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The Abstract
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> By Torie Ludwin, Arnold Ventures
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Evan Mintz, director of communications, writes about high health care prices, site-neutral payments, and this week's hearings:
Much to my enjoyment as a lover and practitioner of dad humor, my four-year-old daughter has been learning how to tell jokes.
“When is a car not a car? When it turns into a driveway.”
“When is a door not a door? When it is ajar.”
I tried to teach her one I learned this week from the Arnold Ventures health care team: “When is a doctor’s office not a doctor’s office? When it is owned by a hospital.”
OK, that one isn’t so funny — and probably because the joke is on the American people.
All across the country, hospitals have been buying up community physician practices, reducing competition and raising costs for consumers and taxpayers alike.
The consolidation is fueled in part by the higher prices hospitals can charge for the same services when delivered under the banner of hospital care. On the taxpayer side, Medicare pays hospital-owned facilities significantly higher rates — between 106 percent and 217 percent more — than independent practices and other outpatient facilities for the exact same services.
Meanwhile, families and individuals with private insurance get stuck paying more through “dishonest billing” practices that reclassify your friendly neighborhood doctor’s office as a hospital — ultimately raising costs for patients and their employers.
That is why Arnold Ventures is teaming up with a broad, bipartisan coalition of think tanks and experts calling for Congress to pursue policies that will tackle dishonest billing and expand site-neutral payments. Just this week we’ve signed onto two letters asking Congress to improve health care affordability by addressing market failures, improving competition, and ensuring transparent information on prices.
These letters come just as Congress begins to hold hearings on policies to address high and rising health care prices by increasing transparency and improving competition, including by expanding site-neutral payments, addressing dishonest billing, and enhancing hospital and insurer price transparency.
At a House Energy and Commerce Committee hearing this week, Brian Connell, executive director of federal affairs for The Leukemia and Lymphoma Society, an AV grantee, explained how hospital consolidation and opaque and predatory billing practices have made treatment less affordable for cancer patients.
“Despite the patient going to the same office, being treated by the same staff, and receiving the same medication, the shift in underlying reimbursement — from the lower physician fee schedule to the higher hospital outpatient payment system — increases the patient’s out-of-pocket costs without any corresponding improvement to the quality of their care,” he said.
There is robust public support and growing bipartisan momentum for addressing these problems and lowering health care costs. Arnold Ventures is dedicated to lowering health care costs and site-neutral payments should be a part of any policy solution — and that’s no joke.
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By Juliana Keeping, communications manager
Across health care, price tags remain hidden. Price transparency is an important first step to creating a more affordable health care system. The Biden administration and states are moving toward a less opaque status quo when it comes to the prices hospitals charge.
What's Happening: A suite of hearings in Washington, D.C., this week addressed rising health care costs and a range of solutions to address market dysfunction and lower prices charged to consumers, like more transparent pricing from hospitals.
Why It Matters: The hospital transparency rules, as well as the insurer transparency rules, have the potential to shine a light on the prices paid to hospitals — helping purchasers, researchers, and policymakers understand what is driving up the cost of health care in this country.
What's Next: Voters from both sides of the aisle support aggressive Congressional action to lower hospital prices — and nearly nine of 10 want hospitals to publicly disclose their prices. On Wednesday, CMS announced stricter enforcement standards for noncompliance with transparency rules; states are also ramping up penalties for hospitals that have yet to comply.
Read our recent voter poll on hospital prices > |
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The Inspiring Second Chance Story of Rep. Tarra Simmons
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By Thomas Hanna, communications manager
As part of Second Chance Month, AV profiled Washington State Representative Tarra Simmons and her amazing journey from incarceration to law school to the state house.
What Happened: After a series of arrests for drug possession and theft in 2011, Simmons — who had struggled to break generational cycles of poverty, substance abuse disorder, and incarceration — was sentenced to 30 months in prison. While incarcerated, she was visited by a group of law students who encouraged her to consider the possibility of law school.
Upon release, Simmons seized her second chance and never looked back. Despite multiple setbacks related to her involvement with the justice system, including a case that went to the state Supreme Court, she graduated from law school, created the nonprofit Civil Survival Project (CSP), which advocates for, and provides legal services to, formerly incarcerated people, and in 2020 was elected to the Washington State House of Representatives.
Why it Matters: Tarra Simmons’ story illustrates the power and potential of providing people with a conviction or arrest record a second chance. It also highlights many of the obstacles and hurdles people with such records face when trying to rebuild their lives and reintegrate into society.
