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The Abstract
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> By Torie Ludwin, Arnold Ventures
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Director of Journalism Rhiannon Collette introduces a photo essay illuminating a vulnerable population in health care and the policy changes needed to help them.
Everyone has a story about trying to get care for themselves or their loved ones and facing a confusing, bewildering web of bureaucracy in the U.S. health care system. No population bears this burden as much as the low-income older adults and people with disabilities who are dually eligible for Medicare and Medicaid. This population of about 12.5 million people (about twice the population of Arizona) has the benefit of coverage from two insurance programs, yet it has some of the worst health outcomes of any population in the nation.
Through a partnership with visual media organization CatchLight, award-winning photographer Isadora Kosofsky spent nearly a year documenting the lives of two women — Melissa and Ann — as they navigated Medicare and Medicaid simultaneously. Kosofsky captured how their personal challenges reflect systemic problems in the way care is delivered to this population. People who are dual eligible have more chronic conditions, more limitations on their daily activities, and more health-related social needs than the average health care patient. Yet the two programs that serve them have not historically worked together as one. Navigating these two separate government health care programs leads to fragmented, disjointed, and inconsistent care, which is why it’s no surprise that people who are dual eligible represent a disproportionately high share of government spending. Despite representing just 19 percent of the Medicare population, they account for 34 percent of Medicare’s spending.
Research and evidence demonstrate that the U.S. can improve care quality, outcomes, and spending for dual-eligible individuals by giving them access to programs that fully integrate their Medicare and Medicaid benefits. Improving the coordination between the two agencies could make it easier for patients like Melissa and Ann to get the care they need while also delivering better value for the public dollars that finance their care.
The photo essay debuts amid bipartisan interest from influential senators and ongoing state progress toward a better health care system for the dually enrolled — one that that provides universal access to fully integrated care plans for every person who needs it.
The photo essay is a partnership with CatchLight, a nonprofit that catalyzes the power of visual storytelling to drive impact and change. We also extend a special thanks to Upstatement and the Perkins School for the Blind for their support on this project.
Experience Melissa’s and Ann’s stories>
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A Stop to Dishonest Billing
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By Juliana Keeping, communications manager
Site-neutral policies are geared toward creating greater parity in health care pricing regardless of the setting in which services are provided. And they're gaining traction.
What’s Happening: Indiana passed a new bipartisan law to curb a predatory billing practice hospitals use to charge patients higher prices. The law will eliminate tacked-on hospital charges called facility fees for health care services provided at a hospital-owned doctor’s office off a hospital’s main campus.
Why It Matters: After hospitals buy doctors’ offices, higher bills follow. In just one example, the cost of a strep test ballooned more than 8X — from $14 to nearly $114 — post-acquisition. The test, office, and the doctor who ordered it hadn’t changed.
What’s Next: There is both broad, bipartisan support for policies that address site-neutral payments and facility fees — and a flurry of federal activity lately geared toward this reform area. House lawmakers this week introduced a new bipartisan bill to help protect patients from dishonest billing practices at doctors’ offices owned by hospitals.
Read the story>
Related: State Policies to Lower Commercial Health Care Prices
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Defining "Gainful Employment"
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By Evan Mintz, director of communications
Higher education advocates have called for accountability for for-profit college programs and public and nonprofit certificate programs to show they lead to “gainful employment” for students. How that term is defined by the U.S. Department of Education is coming into view.
What's Happening: Last week, the Biden administration took the next step in the rulemaking process to propose reinstituted and strengthened gainful employment regulations. These proposed rules aim to make sure career training programs receiving federal dollars provide a quality education that enhances students’ career opportunities and doesn’t leave them with unaffordable amounts of debt.
Why It Matters: “For too long, postsecondary education providers have been able to get away with offering programs of little to no value at the expense of the students and taxpayers who invest their time and money with the promise of moving Americans up the economic ladder,” Kelly McManus, AV vice president of higher education, said in a statement last week.
What's Next: The rules, once finalized, will ensure federal dollars aren't sent to programs that consistently fail to meet this standard, and will also provide prospective students and families in all sectors with greater transparency into the educational programs they’re considering. Congress also needs to build on these efforts with legislation that will further strengthen requirements for all higher education to meet a minimum bar for outcomes.
Related: An AV explainer on how the Notice of Proposed Rulemaking works — and why it matters
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Charlie Anderson, Arnold Ventures' first executive vice president of infrastructure, who lays out his vision of how AV will start to scale up our work helping the United States build faster, at lower cost, and better.
"Obviously, I’m not going to take out a hammer and start to build a bridge," Anderson says. "The goal is to help facilitate those three things — building faster, at lower cost, and better — through expanding the evidence base about what works and doesn't, understanding how we can proliferate solutions that do work to a broader set of places or to stop doing things that don't work. That evidence then leads to policy development. And then we turn those policy ideas into reality through advocacy.”
Read the Q & A>
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$27.8 Billion
The estimated value of the potential merger between pharmaceutical giants Amgen and Horizon Therapeutics
AV grantee Robin Feldman, professor and drug industry expert at UC Law San Francisco, told KFF the FTC’s recent action to block the merger from moving forward was a “shot across the bow for the pharmaceutical industry.”
