February 2023 Mercatus on Healthcare
Updates on healthcare research and commentary from the Mercatus Center's Open Health Project
As the debt ceiling debates rage, Republicans envision spending cuts as a condition for raising the debt limit. But what’s needed to put the budget on a sustainable trajectory is serious entitlement reform. Medicaid and Medicare, along with Social Security and interest payments, are the top drivers of debt growth. Our scholars at Open Health are studying the ways in which Medicaid falls short of its goals so that lawmakers can direct public dollars to services that best help beneficiaries achieve good health. One area of interest is nursing homes, which many Medicaid beneficiaries rely on. This month, Vitor Melo published a new study showing that for-profit nursing homes had lower overall mortality during the COVID-19 pandemic than did nonprofit and government facilities.
COVID-19 Policies
Understanding Nonprofit and Government Ownership: Evidence from Nursing Homes in the COVID-19 Pandemic (working paper)
Vitor Melo finds that for-profit nursing homes implemented less stringent isolation measures during the COVID-19 pandemic than did nonprofit and government ones. As a result, for-profit nursing homes had more COVID-19 infections but lower overall mortality.
Information vs. Implementation (expert commentary)
The COVID-19 pandemic and the monkeypox outbreak highlight the importance of quickly disseminating accurate information during public health emergencies. Tina Marsh Dalton looks at centralized agencies, such as the CDC and WHO, and their increasingly important role in information gathering and dissemination to media, local public health agencies and the general public.
COVID-19 Policies: Will There Be a Reckoning? (blog post)
Post-pandemic delays in medical care have led to an increase in cancer mortality rates and a negative impact on mental health,. Interestingly, the U.S. healthcare system is relatively less burdened than other countries due to higher levels of spending and significant private sector involvement. However, it could still be improved by removing barriers related to efficiency, explains Kofi Ampaabeng.
The Search for a New Face for Public Health (expert commentary)
Dr. Anthony Fauci's departure from public service due to controversy surrounding the COVID-19 pandemic leaves a gap in the public health establishment. Public health's focus on behavioral health rather than pandemic preparedness and perceived partisan alignment with the Democratic Party have contributed to a decrease of trust in public health officials. Tevi Troy argues that to improve public health, a non-political national spokesperson is needed to communicate truthfully, authoritatively and without politics. A "metaphorical lab coat" of truthfulness, authoritative communication and humility is required to earn back public trust.
Medicaid
Medicaid Eligibility Reviews Will Resume in April (blog post)
Medicaid, originally intended to cover the most vulnerable Americans, has expanded to cover almost 100 million people during the pandemic. Most of the people who will lose Medicaid coverage are expected to transition to private coverage, but a small fraction will become uninsured. Markus Bjoerkheim and Liam Sigaud propose three reforms to Medicaid: phased-out coverage with increasing premiums, allowing those who become ineligible to purchase Medicaid coverage with income-adjusted premiums, and introducing work requirements for non-disabled beneficiaries in order to retain Medicaid eligibility.
Medicaid Expansion Moves Low-Income Children to the Back of the Line (Guest: Charles Blahous) (podcast)
Charles Blahous draws upon his recent Mercatus research paper to assess the effects of the Medicaid expansion on spending on low-income children. He explains that per-capita spending on kids has grown much faster in non-expansion states than in expansion states.
Price Transparency
Is the Surgery Center of Oklahoma Cheaper than Hospitals? (blog post)
The Hospital Price Transparency rule went into effect in the US in January 2021 with the intent of making hospital care more affordable by promoting price competition. It requires all US hospitals to publicly list payer-specific prices for standard charges. The Surgery Center of Oklahoma is a notable exception that operates with a model of having patients pay up-front based on a binding quote. A recent exploratory analysis conducted by Markus Bjoerkheim and Hannah Cho compared the prices of the surgery center with other hospital prices for cash-pay services.