Politics and policy

Insight into federal and state health care legislation & CMS regulation

Legislation & Regulation
Richard Mark Kirkner
A few years ago, a patient in Indiana went to his doctor, who ordered a routine cardiac stress test. The visit was in a major medical center, and the patient was sent to another floor to register for the test. Long story short, the patient, who was savvy in the ways of health insurance and was well…
Legislation & Regulation
Richard Mark Kirkner
A federal bill would expand access to experimental treatments, but critics say right to try would take away FDA oversight and create a ‘Wild West.’ Meanwhile, most states’ right-to-try laws have gone unused.
Viewpoint
Zachary Hafner
It’s a must because there is a cost to keeping the underserved that way whether that means funding integrated primary care to help people live healthier lives or footing the bill when people get care in the emergency department.
Robert Calandra
CMS is granting waivers that impose work and other new requirements on some Medicaid beneficiaries. Medicaid managed care plans are wary of the added administrative complexity—and possibly a change in the Medicaid population’s risk profile.
News & Commentary
Kentucky was the first state to take advantage of the Trump administration’s invitation for states to set work requirements for Medicaid, but others are sure to follow.
Book Review
Peter Boland
Ezekiel J. Emanuel’s Prescription for the Future is true to its title and proposes a five- to 10-year agenda for transforming expensive, wasteful American health care into a system that delivers high-value care. This is a qualitative book based on case studies that identify and systematize how to improve quality, patient experience, and cost.
Joseph Burns
The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.
2018 Year in Preview
Susan Ladika
CMS chief Seema Verma wants to reshape the entitlement program that covers about 62 million people. Verma endorses “community engagement”—work or community service— as a condition for “able-bodied” people to get Medicaid coverage and accused the Obama administration of the “soft bigotry of low expectations” for opposing such a requirement.