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January 2023 Mercatus on Healthcare
Updates on healthcare research and commentary by the Mercatus Center's Open Health Project
Happy new year! Once the new Congress gets its act together and elects a House Speaker, it’ll be time to get down to business. Last month’s omnibus bill established an end date of April 1 for the requirement that states keep Medicaid beneficiaries enrolled even if they’re no longer eligible for the program. Our scholars wrote about this clause in The Wall Street Journal and explained why resuming eligibility reviews is a good idea as well as how to improve the program moving forward. Mercatus experts also published new research on the effects of the Medicaid expansion and nursing home policy during COVID.
The Affordable Care Act’s Medicaid Expansion Is Shifting Resources away from Low-Income Children (research paper)
Among the groups intended to be served by Medicaid are low-income seniors, those with disabilities, and low-income children and their parents. Mercatus Senior Research Strategist Charles Blahous and Liam Sigaud assessed the negative impact of the expansion on the most vulnerable and found that growth rates in Medicaid spending per capita on children, the elderly, and people with disabilities were considerably lower in expansion states than in non-expansion states.
The Covid ‘Emergency’ Is All About Medicaid (The Wall Street Journal)
Medicaid enrollment increased by about 25% since Congress tied Medicaid funding to a ban on eligibility reviews during the pandemic. Medicaid is supposed to be a temporary assistance program, yet many people — including adults without disabilities — stay on Medicaid for many years. That’s a problem, Mercatus Post-Doctoral Fellow Markus Bjoerkheim and Liam Sigaud argued, because the program limits participants’ economic mobility. Bjoerkheim and Sigaud tempered fears around the resumption of eligibility reviews and offered reform ideas to remove the benefit cliff and allow Medicaid to better fulfill its original mission.
Medicaid patients tend to be sicker, are less likely to have access to specialist care, and have generally worse outcomes than patients funded by other insurance types. In light of states gradually moving most of their Medicaid beneficiaries to managed care plans, Mercatus Senior Research Fellow Kofi Ampaabeng examined access to specialist care for a population that generally requires it.
Most patients with severe traumatic brain injuries (TBI) are discharged a few days after being admitted to the hospital. But some of them stay there for months. The reason isn’t that they’re too sick to leave; in fact, they’re well enough to be discharged. A team of physicians led by Dr. Anthony DiGiorgio, neurosurgeon at Zuckerberg San Francisco General Hospital, conducted a study that explains why, described in Elise Amez-Droz’s blog post.
Nursing Home Policy
Covid in the nursing homes: the US experience (research paper)
The death toll in nursing homes accounted for almost 30% of total COVID-19 deaths in the US during 2020. Markus Bjoerkheim and Alex Tabarrok examined the course of the pandemic in nursing homes, focusing especially on whether nursing homes could have been better shielded. Among other findings, they estimated that starting vaccinations just five weeks earlier could have saved in the order of 14,000 lives, and starting them 10 weeks earlier could have saved 40,000 lives.
Millions of people in nursing homes were isolated for several months during the COVID-19 pandemic. While the intention was to save lives, little is known about their effects. In a new working paper, Mercatus Post-Doctoral Fellow Vitor Melo provided evidence that isolating nursing home residents caused more deaths than it prevented.
In the policy debates on drug pricing, lawmakers should give more attention to reforms that incentivize the sale of generics and eliminate price-inflating mandates that line the pockets of middlemen such as pharmacy benefits managers (PBMs), Kofi Ampaabeng argued in his latest op-ed.
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