January 31, 2020
The Out-of-Pocket Health News Digest
Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.
This compilation is produced by the HPSA Education Committee: Sharoni Bandyopadhyay, Matthew Dunn, Payton Watt and Courtney Zott.
How Are Countries Containing the 2019 Novel Coronavirus?
The number of the 2019 novel coronavirus cases continues to skyrocket. On Wednesday, the number of confirmed cases rose by over 1,000 in just one night. As of Wednesday morning, China has had 132 deaths and 5,974 confirmed cases-- a larger amount of cases than they had of SARS in 2002. The number of global cases has reached almost 8,000 .  

The WHO decide to recognize the outbreak as a international public health emergency, and countries across the world are taking serious measures to contain the virus. China has ordered a quarantine of 50 million people . They are accommodating this number by placing individuals in hotels and two temporary hospitals that they aim to build within a 10 day period. Most countries are evacuating their citizens fro Wuhan and are also placing them in quarantine. Australia is evacuating their citizens to Christmas Island , a remote island in the middle of the Indian Ocean in order to quarantine them for two weeks. North Korea is implementing a one-month quarantine of any foreigners who have recently visited China. The U.S. evacuated their citizens this past Wednesday to the air force base in southern California , where they will stay until tomorrow for testing. All individuals will then be sent home if they do not have the virus, but will continue to be monitored for 14 days.

Scientists across the globe are dedicated to stopping this spread as quickly as possible not only to protect the health of the people, but also to minimize disruption to businesses, airlines, and tourist cities. Several countries, including the United Kingdom, Canada, Indonesia, and South Korea have cancelled all U.S.-China flights for the time being. The U.S. is considering this route if the outbreak continues to worsen. For now, the U.S. continues to screen all individuals coming in from China. Scientists are working hard to get more details on the virus, and individuals in Australia and China have recently replicated the virus in the lab . This will allow for a greater understanding of the virus and hopefully effective treatment options.

Mixed Results for “Hotspotting” Method to Address Social Determinants of Health
In the United States, 5% of all patients account for about 50% of health care spending . Some health systems have tried to use a “hotspotting” strategy to reduce the need for health care among the heaviest users. This targets the most vulnerable members of a patient population, offering services to address non-medical barriers to health, including lack of housing or food insecurity. The hope of such programs is to decrease health care costs in the long-term by reducing the frequency of emergency room visits.

 So far, that goal has not been achieved. Recent studies of programs in New Jersey and California report that hospitalization rates have not decreased at all among the intervention populations. Still, hospitals are not abandoning these programs , emphasizing that it may take more time and increased enrollment to achieve the intended results. 

However, hospitalization rates are not the only measure of health, and there is reason to be optimistic about the potential of hotspotting. The UCLA study of California’s Whole Person Care program found a decrease in homelessness and incarceration rates among participants, in addition to improvements in self-reported physical and emotional health, blood pressure control, and blood sugar control. Emergency room visits may be unavoidable for some patients living with chronic conditions, but these programs can improve the overall picture of their health. 

CMS Will Allow States to Implement Medicaid Block Grants
CMS Administrator Seema Verma announced a plan Thursday to allow states to convert federal funding for parts of their Medicaid programs into block grants.
 
Under the current funding model, the federal government matches a certain percentage of state spending based on per capita income. For example, California and other higher-income states receive the lowest (by statute) match rate of 50%, while Mississippi receives the highest rate of nearly 78%. Under the new block grant model—which states must “apply” for through Section 1115 waivers—states would receive a preset amount of money annually based on “the most recently available eight consecutive quarters of expenditure data” for the populations on which they choose to pilot block grants. CMS encouraged states to focus on expansion populations.

Block grant funding has been a longtime GOP agenda item for reducing federal Medicaid spending, which has been growing and accounted for 9.4% of the federal budget in fiscal year 2017. The idea is that, with a fixed amount of money and some additional flexibility—for example, CMS’ plan allows modifications to benefits packages—states will become more efficient and innovative in running their Medicaid programs.
 
Critics counter that fixed funding leaves states in a poor position to weather unplanned fiscal pressures on their Medicaid programs, such as recessions or natural disasters, and will ultimately lead to more restrictive eligibility requirements and/or benefits packages.
 
States that have already expressed interest in block grants include Alaska, Tennessee, Utah, and Texas.
 
One-Liners
  • Immigration: The U.S. Supreme Court allowed the Trump Administration to move forward with implementing the “public charge” rule, which expands the government's ability to deny green card obtainment for lower-income legal immigrants who may require public assistance. (Politico)
  • LGBTQ+ Health: More than a dozen Republican states have introduced legislation that would penalize physicians for providing gender reassignment therapies to transgender minors; LGBT+ advocates argue that this will lead to poorer mental health outcomes in a vulnerable community. (The Washington Post)
  • Reproductive Rights: The U.S. Supreme Court has agreed to review a case on the ACA’s provision requiring employers to provide free contraceptives coverage despite religious beliefs, in a continuation of the conservative movement to restrict reproductive rights. (NY Times)
  • Maternal Mortality: The U.S. has finally standardized national data on maternal mortality, with 2018 research revealing that black mothers are still 2.5x more likely to die than white mothers during childbirth. (NBC News)
  • Criminal Justice: The Mississippi Governor was forced to shut down Parchman prison after 9 inmates died within one month, drawing attention to the overlooked and inhumane conditions of private prisons. (CNN)