This week, Evan Mintz, director of communications, looks at what should be versus what is in the realm of health care pricing.
If you’ve spent any time lately on the Arnold Ventures website in pursuit of the latest in evidence-based, data-driven policy, you probably noticed that we’ve added a new landing page: Same Service, Same Price.
The page is dedicated to our work on site-neutral billing, the idea that patients should be charged the same amount for the same medical services no matter where they get them. The concept makes sense, but that’s not what’s happening. In reality, big hospital systems are buying up small physician practices, keeping the same doctors but changing the logo on the door, and then charging more to patients, employers, and taxpayers.
This market consolidation allows hospitals to quash competition and hike prices. Research finds that prices increase by an average of 14% after a physician’s office is acquired by a hospital system.
New ownership also means hospital prices can be charged for routine services like a regular check-up or MRI scan. This price hike affects people’s health; around 40% of adults say they have delayed or gone without medical care because of unaffordable cost.
It should be no wonder that a growing coalition is urging Congress to pass common sense, bipartisan legislation to protect patients from being charged more for services simply based on where they receive them. To put it simply: Patients, not profits, should come first.
“Just as we strive to hold Big Pharma and insurance corporations accountable for price gouging, we must also hold large corporate hospital systems accountable for sticking patients with hundreds, even thousands, of dollars of extra fees for no other reason than that they can,” wrote Dr. Raina Young, a family physician, in an op-ed for the Star Tribune.
Expect that call for action to keep growing. And expect Arnold Ventures to be there with the research and data to back it up.
What Happened: Five years in, the work of NCGVR has begun to illuminate the scope and scale of gun violence as well as effective ways to address it. For instance, one study funded by NCGVR found that people who don’t own handguns but live with lawful handgun owners are more than twice as likely to die by homicide as their neighbors living in gun-free homes, and they were seven times more likely to be shot by a spouse or intimate partner. Another study found the enactment of “stand your ground laws” was associated with an average 8% to 11% national increase in monthly rates of homicide, including firearm homicide.
Why It Matters: Between suicides, homicides, and accidents, firearms kill almost 50,000 people a year in the United States and injure another 75,000. By almost every measure, gun violence is a public health crisis. Coupled with this crisis is significant legal and political uncertainty about the constitutionality of various gun laws due to the Supreme Court’s 2022 Bruen decision. In this environment, research and data collection — like that being supported by NCGVR — is critically needed in order to learn which gun policies are backed by science as being able to reduce deaths and injuries.
What’s Next: NCGVR recently announced more than $3 million in new funding for research on extreme risk protection orders (ERPOs). Such laws are risk-based, temporary protective orders issued by courts to remove firearms from people who have been determined to pose a risk of harm to themselves or others.
Related: Register for NCGVR's series of upcomingwebinars on gun violence research.
Clarity on Complex Care
Dual eligibility for both Medicare and Medicaid is overly complex, but it doesn’t have to be. To help policymakers understand the challenges Americans face who qualify for both Medicare and Medicaid, Arnold Ventures has published a new fact sheet and policy primer on the topic.
What’s Happening: More than 12.2 million individuals are simultaneously enrolled in Medicare and Medicaid — two separate government health care programs never intended to work together. This population is often elderly or disabled and has complex health needs, and they also face a mountain of bureaucracy, waste, and lack of coordination between the two programs. Melissa, a working mom of six who lost her vision, compares it to trying to tie a shoelace when one end can’t make a knot with the other.
Why It Matters: The United States spends nearly twice as much on care for dual-eligible individuals than other Medicare and Medicaid enrollees. At the same time, this population has worse health outcomes, requires higher cost care, and suffers from more chronic conditions.
What’s Next: Seventy percent of voters favor major reforms that will cut red tape and improve coordination between Medicare and Medicaid. These reforms include increasing access to meaningfully integrated coverage, seamless enrollment into integrated coverage, and ensuring accountable delivery of services.
Related: Explore our photo essay on people who are dually eligible for Medicare and Medicaid.
Estimated years of life expectancy lost for a year of time spent in prison.
According to The National Institute for Health Care Management (NIHCM), the roughly 5.5 million people in the U.S. who are on probation, in jail, in prison, or on parole are disproportionately affected by chronic illness, substance use disorders, and mental health issues. The NIHCM’s recent set of infographics unpack and illustrate several data points showing the pervasive issues of poor health and health care, along with high costs, associated with incarceration.
What We're Reading
In an op-ed in The Hill, Farhang Heydari writes that the federal government should look at its own role in encouraging police to make pretextual traffic stops, and how such stops may be ineffective and counterproductive.
The Chicago Tribune covers public statements made by DuPage County State’s Attorney Bob Berlin saying his office is "absolutely prepared" for enactment of the Pretrial Fairness Act in Illinois on September 18.
The Journal of the American Statistical Association has published a peer-reviewed article by AV grantees Dean Knox (University of Pennsylvania) and Jonathan Mummolo (Princeton University) in which they describe the statistical methodology underlying their algorithm for measuring racial bias in traffic stops.
