Small Change, Big Consequences — Partial Medicaid Expansions under the ACA

Adrianna McIntyre, M.P.P., M.P.H., Allan M. Joseph, M.P.H., and Nicholas Bagley, J.D. Though congressional efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled, the Trump administration retains broad executive authority to reshape the health care landscape. Perhaps the most consequential choices that the administration will make pertain to Medicaid, which today covers more than 1 in 5 Americans.1 Much has been made of proposals to introduce work requirements or cost sharing to the program. But another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion, and other states may well follow its lead.2 To understand Arkansas’s request, and why it matters so much, some background is in order. Medicaid waivers have long allowed states to experiment with delivery reform and coverage expansions, but waivers became more consequential in 2012, when the U.S. Supreme Court gave states a choice about whether to expand their Medicaid programs to cover everyone with an income of up to 138% of the federal poverty level. Some states sought greater flexibility to expand Medicaid on their own terms, which made participation in the expansion more palatable in Republican-controlled states. After intense negotiations, the Obama administration granted expansion waivers to seven states... Full article published in The New England Journal of Medicine...

The Dubious Empirical and Legal Foundations of Wellness Programs

Abstract The article offers information on the dubious empirical and legal foundations of workplace wellness programs in the U.S. Topics discussed include enactment of Affordable Care Act for expanding the scope of incentives availas; analysis of financial incentives offered to the employees for encouraging their participation in wellness programs; and targeting incentives specifically toward individuals diagnosed with chronic diseases. Source: Adrianno McIntyre, Nicholas Bagley, Austin Frakt, and Aaron Carroll, The Dubious Empirical and Legal Foundations of Wellness Programs, 27 Health Matrix 59 (2017) Available at:...

BOOK REVIEWS: Our Health Care Tug-of-War

Steven Brill makes some keen points about what works—and what doesn’t—in our health care system. He’s not so good on what will fix it. BY ADRIANNA MCINTYRE FROM SUMMER 2015, NO. 37 America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System By Steven Brill • Random House • 2015 • 528 pages • $28 Several weeks after the disastrous October 1, 2013, launch of Healthcare.gov, I had dinner with friends who also happened to be reporters on the health-care beat. “We knew it was going to be bad,” one person at the table remarked grimly. “But did we know it was going to be this bad?” On the first day that the federal insurance exchange was online, just six people were able to register for coverage. The site struggled to work for months. But when open enrollment finally ended in April 2014, after several extensions from the Administration, more than eight million people had found coverage through the state and federal insurance exchanges, surpassing projections from the Congressional Budget Office. In America’s Bitter Pill, Steven Brill deftly chronicles this disaster and recovery with a depth of reporting that day-to-day coverage didn’t provide. With the benefit of hindsight and the space of 455 pages of text, Brill is able to trace the stubborn and complex confluence of pressures, inescapable trade-offs, and fallible actors that brought us the nation’s most sweeping health reform in half a century. But Brill, the celebrated investigative journalist, proves to be fallible, too: Rather than stick to reporting, he chooses to play pundit and issue ill-informed prescriptions for our health-care system. His recommendations demonstrate a...