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The Doctor will see you Now (For $160)

by Kyle Fischer, MD, MPH in Access to Care

Although the Affordable Care Act sought to expand health insurance to near universal levels, this has not occurred. In the Supreme Court case National Federation of [...]


Continuity of Care

Health care costs

Access to Care

  • Source: Allen Skyy (Flickr/cc)

    Medicaid crowd out: hype or reality?

    With Medicaid expansion underway, questions about whether Medicaid coverage “crowds out” private coverage have reemerged. Critics of Medicaid expansion contend that public health insurance causes individuals to forego private coverage. A recent study published in Inquiry sought to quantify this phenomenon—specifically, to determine how many new Medicaid enrollees had private insurance at the time of Medicaid enrollment and, of those new Medicaid recipients, how many dropped their private [...]
  • Source: Bob the Lomond (Flickr/CC)

    The Dynamics of Health Insurance Post-ACA

    We know that the number of uninsured in the United States has decreased significantly (by 16.9 million) since the Affordable Care Act (ACA), but how are people moving between different types of insurance coverage? Source: Bob the Lomond (Flickr/CC) Despite intense focus on Medicaid expansion and the health care Marketplaces as key elements of the ACA, employer-sponsored insurance, which 9.6 million uninsured Americans obtained between September 2013 and February 2015, was responsible for the [...]
  • Source: Robbie Shade (Flickr/CC)

    Looking to Massachusetts for Answers

    Massachusetts’ health reform in 2006 served as a model for the Affordable Care Act (ACA), and many policy experts are closely following the state to estimate what we can expect with the ACA. One important question to policymakers and the public is whether the ACA will decrease emergency department (ED) visits. Source: Robbie Shade (Flickr/CC) A new study published in Medical Care this year specifically focused on ED use by people who gained Commonwealth Care (CommCare) after health reform in [...]
  • Source: Carol Von Canon (Flickr/CC)

    The Doctor will see you Now (For $160)

    Although the Affordable Care Act sought to expand health insurance to near universal levels, this has not occurred. In the Supreme Court case National Federation of Independent Business v Sebelius, the court ruled Medicaid expansion to be optional. Subsequently, 20 states opted not to participate in expansion. What was left were significant questions regarding access to care for those left out of Medicaid expansion. Source: Carol Von Canon (Flickr/CC) In an article recently published in Health [...]
  • Source: lunar caustic (Flickr/CC)

    Protecting Babies and Women’s Rights

    Does protecting abortion rights paradoxically lower infant mortality rates? A new study from Health Affairs examined trends in US infant death rates between1960–1980, and though the hypothesis is provocative, the study’s level of evidence is limited due to its descriptive analysis. Source: lunar caustic (Flickr/CC) Several states have introduced hundreds of abortion bills in the past few years. Often referred to as targeted regulation of abortion providers (TRAP), the laws have affected [...]
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    The First Five Years of the ACA in Review

    This article is the second of a two part series. See article one here. Cost of Care: The ACA encouraged the creation of Accountable Care Organizations (ACOs) to integrate and coordinate patients’ health care experiences. Under the Medicare Shared Savings Program (MSSP), providers who create ACOs and meet quality metrics are eligible to share in part of the savings. There are currently 405 ACOs participating in the MSSP, serving 7.2 million Medicare beneficiaries and saving approximately $700 [...]
  • Source: Dan Moyle (Flickr/CC)

    It Costs More to be Poor

    Uninsured patients are the most financially vulnerable to hospital charges. Hospitals bill a high charge for medical services, with the expectation that a fraction of that is actually paid by insurance companies. With a large consumer base, commercial and government insurance programs negotiate for substantially lower rates. Meanwhile, the uninsured have little to no bargaining power, and thus are frequently tethered with substantial payments at the gross price. Source: Dan Moyle (Flickr/CC) To [...]
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    Less is More: HIE Prevents Repeat Tests

    Health Information Exchange (HIE) lets doctors see all of their patients’ records online, no matter where patients choose to go for care. If a patient has a doctor they really like in one hospital, but wants their labs drawn and prescriptions filled at a more convenient location in their neighborhood, then winds up in the ER across town after falling at a shopping mall, their ER doctor can see which medicines they are taking, and their bone specialist can see the results of the X-rays done at [...]
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    Toppling the Ivory Tower of Medicine

    Last summer’s Institute of Medicine report on Graduate Medical Education (GME) raised vociferous concerns from stakeholders ranging from academic medicine (Association of American Medical Colleges), hospitals (American Hospital Association), and organized medicine (American Medical Association). In this Health Policy Report from the NEJM, the details of the IOM report are summarized and the salient issues surrounding the reform of GME are explained. Graduate medical education, the system by [...]
  • Source: NIH/NIAID (Flickr/CC)

    The Economic Benefit of Preventing HIV

    In May 2014, the CDC released guidelines for pre-exposure prophylaxis (PrEP) for individuals considered high risk for HIV infection: those in relationships with HIV positive partners, those engaged in high-risk sexual behavior, and those with ongoing intravenous drug use. The recommendations include daily Truvada, an antiretroviral drug, and follow-up visits with STI/HIV testing and lab work every 3 months. These guidelines represent a significant investment estimated at $13,000 annually [...]

Health IT

Public Health

Lessons from Abroad

Affordable Care Act

  • Source: Marc Dalmulder (Flickr/CC)

    Will Medicaid gains offset DSH cuts?

    September 20, 2014 // 1 Comment

    The Disproportionate Share Hospital (DSH) program was developed to provide financial assistance for hospitals that care for large numbers of Medicaid and uninsured patients. [...]
  • Source: Francois Karm (Flickr/CC)

    States opt for lower smoking fees

    September 15, 2014 // 0 Comments

    The Affordable Care Act (ACA) allows insurance companies to charge smokers up to 50% higher premiums than nonsmokers. However, this study found that most insurance companies [...]
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    Drying the DSHs

    August 20, 2012 // 5 Comments

    I was asked an interesting question last week when giving a presentation to Baylor College of Medicine’s Emergency Medicine Residency program. As a program housed in a [...]
  • Image: Tanya Little (Flickr / Creative Commons)

    Debunking “FloozyCare”

    April 21, 2014 // 1 Comment

    Image: Tanya Little (Flickr / Creative Commons) As the implementation of the Affordable Care Act continues, controversy remains around requiring contraception coverage as [...]
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    Dr. Jesse Pines joins our Executive Editor Cedric Dark, MD, MPH for a discussion about the effect of the Affordable Care Act on emergency physician reimbursement. This [...]
  • Photo courtesy the City of North Charleston, SC (Creative Commons / Flickr)

    Insuring Our Nations Veterans

    April 14, 2014 // 4 Comments

    Photo courtesy the City of North Charleston, SC (Creative Commons / Flickr) Myth: All United States military veterans receive health insurance. Fact: More than 1.5 million [...]

Medicaid Expansion Map