Regulatory Policy

Title	Date
Sine Qua Non: A Healthy Nation Requires Real Budget Constraints in All Government Health Programs Every government health program should operate under the same budget constraint that applies to other government programs. Failure to do so represents bad budgeting and economic, social, and health policy; redistributes income in perverse ways; and makes health care allocation extremely inefficient. No excuses for this failure to act—largely centered…	November 4, 2020
Did Medicare Advantage Payment Cuts Affect Beneficiaries Access and Affordability? DISCUSSION The ACA’s cuts to MA payments were expected to reduce the attractiveness of MA to both plans and beneficiaries, primarily through reductions in rebates, thereby decreasing enrollment in the MA plan program.7-9 Instead, MA enrollment steadily increased as the ACA was implemented. Prior research indicates that MA plans…	September 5, 2019
Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax Exclusion NIHCR Research Brief No. 20 Among the most expensive "but nearly invisible" federal expenditures is the roughly $250 billion1 annual tax break for employer-sponsored health insurance. Under current law, the value of both employer and most employee contributions for health insurance are excluded from employee federal income tax and employer and employee payroll taxes. While…	October 8, 2015
Health Reform 2.0: Alternate State Waiver Paths Under the Affordable Care Act NIHCR Research Brief No. 19 State leaders interested in reforming their health care systems face a dilemma. Every state’s health care system is utterly dependent on funding flows from federal health programs and subsidies in the federal tax system, but federal programs, in some cases, run counter to state political cultures and priorities. Section 1332…	September 24, 2015
Cutting Medicare Hospital Prices Leads to a Spillover Reduction in Hospital Discharges for the Nonelderly Health Services Research Objective. To measure spillover effects of Medicare inpatient hospital prices on the nonelderly (under age 65). Primary Data Sources. Healthcare Cost and Utilization Project State Inpatient Databases (10 states, 1995-2009) and Medicare Hospital Cost Reports. Study Design. Outcomes include nonelderly discharges, length of stay and case mix, staffed hospital bed-days,…	May 21, 2014
Accountable Care Organizations 2.0: Linking Beneficiaries JAMA Internal Medicine There is broad consensus among physicians, hospital and health insurance leaders, and policy makers to reform payment to health care providers so as to reduce the role of fee for service, which encourages high volume, and instead to use systems that reward better patient outcomes, such as bundled payments for…	April 22, 2014
How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices? Health Services Research, Early View Objective. To estimate the effects of changes in Medicare inpatient hospital prices on hospitals’ overall revenues, operating expenses, profits, assets, and staffing. Primary Data Source. Medicare hospital cost reports (1996–2009). Study Design. For each hospital, we quantify the year-to-year price impacts from changes in the Medicare payment formula.We use cumulative simulated price impacts as…	October 3, 2013
Achieving Health Care Cost Containment Through Provider Payment Reform that Engages Patients and Providers Health Affairs, Vol. 32, No. 5 The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of…	May 6, 2013
Contrary to Cost-Shifting Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates Health Affairs, Vol. 32, No. 5 Many policy makers believe that when Medicare constrains its payment rates for hospital inpatient care, private insurers end up paying higher rates as a result. I tested this “cost-shifting” theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports. Contrary to the…	May 6, 2013
Small Employers and Self-Insured Health Benefits: Too Small to Succeed? HSC Issue Brief No. 138 Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees’ medical care through self-insurance. Because self-insurance arrangements may offer advantages—such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design—they are…	July 19, 2012
Addressing Hospital Pricing Leverage through Regulation: State Rate Setting NIHCR Policy Analysis No. 9 Although U.S. health care spending growth has slowed in recent years, health spending continues to outpace growth of the overall economy and workers’ wages. There are clear signs that rising prices paid to medical providers—especially for hospital care—play a significant role in rising premiums for privately insured people. Over the…	May 8, 2012
The Growing Power of Some Providers to Win Steep Payment Increases from Insurers Suggests Policy Remedies May be Neededuggests Policy Remedies May be Needed Health Affairs, Vol. 31, No. 5 In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large…	May 7, 2012
Limited Options to Manage Specialty Drug Spending HSC Research Brief No. 22 Spending on specialty drugs typically high-cost biologic medications to treat complex medical conditions is growing at a high rate and represents an increasing share of U.S. pharmaceutical spending and overall health spending. Absence of generic substitutes, or even brand-name therapeutic equivalents in many cases, gives drug manufacturers near-monopoly pricing power…	April 16, 2012
State Benefit Mandates and National Health Reform NIHCR Policy Analysis No. 8 From requirements that insurers cover prescription drugs to services of chiropractors, state health benefit mandates have a long and controversial history. Critics contend mandates drive up health insurance costs, while advocates assert they ensure access to important care. The 2010 national health reform law requires states to pay for mandated…	February 29, 2012
Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs NIHCR Policy Analysis No. 6 Under national health reform, new federal rules will govern the nongroup and small-group health insurance markets, including a requirement for state-based health insurance exchanges, or marketplaces, to be operational by Jan. 1, 2014. Between now and then, both the federal government and states must make key decisions about the design…	November 9, 2011
Reforming Provider Payment—The Price Side of the Equation New England Journal of Medicine, Vol. 365, No. 14 It's pretty basic economics: spending equals price times quantity. For some time, public health care payers, such as Medicare and Medicaid, have focused much of their cost-containment effort on constraining the prices they pay for health care services, which they set administratively. The Affordable Care Act includes additional constraints on…	October 6, 2011
Spending to Save—ACOs and the Medicare Shared Savings Program New England Journal of Medicine, Vol. 364, No. 22 While criticism that the government set the bar too high for accountable care organizations (ACOs) has been fast and furious, the proposed rule for the Shared Savings Program is a wake-up call that Medicare is serious about achieving better care for individuals, better health for populations and lower growth in…	May 25, 2011
Health Care Certificate-of-Need (CON) Laws: Policy or Politics? NIHCR Research Brief No. 4 Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center…	May 19, 2011
Ginsburg Testifies Before Joint Senate and House Committees in Maryland on Hospital Rate Setting Testimony Paul B. Ginsburg, Ph.D., HSC President and research director of the National Institute for Health Care Reform, testified before a joint hearing of the Maryland Senate Finance Committee and House Health and Government Operations Committee on hospital rate setting. Access Ginsburg's testimony	March 22, 2010
Ginsburg Testifies Before the Massachusetts Division of Health Care Finance and Policy Testimony Paul B. Ginsburg, Ph.D., HSC president and research director of the National Institute for Health Care Reform, testified before the Massachusetts Office of Health and Human Services, Division of Health Care Finance and Policy, on health care spending trends.	March 18, 2010
Episode-Based Payments: Charting a Course for Health Care Payment Reform NIHCR Policy Analysis No. 1 As consensus grows that true reform of the U.S. health care system requires a move away from fee-for-service payments, designing alternative payment methods, including episode-based payments, has emerged as a high priority for policy makers. An episode-based payment approach would essentially bundle payment for some or all services delivered to…	January 14, 2010

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Regulatory Policy