In a New York Times op-ed, Larry Levitt, executive vice president for health policy at KFF, documents the four arguments that Big Pharma are throwing against the popular policy of Medicare drug price negotiations. (free link)
A Reuters column points out how drug price negotiations are a good start to bringing down health care costs across the board.
Primary care physicians affiliated with large health systems drive up spending on patient care through increased referrals to specialists, emergency department visits, and hospitalizations, according to a new study published in JAMA health forum, undermining claims that hospital consolidation leads to less spending.
The federal government has started penalizing Medicare Advantage insurers for overcharging members, STAT reports.
The Alabama Political Reporter published an op-ed calling for Congress to pass legislation that “would ensure fair hospital billing and implement site-neutral payments.”
BYU-Idaho and Ensign College have received approval for three-year bachelor’s degree programs, the first among a dozen participants in a three-year degree pilot program to win accreditor approval, Inside Higher Ed reports.
Higher Ed Drive covers plans by the Education Department to discharge $72 million in student loans for 2,300 student borrowers who attended Ashford University after the online, for-profit college was successfully sued for misrepresenting the cost and career outcomes of its programs.
Utah City, a 300-acre development outside Provo, aims to be one of the most ambitious transit-oriented projects in the nation, Public Square reports.
The Wall Street Journal editorial board takes on preservation activists who are trying to block the much-needed replacement of a 140-year-old railroad bridge, an example of litigation standing in the way of the nationwide effort to replace crumbling infrastructure. (free link)
Congratulations to the winners of the Institute for Nonprofit News’s annual awards honoring excellence in nonprofit news. A special kudos to AV grantees Arizona Luminaria, New Mexico in Depth, Wisconsin Watch, Texas Tribune and ProPublica’s collaboration in Texas, the Flatwater Free Press, The CT Mirror, the Center for Public Integrity, Spotlight PA and the Sahan Journal.
“Unless reporters are paying attention to policymakers in the community, local residents are deprived of an opportunity to make information-based decisions when they go the ballot box.” An op-ed in The Chronicle of Philanthropy makes the case that more funding to nonprofit news is essential to sustain our democracy.
What We're Watching
NBC Nightly News has covered the public defense crisis in Mississippi, focusing on the story of Duane Lake, a local man who spent six years in jail before trial — at which he was found not guilty — due to lack of access to an attorney. Watch here.
Local news is essential to community cohesion — local reporters uncover wrongdoing, hold the powerful to account, and illuminate important facts and trends. In essence, local news serves as the glue that holds people together, even when they don’t agree on much else. But commercial journalism has been in a free fall, sent into a tailspin by disappearing advertising revenue. As a result, about 2,500 communities across the United States have lost their primary sources of credible local news. But promising new experiments are rising in the ashes, most notably ambitious nonprofit newsrooms that embrace a business model requiring them to reinvest all profit back into their operations.
In her ongoing series on division across the country, America at a Crossroads, former PBS NewsHour anchor Judy Woodruff turns her attention toward the role and value of local journalism. Her most recent episode examines the rapid growth of nonprofit news sites, like AV grantee Mississippi Today, with support from AV grantee American Journalism Project, that are replanting local journalism and reimagining ways to ensure the long-term sustainability of independent news. Watch here.
Some Final Inspiration
This week's final inspiration is dedicated to rising tennis star Coco Gauff, age 19, who just advanced to the finals of the U.S. Open at Arthur Ashe Stadium in New York last night. Check out highlights from her semifinals match with Karolina Murchova here, including their epic 40-shot rally.
What inspires Gauff? Apparently, anime. In the post-match interview, Gauff said she'd watched a few episodes of My Hero Academia prior to the semifinals, and might watch some more before the final.
Gauff entered the pro circuit in 2018 at age 14 after becoming a junior world champion, and since then has been moving up in the rankings, although her rise has not been a straight shot up. After a hard first round defeat at Wimbledon earlier this year, Gauff brought "old dude" Brad Gilbert onto her training team and has seen a turn in her playing, winning her first 500 and 1000 WTA tournaments this summer. Now she's set to play in the finals for the Grand Slam title on Saturday at 4 p.m. ET, on ESPN. She's the youngest U.S. Open finalist since her hero, Serena Williams. Go Coco!
Save the Date
On Tuesday, September 12, at 3 p.m. ET, the National Collaborative on Gun Violence Research will hold a webinar on interventions to improve police effectiveness. Register here.
On Tuesday, September 12, from 2 p.m. to 3 p.m. ET, RTI International will host a webinar on improving community safety through mental health response strategies and innovative policing partnerships. Register here.
On September 21 and September 22, RTI International will host a two-day, in-person symposium in Research Triangle Park, North Carolina, focusing on issues surrounding the implementation, sustainability, and evaluation of alternative policing response strategies. Register here.
We're Seeking Proposals
The National Collaborative on Gun Violence Research will be awarding more than $3 million in funding, provided by AV, to study extreme risk protection orders (ERPOs). Access the RFP here.
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.
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