The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowWhile there is evidence noise-induced hearing loss among adolescents has increased due to the use of smartphones and other mobile devices, the evidence to date is not compelling or is still the subject of scientific debate.  Nevertheless, noise induced-hearing loss is a legitimate concern and therefore a topic in need of health education to combat, particularly since exposure is frequently voluntary, the consequences are cumulative and because the effects typically do not manifest until years later. Already, it is estimated 12 to 15 percent of school age children have some hearing deficits attributable to noise exposure and in adults, 15 percent of 26 million Ameeicans between the ages 20 and 69 have noise induced hearing loss.  The consequences can be significant.  In children, for example, hearing loss can delay language development, reduce educational achievement, produce social isolation and compromise quality of life.   During this 21 minute conversation Dr. Battey discusses the effects of being deaf, the physiological causes of deafness, the evidence for noise induced hearing loss and moreover the impetus for the NIDCD's "It's a Noisy Planet" and the educational program's goals, targeted audiences, activities and success or impact to date.  Since 1998 Dr. James Battey has served as Director of the NIH's NIDCD.  Previously he served as the Institute's Director of Intramural Research.   He has also served as an Investigator and Section Chief at the NIH's National Cancer Institute and the National Institute of Neurological Disorders and Stroke.  Dr. Battey received his undergraduate degree in physics at the California Institute of Technology and his MD and Ph.D. in biophysics at Stanford University School of Medicine.  He did his residency training in pediatrics also at Stanford and did postdoctoral training in genetics at Harvard Medical School. For information concerning NIDCD's "It's a Noisy Planet" go to: https://www.noisyplanet.nidcd.nih.gov/.For a review article concerning noise induced hearing loss among children, see, for example, Robert V. Harrison, "The Prevention of Noise Induced Hearing Loss in Children," International Journal of Pediatrics (2012) at: https://www.hindawi.com/journals/ijpedi/2012/473541/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowOn any given day US prisons and jails hold between 80,000 and 120,000 men, women and children in solitary confinement.   A significant percent of these individuals enter solitary with a mental disease and a similar percent of those held in isolation for extended periods of time develop severe psychiatric illnesses that include self amputation and suicidality.  (US prisons and jails constitute the largest psychiatric hospitals in the country.)  The UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment, Juan E. Mendez, has concluded solitary confinement for more than 15 days constitutes torture.  In Hell is a Very Small Place, Voices from Solitary Confinement," edited by Jean Casella, James Ridgeway and Sarah Shourd, 16 former and current solitary confinement inmates discuss their experience in solitary and  two physicians and three professors (in law, political science and philosophy) discuss its physical and psychological effects and legal justification. During this 32 minute conversation, Ms Casella provides an overview of Hell Is a Very Small Place.  She explains why inmates are placed in solitary confinement, for how long and describes conditions under confinement.  She provides an overview of the psychological effects of solitary noted by contributing authors Dr. Stuart Grassian and Dr. Terry Kupers.  She addresses whether solitary confinement constitutes torture, explains how inmates attempt to keep their sanity, explains to what extent private sector profit making contributes to the practice and discusses what continued progress, if any, may be made under a new, incoming administration. Ms. Jean Casella is co-director of Solitary Watch, a web-based watchdog project that investigates, documents, and disseminated information about solitary confinement in US prisons and jails.  Prior to co-founding Solitary Watch in 2009, Ms. Casella managed several mission-driven book and magazine publishers including Thunder's Mouth Press and the Feminist Press.  Jean's writing has appeared in The Nation, Mother Jones, The Guardian, Al Jazerra, and other publications and media outlets.  The Hell is a Very Small Place anthology edited was published by The New Press in February.  For her work on solitary confinement, Jean was awarded a Soros Media Fellowship in 2012. For more information concerning Hell Is a Very Small Place go to: http://thenewpress.com/books/hell-very-small-place.The UN Special Rapporteur's report is at: http://solitaryconfinement.org/uploads/SpecRapTortureAug2011.pdf. For another physician's review of solitary confinement, see, for example, Dr. Atul Gawande's essay titled,"Hellhole," in the March 30, 2009 issue of The New Yorker.  At: http://www.newyorker.com/magazine/2009/03/30/hellhole.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowWith the election of Donald Trump Congressional Republicans are poised to repeal the Affordable Care Act (ACA) within the first 100 days of the 115th Congress via the budget reconciliation process.  (At some future date they are pledging to draft ACA replacement language or legislation.)  The expectation is repeal would have an effective date of 2018 or 2019, or after the mid-term Congressional elections.  However, many if not most health policy experts agree the simple act of repeal would cause such instability state insurance marketplaces would collapse long before repeal would, legally, go into effect.  Congressional Republican leadership is also promising to move major Medicare, via premium support and major Medicaid legislation, via block grants or per capita caps, though the upcoming Congress.       