Research Roundup: Heart disease and disability; Medicaid and health reform, mental illness

Sep 3 2010

Urban Institute/Robert Wood Johnson Foundation: The Health Status Of New Medicaid Enrollees Under Health Reform - Using the Medical Expenditure Panel Survey, authors of this paper found "strong evidence that those who will enroll [in Medicaid after 2014] are likely to be healthier than nondisabled adults currently enrolled in Medicaid ... There is, however, a high likelihood of adverse selection - the least healthy and older among the new eligibles will be more likely to enroll. … A high rate of adverse selection is especially likely in the initial period following implementation of the Medicaid expansion and the other major policy changes associated with health reform, as we expect that those with the greatest health needs will be among the first to enroll" (Holahan, Kenney and Pelletier, August 2010).

Mathematica: How Are the Experiences Of Individuals With Severe Mental Illness Different From Those Of Other Medicaid Buy-In Participants? - The Medicaid Buy-In [MBI] program "allows states to extend Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid." About a third of the program's participants have a mental illness. The study "linked state-level data on program participation to demographic and diagnosis information" from Medicare and Medicaid data files and found that "compared with other MBI participants, participants with[severe mental illness [SMI] had lower medical expenditures and were more likely to be employed and to increase their earnings over time. These findings suggest that for relatively lower expenditures, participants with SMI have better employment outcomes than other participants, at least in the short to medium term" (Liu and Croake, August 2010).

Commonwealth Fund: Realizing Health Reform's Potential: Small Businesses And The Affordable Care Act Of 2010 - This issue brief notes that the new health law has provisions designed to help small businesses afford health insurance, starting with a tax credit this year. And, "beginning in 2014, the ACA will create new insurance exchanges with standardized and comprehensive health benefits, new market rules, and greater federal and state oversight of the individual and small-group markets. In addition, the value of the small business tax credit will increase to half of an employer's premium contribution, starting in 2014. The CBO estimates that the credits will reduce premiums for eligible small firms by 8 percent to 11 percent, providing savings of up to $40 billion over the next 10 years" (Collins et al., 9/2).

KHN summarized news coverage of the brief: Study: Health Overhaul's Tax Credit For Small Business Could Affect Millions

Institute of Medicine: Cardiovascular Disability: Updating The Social Security Listings - "As medical knowledge continues to advance—and as the U.S. government seems likely to face continuing financial pressures—improving the Social Security Administration's (SSA) capacity for determining disability benefits more efficiently assumes ever greater importance," according to the summary of this IOM report. The report features the agency's recommendations for how to enhance SSA's cardiovascular system listings that are used to determine disability benefits. The authors found "a number of knowledge gaps that SSA should address in order to improve the quality of the current Listings" and recommend "that SSA revise most Listings to require evidence of serious functional limitations in addition to appropriate measures of cardiovascular impairment" (8/27)

Government Accountability Office: VA Drug Formulary: Drug Review Process Is Standardized At The National Level, But Actions Are Needed To Ensure Timely Adjudication Of Nonformulary Drug Requests - Although the Department of Veteran Affairs (VA) "provides drugs on its national formulary … all VA medical centers must have a nonformulary drug request process that is overseen by their regional Veterans Integrated Service Network (VISN)," according to the highlights of this report. The GAO "recommends that VA establish additional mechanisms to ensure nonformulary drug requests are adjudicated in a timely fashion. VA concurred with this recommendation" (August 2010).

Institute of Medicine: A Summary Of The February 2010 Forum On The Future Of Nursing: Education - During a  recent Robert Wood Johnson Foundation Initiative on the Future of Nursing forum, designed to examine challenges and opportunities associated with nursing education, "experts considered innovations and strategies in three areas: what to teach, how to teach, and where to teach," according to an IOM summary which adds that the findings from the forum will help inform a final report to be released in October 2010 (8/31).