Research roundup: States struggling with Medicaid expansion "complex issues"

Nov 4 2013

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Annals of Emergency Medicine: Anticipated Changes In Reimbursements For US Outpatient Emergency Department Encounters After Health Reform 
We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. ... Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. ... Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges (Galarraga and Pines, 10/30).

JAMA Internal Medicine: Public Preferences About Secondary Uses Of Electronic Health Information Importance
We surveyed 3336 adults (368 Hispanic, 500 non-Hispanic African American and 2268 non-Hispanic white); participants were randomized to 6 of 18 scenarios describing secondary uses of electronic health information ... marketing uses, quality improvement uses, drug company users and public health department users were associated with less willingness to share health information than research uses and university hospital users. Hispanics and African Americans differentiated less than whites between uses. ... Participants cared most about the specific purpose for using their health information, although differences were smaller among racial and ethnic minorities. The user of the information was of secondary importance and the sensitivity was not a significant factor (Grande et al., 10/28). 

Health Affairs: Navigators And Assisters
Trained counselors and organizations are helping consumers enroll in health plans through the Affordable Care Act's new insurance Marketplaces. ... With the rough launch of the Marketplaces making it difficult for people to shop for plans and enroll online, navigators and assisters are more important than ever. Much of the job educating and enrolling people will be on a one-on-one basis, a time-intensive and costly effort that will be more difficult in states that are hostile to the law. In addition to navigators and assisters, HHS is relying in part on not-for-profit organizations that have pledged to provide outreach and education on the Affordable Care Act. ... The battle over state laws imposing additional requirements on navigators will likely play out over the next several months as navigators and assisters begin their work (Goodell, 10/31)

National Association of Medicaid Directors: NAMD Snapshot, Open Enrollment, Week 4
During the fourth week of open enrollment, the state experience remained varied depending on the type of Marketplace operating in the state and whether the state is planning to expand Medicaid eligibility January 1, 2014. ... All states described a range of complex issues in their efforts to integrate with the Marketplaces, with the specifics dependent on the use of a Federal or state model. Beyond these variables, all states continued to develop or refine a number of complex aspects of their eligibility and enrollment systems, reporting mechanisms and tools for interfacing with consumers and stakeholders. Medicaid agencies are all working to comply with the January 1, 2014 effective date for using Modified Adjusted Gross Income to determine eligibility for certain Medicaid applicants as well as ensuring their systems provide the experience for applicants and enrollees (10/29).

British Medical Journal: Non-Publication Of Large Randomized Clinical Trials: Cross Sectional Analysis
PubMed, Google Scholar, and Embase were searched to identify published manuscripts containing trial results. ... Of 585 registered trials, 171 (29%) remained unpublished. These 171 unpublished trials had an estimated total enrollment of 299 763 study participants. ... Non-publication was more common among trials that received industry funding (150/468, 32%) than those that did not (21/117, 18%),>

UCLA Center for Health Policy Research: Migration and Health: Mexican Immigrants In The U.S.
The results of this report indicate that the Mexican population has a lower prevalence of chronic diseases such as cancer, hypertension, asthma and cardiovascular disease, compared to other ethnic or racial groups, which, in part, could be associated with its younger age structure. However, it is also possible that the prevalence of diseases is higher than that recorded in the statistics, precisely because there is underdiagnosis related to immigrants' limited health insurance coverage, greater financial difficulties to cover the costs involved, fear about immigration status, or with health literacy problems and difficulty navigating a health care system that is increasingly more complex and automated. ... In 2014 the Affordable Care Act will integrate millions of newly insured Latinos, including many lawful permanent resident (LPR) Mexican immigrants, into the health system. ... However, the exclusion of undocumented immigrants from Medicaid, health insurance subsidies, and even the health insurance exchanges under the ACA will leave millions of Mexican immigrants without coverage (Ramirez et al., 10/1).

Here is a selection of news coverage of other recent research:

MedPage Today: Paying Kidney Donors Can Save $$, Help Patients
Paying living donors for their kidneys would reduce the number of end-stage renal disease (ESRD) patients on dialysis and transplant wait lists, and save the healthcare system money, researchers in Canada concluded. Using decision analysis modeling, they estimated that a $9,648 ($10,000 Canadian) payment per living donor would increase the number of kidneys available for transplant by 5%, with an incremental cost savings of around $328 ($340 Canadian) per patient, ... researcher Lianne Barnieh, PhD, of the University of Calgary, and colleagues wrote online in the Clinical Journal of the American Society of Nephrology (Boyles, 10/25).

Reuters: JAMA Study Questions FDA's Shorter Drug Approval Times
New drugs that receive expedited review by the Food and Drug Administration are being tested on fewer patients, leaving many safety questions unanswered even after they are approved, a study released on Monday in the Journal of the American Medical Association found. Study authors Thomas Moore of the Institute for Safe Medication Practices and Dr Curt Furberg, a professor at Wake Forest School of Medicine, examined the development times, clinical testing and risks associated with 20 new drugs approved in 2008. Eight were given expedited review and 12 standard review (Clarke, 10/28).

MedPage Today: Futile Measures Deprive Others Of ICU Care
Patients in the intensive care unit (ICU) who are unlikely to benefit from the care they're getting may be receiving treatment at a cost to other patients who would actually gain from an ICU bed, researchers said here. In a single-center analysis, there were several instances of emergency department (ED) boarding and delays or failures in transferring patients from other hospitals when the ICU was full and "futile" patients were receiving care there, Thanh Huynh, MD, of the University of California Los Angeles, reported at the CHEST meeting here (Fiore, 10/29).

Reuters: Patients Might Benefit From Health Literacy Tests
Doctors often assume they're explaining things in a way patients understand. When patients are confused, doctors don't always realize it. A new study shows patients might benefit from having their "health literacy" tested. Researchers at a large Arizona healthcare center looked at how a short health literacy test would affect the way patients felt about their treatment. They found it did no harm and may have helped to improve patient satisfaction (Jegtvig, 10/25).

Stateline: Study Finds Aging Inmates Pushing Prison Health Care Costs
State spending on prisoner health care increased in 42 states between 2001 and 2008, with a median growth of 52 percent, according to a new report from The Pew Charitable Trusts. The primary driver of the cost spike is bigger and older prison populations. "Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend," said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation (Vestal, 10/29).