Read Simmons’ story >
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A New Opportunity to Strengthen Accountability in Higher Education
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By Evan Mintz, communications director
Arnold Ventures’ Higher Education team published a letter reiterating its call to improve accountability in higher education and strengthen the program integrity triad, which incorporates oversight by states, accrediting agencies, and the U.S. Department of Education.
What’s Happening: The U.S. Department of Education has announced its intent to establish another negotiated rulemaking committee. This upcoming rulemaking can be an opportunity to implement reforms that will help ensure students get a fair shake and institutions fulfill the economic promise of higher education.
Why It Matters: Our nation faces a crisis of accountability in higher education. Fewer than two-thirds of bachelor’s degree-seeking students graduate within six years. Only one-third of students at two-year schools graduate within three years. More than 7 million borrowers are in default on their loans. Students in hundreds of postsecondary programs graduate no better off than they would have been with just a high school diploma.
What’s Next: AV’s letter recommends some specific reforms, including improving the effectiveness of accreditors’ standards and practices, updating the accreditor recognition process, permitting states to enforce their law and protect their residents, strengthening third-party servicer regulations, and improving reporting on distance education.
Read our letter and recommendations >
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Criminal Justice
- In RealClear Politics, AV Executive Vice President of Advocacy James Williams writes about his family’s personal experience with the criminal justice system and why we should be outraged at the scope and effects of mass incarceration in America.
- AV Vice President of Criminal Justice Juliene James released a statement on the Department of Justice’s revised and updated Dear Colleague letter regarding the assessment of criminal legal fines and fees. The Justice Department’s action was covered in the New York Times. (free link)
James also released a statement on the Department of Housing and Urban Development’s proposed action plan on removing barriers to housing for people with criminal records.
- The Trace reports on growing questions about the effectiveness of gun buyback programs in reducing community violence.
- NPR covers the recent decision by the Carroll County Sherriff’s Office to hire Myles Cosgrove, the former Louisville police officer who killed Breonna Taylor. The hiring highlights how police officers fired in one jurisdiction for misconduct can often return to the force again in other jurisdictions.
- Northwestern Now presents the results of a new longitudinal research study showing that nearly 25% of Black and Hispanic males entering juvenile detention were shot or killed within the next 16 years. “Youth in the juvenile justice system are commonly viewed as perpetrators of violence — but we found that they are highly likely to become victims of firearm injury and death,” Linda Teplin, the study’s director, said.
- The Responsible Business Initiative for Justice (RBIJ), an AV grantee, has released a new “roadmap” to improve Second Chance hiring practices and provide better employment opportunities for the more than 70 million Americans with a criminal record. Read an article about the roadmap by Ashley Furst, Senior Program Manager Employment Opportunities at RBIJ.
Health Care
- AV grantee Families USA makes recommendations for the Biden administration to strengthen transparency efforts around hospital pricing in its recent report — while noting hospitals continue to subvert or skirt the regulations all together. The group is calling for stronger enforcement of the existing regulations, improved clarity for consumers, more Congressional hearings, and for strengthened regulations to be codified into law.
- A new report from the Kaiser Family Foundation sheds light on data gaps about Medicare Advantage plans that limit the policymaking and research communities’ ability to conduct oversight. About half of Medicare beneficiaries enroll in Medicare Advantage plans — Medicare’s privately run arm for seniors and people who are disabled.
- Maryland has created a Prescription Drug Affordability Board to rein in prescription drug prices, and other states are following Maryland’s lead, via NPR.
- AV grantee Primary Care Collaborative published a blog post calling on the Biden administration to rapidly implement a hybrid primary care payment option within the Medicare Shared Savings Program (MSSP).
Related: Federal Reforms Poised to Strengthen Model that Offers High-Quality Care at Lower Costs
Public Finance
- AV grantee the National Taxpayers Union Foundation launched the Taxpayers For IRS Transformation (FIRST) advisory board, highlighted in Politico’s Morning Tax. The bipartisan group will develop recommendations on how the IRS can effectively use its new funding to close the tax gap while protecting taxpayer rights.
- Matt Weidinger of AV grantee the American Enterprise Institute highlights the scale of improper payments made in government programs.
- Elaine Maag, Amelia Coffey, and Hannah Daly of the Tax Policy Center highlight trade-offs around converting Child Tax Credit payments to monthly checks compared to a lump sum in beneficiaries’ tax returns.
Evidence-Based Policy
- The City University of New York (CUNY) in partnership with Metis Associates released a four-year interim study report on a recent evaluation of the Accelerate Compete Engage (ACE) student success program, an application of CUNY's successful Accelerated Study in Associate Programs (ASAP) to a four-year degree. ACE students graduated at a rate 12.4 percentage points higher than the control group — a 27 percent increase. Few interventions have shown to work so well in so many settings as ACE and ASAP. There is a summary available in addition to the report.
