Our Sidneys: The Six Key Studies That Shook Up the Summer

Fall has officially fallen, but have you finished your summer policy reading yet?

Fear not. “Road to Reform” is here to help, with six hand-picked studies that are must-reads.

Our honors are explicitly inspired by New York Times columnist David Brooks, who announces his annual Sidney Awards — named for the late Sidney Hook, a famed public intellectual — as a way of recognizing long-form journalism that advanced public debate and discourse.

While “Road to Reform” considered bestowing the Rubinows (in honor of I.M., the great pioneer of social insurance) or the Enthovens (to recognize California’s titanic Alain), we’ll offer up our own Sidneys — in honor of Sidney Garfield, Kaiser Permanente co-founder — to capture six studies that resonated in summer 2011.

Our first Sidney goes to the Oregon Health Study Group, which tracked health insurance’s impact on outcomes for some state residents. It wasn’t what researchers found that made the study groundbreaking — few were surprised that insurance offers tangible health and financial benefits — but that they found it at all. Because Oregon relied on a lottery to apportion its 2008 Medicaid expansion, the study offered a rare chance for a randomized controlled trial in health care. Policy wonks now believe that the findings will provide key evidence to defend public insurance programs from would-be budget cutters.

Another Sidney is awarded to the Kaiser Family Foundation’s study on raising the Medicare eligibility age, which was updated this summer and helped shape the ongoing battle over Medicare reform. While some advocate raising program eligibility from age 65 to 67 as a strategy to tamp down Medicare spending, foundation researchers cautioned that $5.7 billion in federal savings would be more than wiped out by resulting cost hikes for elderly U.S. residents and employers. At The Incidental Economist blog, Austin Frakt and Aaron Carroll argued that the fiscal calculus and downstream impact make “monkeying with the Medicare age” a very bad idea.

A Sidney-winning study from Thomson Reuters revisited assumptions about McAllen, Texas, which was infamously portrayed in a 2009 New Yorker article as the Wild West of Medicare spending: too many physicians and home health agencies offering unnecessary treatment, and no sheriff to tamp down costs. That article drew on the famed Dartmouth Atlas, which monitors utilization among Medicare beneficiaries, but Thomson Reuters tracked variations in spending among the commercially insured. According to researchers, McAllen really is a standout — on cost control. The Texas town was among the nation’s 10 lowest-spending markets, with overall spending at about 72% of the U.S. average.

The average U.S. family’s annual income rose by $23,000 between 1999 and 2009 — and nearly all of those gains were wiped out by rising health costs, according to a RAND study published in Health Affairs that also gets a Sidney. Researchers pegged increases in insurance premiums, out-of-pocket health costs and taxes for health care for absorbing at least $450 in additional monthly income, leaving the average four-member family with just $95 in new income per month.

Sidney No. 5 is awarded to an August National Bureau of Economic Research working paper that went deep on a crucial, if underexplored, provision in the Affordable Care Act: what does “affordable” mean? As researchers noted, the Obama administration’s ultimate choice — between defining care as affordable for an individual or for a family — could affect whether millions of Americans receive employer-sponsored health insurance in the future or pursue subsidies in the new health insurance exchanges. Modeling the far-reaching implications, the Washington Post‘s Sarah Kliff observed that basing the definition on family-based affordability could lead to an additional $48 billion in federal subsidies, an unwelcome surprise in the current budget climate.

The sixth and final Sidney goes to a Center for Studying Health Change study that unexpectedly found fewer Americans were delaying medical care or encountering access problems. HSC researchers posited that the change reflected a recession-driven decrease in health demand, freeing up capacity, but noted that lower-income and sicker people still faced major barriers. The study also is “hugely important,” according to John Goodman of the National Center for Policy Analysis, because it’s “further evidence that non-price rationing is the most important barrier to care … [and HSC’s] prediction: Non-price rationing will intensify” under ACA.

Off the List but not Overlooked

For the ambitious reader, a slew of other studies and papers may not have garnered our Sidneys but are worth noting, too.

Earlier this summer, NCPA’s Goodman observed that a paper in Health Services Research offered a striking assessment of how raising the time price of care — as opposed to just the money price of care — can dissuade poor patients from receiving necessary treatment.

A study in the Journal of the American Medical Association investigated the quality of care at critical access hospitals, with Duke University’s Don Taylor wondering if the findings revealed the downside of patient choice.  

Finally, McKinsey’s analysis that 30% of employers planned to drop health insurance benefits because of ACA caused quite a stir, perhaps for the wrong reasons.

Still seeking reading material? There’s plenty more to review from around the nation. Here’s our weekly recap of health reform-related updates.

Administration Actions

  • Last week, HHS announced grants and competitive funding awards totaling $224 million to improve maternal and child health through home visits from nurses and social workers. The package includes $124 million in formula grants that will be distributed to 55 government agencies, including 49 states, the District of Columbia and U.S. territories. The remaining $100 million in competitive funding awards will go to states that demonstrate their ability to expand existing home-visiting initiatives (Adams, CQ HealthBeat, 9/22).

Election Watch

On the Campaign Trail

  • During a debate in Orlando, Fla., last week, Republican presidential candidates briefly discussed several health care issues (Oliphant, “Politics Now,” Los Angeles Times, 9/22). Texas Gov. Rick Perry continued his criticism of former Massachusetts Gov. Mitt Romney‘s statewide health care overhaul (O’Connor/Weisman, Wall Street Journal, 9/23). Meanwhile, business owner Herman Cain said he would have succumbed to stage 4 colon and liver cancer in 2009 if the federal health reform law was in effect during his treatment (Rutenberg/Zeleny, New York Times, 9/22).

On the Hill

  • Last week, lawmakers on the Senate Finance Committee questioned a CMS official about how the federal government plans to improve care coordination and address the rising costs of care for U.S. residents who are eligible for both Medicaid and Medicare. Melanie Bella, director of the Medicare-Medicaid Coordination Office, said the office needs more time to develop such plans. Some panel members expressed skepticism, saying that the office’s efforts are just the latest in a series of limited attempts to address the issue (Daly, Modern Healthcare, 9/21).
  • Last week, the Senate Appropriations Subcommittee on Labor, HHS and Education voted 10-8 along party lines to approve a fiscal 2012 spending bill that includes funding for the federal health reform law, despite objection from Republican panel members (Attias, CQ Today, 9/20). Sen. Richard Shelby (R-Ala.), the panel’s ranking member, said he would propose an amendment to repeal funding for the law’s provisions. Other Republicans criticized the $1 billion allocated for the reform law’s prevention fund (Pecquet, “Healthwatch,” The Hill, 9/20).

Rolling Out Reform

  • Last week, officials from HHS and 46 states, the District of Columbia and two territories at a meeting near Washington, D.C., discussed the three available options to establish state-based health insurance exchanges as mandated by the federal health reform law (Selyukh, Reuters, 9/20). Some state officials expressed concern about the partnership model, which would allow the government to assist states in establishing the exchanges without completely taking over operations. An Obama administration official noted that the partnership proposals are not yet official and it has not been declared as a final policy (Baker, “Healthwatch,” The Hill, 9/20).

Related Topics

Road to Reform The Health Law