and associate’s degree holders up to $400,000 more than high school graduates during their work lives. Expanded access and increased affordability are goals highlighted in the report that may be addressed in the next reauthorization of the Higher Education Act 

The report can be obtained at https://edlabor.house.gov/imo/media/doc/FINAL%20VALUE%20OF%20COLLEGE%20REPORT.pdf.

Toolkit For Strengthening Medicaid Long-Term Services And Supports

As the population ages, one of the greatest challenges facing state officials is how to organize and pay for long-term services and supports (LTSS) for low-income elderly and disabled adults—the most complex, expensive, and fastest-growing group covered by Medicaid. To help address this challenge, a toolkit for state leaders published in December 2017 has been updated by Manatt Health Strategies and the Center for Health Care Strategies. 

The toolkit can be obtained at https://www.milbank.org/wp-content/uploads/2019/03/Strengthening-LTSS-Toolkit_032019.pdf.

Closing The Medical Research Gap Involving Women

Women have long been left out of biomedical research, even though some of the most common diseases, like cancer and heart disease, present differently in men and women. As a result, much less is known about how to prevent, diagnose, or treat these diseases in women. An article from the Commonwealth Fund examines how attitudes toward the health of women are changing and describes efforts to close the gender gap in medical research.

The article can be obtained at http://features.commonwealthfund.org/closing-the-medical-research-gap.