Related: Another Promising Path to Student Success
Higher Education
- This week, Congress reintroduced the College Transparency Act. Read AV Vice President of Higher Education Kelly McManus' statement on the bicameral, bipartisan bill.
- Lilah Burke at Higher Ed Dive provides an overview of how the Office of Federal Student Aid (FSA) will struggle to fulfill its duties without a significant bump in funding.
- The Century Foundation also released commentary on the implications of FSA’s budget, arguing that the current funding level poses high risk to consumer protections. The U.S. Department of Education has noted that the 2022 funding level would cause more than 40 million borrowers to face decreased service hours and longer turnaround times in making any changes to their student loans.
Related: Defunding Borrower Trust
- Michael Stratford at Politico points out the higher education implications of the House GOP debt limit plan: it would nullify Biden’s student loan cancellation plan, end the freeze on monthly payments and interest, bar the Biden administration from moving forward with a new income-driven repayment plan, and would permanently prohibit the Department from issuing any significant regulation or executive action that would increase the long-term cost to the government of operating the federal student loan programs.
- NBC Chicago reports on Sen. Durbin's letter to education professionals advocating against the promotion of for-profit institutions to prospective college students. “You have dedicated your life to preparing Illinois students for better opportunities through education," wrote Durbin. "For-profit colleges have proven themselves to be a direct threat to your life’s work."
Contraceptive Choice and Access
- Health Affairs outlines the benefits and implications for individuals who are able to access a 12-month supply of contraception. "Ensuring contraceptive equity by requiring health insurance plans to cover dispensing of a 12-month supply without copayments at the point of sale is an important policy-based approach to improving uninterrupted access."
Democracy
- Walter Olson at AV grantee the Cato Institute explains why conservatives have nothing to fear when it comes to ranked-choice voting, in RealClear Policy.
Journalism
- Congratulations to AV grantee KFF Health News, which earned recognition for its Diagnosis Debt series, taking home awards from the Society for Advancing Business Editing and Writing (SABEW) and the National Institute for Health Care Management (NIHCM) Foundation’s 2023 Awards in Journalism and Research.
Climate
- The New Yorker reports on the efforts to get a new satellite in space to track emissions of methane, a gas that significantly contributes to global warming.
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On Thursday, May 4, the Committee on Law and Justice of the National Academy of Sciences, an AV grantee, is hosting two public events in Washington, DC. At 10:30 a.m. ET, AV Vice President of Criminal Justice Research Jocelyn Fontaine will speak as part of a panel on “Innovative Approaches to Measuring Community Perceptions on Public Safety.” Attendance is virtual and in-person. Register here.
On Friday, May 5, at 9 a.m. ET, at the National Press Club in Washington, D.C., AV grantee Student Defense will host a panel discussion entitled, “OPM Outlook: The Next Frontier in Higher Ed Policy and Accountability.” The panel will explore the online program management company landscape and examine current accountability and oversight mechanisms that govern their participation in higher education. RSVP here.
On May 8 and May 9, AV will be supporting the Safe and Just Communities Summit at the John Jay College of Criminal Justice in New York City. Co-hosted by the National Urban League, the Summit will provide a comprehensive, community-centered framework for safe communities. On May 8, AV’s Executive Vice President for Criminal Justice Jeremy Travis will participate in a panel discussion about his book “Parsimony and Other Radical Ideas About Justice.” Also on May 8, AV’s Vice President of Criminal Justice Walter Katz will moderate a panel on fair and accountable policing for safe communities. Learn more and register here.
On Tuesday, May 9, Punchbowl News in partnership with The Network and LBJ Women's Campaign School will host Women Challenging Washington at 8:30 a.m. ET at Union Station (Columbus Club). A bipartisan group of women lawmakers will discuss how they are challenging the status quo and working across party lines to disrupt Washington. Arnold Ventures Co-Founder and Co-Chair Laura Arnold, The Network's Holly Harris & LBJ Women's Campaign School Founder Amy Kroll will also take to the stage for a fireside chat. Find more information and register here.
The Harvard Kennedy School Government Performance Lab (GPL) is inviting applicants for its third Alternative 9-1-1 Emergency Response Implementation Cohort. Applications close May 15. Apply here.
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Have an evidence-based week,
– Torie
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Torie Ludwin edits the Abstract, produces branded content, and covers public finance and evidence-based policy for Arnold Ventures.
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