Allowing the merger to proceed would concentrate market power in a way that would disadvantage rivals, keeping prices high, the FTC alleges. Horizon drugs that treat thyroid eye disease and severe gout are priced at $650,000 and $350,000 a year, respectively.
“How [the suit] plays out will serve as a litmus test for the ability to use antitrust law as a way to promote affordable access to pharmaceuticals,” Dr. Ameet Sarpatwari, an AV grantee with the Program on Regulation, Therapeutics and Law, told The New York Times. (free link)
Related: AV Policy Focus: Drug Pricing
Related: Drug Pricing Fact Sheet
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Criminal Justice
- A new report from the Robina Institute, an AV grantee, provides additional insights into how states released people from incarceration during the Covid-19 pandemic and what this suggests for the effort to reduce mass incarceration.
- In an op-ed for the Pennsylvania Capital-Star, Alex Halper, vice president of government affairs for the PA Chamber, discusses how expanding the state's clean slate law will help Pennsylvania families and businesses as well as the local economy.
- A new report from the Justice Policy Institute analyzes data and practices related to Maryland’s parole system. It is the first analysis of parole in the state for nearly 100 years.
- The Bureau of Justice Administration (BJA) has released a new solicitation aimed at funding a training and technical assistance provider to help efforts to transform and improve cultures and physical spaces within prisons.
- A cover story in Terp Magazine reviews the work of the AV-supported Center for the Study and Practice of Violence Reduction (VRC) at the University of Maryland and its partnership with the city of Knoxville, Tennessee. The VRC has also recently launched a new website detailing its efforts.
Health Care
- About one in five adults 65 and over skipped, delayed, took another person’s medication, or took less than prescribed due to concerns about cost, a new study in JAMA Network Open found, via NBC.
- From Axios, rising medical costs force Americans to skip the doctor.
- STAT News reports on a growing coalition, from rappers to billionaires, aligned to address hospital pricing.
Public Finance
- In The New York Times, Alan Rappeport unpacks the question of when the U.S. will no longer be able to make certain debt payments – the so-called “X-date” range. (free link)
- Richard Rubin and Ruth Simon write in the Wall Street Journal about the rush to retroactively claim the Employee Retention Credit – a pandemic-era tax break for small businesses – and the trade-offs the IRS is facing in terms of expediency and fraud prevention. (free link)
- In the Wall Street Journal, Laura Saunders discusses the current state of the U.S.’ gift tax in the context of Harlan Crow’s gifts to Supreme Court Justice Clarence Thomas. (free link)
- Manhattan Institute budget expert Brian Riedl breaks down the dynamics of the debt limit fight on the American Enterprise Institute’s podcast, What the Hell is Going On?
Higher Education
- Who will accredit the accreditors? A new report from The Foundation for Research on Equal Opportunity analyzes how college accreditors perform in terms of identifying programs that provide low financial value for students, finding that every accreditor oversees a significant number of higher education programs with negative returns on investment without issuing consequences.
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On Thursday, June 1, at 1 p.m. (EST), Arnold Ventures will be holding an informational call related to our newly released RFP on pretrial release decisions, conditions, and services. For more information and to register for the call, please see page 10 of the RFP.
From Thursday, June 1, to Sunday, June 4, Arnold Ventures will be at the Education Writers Association National Seminar in Atlanta, Georgia. Be sure to stop by our table and say hello. |
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- The Neiman Lab explains why seeing stories of kindness can counteract the impact of consuming negative news.
- The late Tina Turner, an icon in music, women's rights, and fashion, was also the recipient of an organ transplant; her husband Erwin Bach donated his kidney to her in 2017 to save her life. Her music and his gift bring to mind one of our favorite acoustic renditions of Turner's hit, "Simply the Best."
- See how Yankees fans really feel about squirrels.
- What's in a name? Sometimes more than you think when you share it with others. Find out what it's like to hang out at a gathering of the Kyles, and meet a collection of Connies, Asian American women named after the national news anchor Connie Chung and who also grew up to be journalists. (free link)
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The Pretrial Justice team has released a request for proposals that will help inform and advance the field’s collective understanding of the policies and practices related to pretrial release decisions, pretrial release conditions, and pretrial services.
The Higher Education and Evidence-Based Policy teams have created a request for proposals for rigorous impact evaluations of programs and practices (“interventions”) to promote college success in the United States.
The Criminal Justice and Evidence-Based Policy teams at Arnold Ventures are teaming up to learn more about what works in criminal justice reform in an ongoing request for proposals for randomized controlled trials (RCTs) that will test programs and practices. There is no deadline for submissions.
The Evidence-Based Policy team invites grant applications to conduct randomized controlled trials (RCTs) of social programs in any area of U.S. policy. Details are here.
View our RFPs here.
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Have an evidence-based week,
– Torie
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Torie Ludwin produces the Abstract and other multimedia work, and covers communications for public finance and evidence-based policy at Arnold Ventures.
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