During this 23 minute conversation Chris Jennings discusses whether, and moreover how if at all, Congressional Republicans can repeal the ACA with an out-year effective date without fatally damaging state insurance marketplaces, the likely consequences of a simple repeal (without replace), when and how will Republicans will replace the ACA and whether that effort would garner any Democratic interest or support, what substantively explains Republican opposition to the current law and what might Republican leadership do to reform the Medicaid program and its likely effects.Chris Jennings is currently Founder and President of Jennings Policy Strategies, a DC-based policy firm where he consults with foundations, purchasers and other aligned stakeholders on policies to ensure higher quality, more affordable health care for all Americans.  Previously, Mr. Jennings served as Deputy Assistant for Health Policy to President Obama and for eight years as White House Health Care Adviser to President Clinton.   Prior still he served for a decade in the US Senate for Senators Glenn, Pryor and Melcher where he worked on Medicaid CHIP, HIPAA, PDUFA, major Medicare reforms in the 1997 Balanced Budget Act and related work concerning long term care, prescription drug coverage, rural healthcare and other related issues.  Chris has been a campaign adviser to six Democratic presidential campaigns and is a frequent contributor on health reform issues to the New England Journal of Medicine and numerous other scholarly journals, periodicals and newspapers.    This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowThough comparatively late to adopt quality ratings, many health care products and services are today quality rated.  For example, CMS rates hospital, nursing home and home health care care quality along with Medicare Advantage insurance and prescription drug, or Part D plans.  Quality performance is a factor in calculating rewards and penalties in Medicare pay for performance agreements, for example, in scoring earned shared savings for Accountable Care Organizations.   Though today common, rating care quality is not without criticism.  For example, researchers question the validity of how component or domain scores are weighted or clustered, the absence or inadequacy of risk adjustment, meaningfulness to patients, patient literacy/numeracy limitations and unintended negative consequences.     During this 21 minute conversation, Dr. Peter discusses why Consumer Reports rates hospital care quality, the methodology used in scoring hospital care quality, specifically types of care quality, for example prevalence of hospital-acquired infections, the response to ratings by hospitals, use by patients or consumers, the imperfections or limitations in rating hospital care quality, unintended negative consequences and how Consumer Reports intends to improve upon its work in the near term.Dr. Doris Peter is the Director of Consumer Reports Health Ratings Center, a part of the nonprofit organization, Consumer Reports.   Beyond hospitals her team rates other health care services including physicians and insurance plans and as well health care products, e.g., drugs.  Dr. Peter is also the Principal Investigator of a grant from the Consumer and Prescriber Education Grant Project that helps consumers understand safety, effectiveness and the cost of prescription and over-the-counter medications.  Prior to joining Consumer Reports Dr. Peter was an editor and then publisher of the nonprofit organization, The Medical Letter, and then North American editor for an international evidence-based medicine journal.  Dr Peter is a neurobiologist by training, earning her Ph.D. at UCLA.  She completed a postdoctoral fellowship in cellular biophysics at Rockefeller University.For more on Consumer Reports hospital quality ratings efforts go to: http://www.consumerreports.org/cro/health/doctors-and-hospitals/index.htm.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAs has been widely reported the US has faced an opioid addiction epidemic over the past decade.  Opioid-related overdose deaths have quadrupled in recent years.  (Drug overdose deaths, in sum, now equal or exceed auto accident fatalities.)   What explains the dramatic increase use and addiction to these medicines?  In Drug Dealer, MD, recently published by Johns Hopkins University Press, Dr. Anna Lembke presents a nuanced explanation of what is a highly complex problem. The 30 minute conversation begins with Dr. Lembke briefly explaining work's title, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked and Why It's So Hard to Stop.  Moreover, Dr. Lembke discusses several of the numerous reasons that explain the opioid addiction epidemic, i.e., patient and prescribing physician behavior, organized medicine's contribution, pharmaceutical industry marketing strategies and market forces that all contribute to fostering the epidemic.Dr. Anna Lembke is an Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University.  She is also a faculty member at the Stanford University School of Medicine, Program Director for the Sanford University Addiction Medicine Fellowship and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.  She is also a Diplomate of the American Board of Psychiatry and Neurology and a Diplomate of the American Board of Addiction Medicine.  Dr. Lembke has published over 50 peer-reviewed articles, chapters and commentaries in numerous journals including the New England Journal of Medicine and the Journal of the American Medical Association and the Journal of General Internal Medicine and Addiction. Dr. Lembke recieved her undergraduate degree in Humanities from Yale University and her medical degree from Stanford. For more information on Dr. Lembke's work go to: https://jhupbooks.press.jhu.edu/content/drug-dealer-md.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowSection 1332 of the Affordable Car Act allows states to propose Affordable Care Act-comparable state insurance programs.   Programs would need to meet certain criteria in order to win federal waiver authority.   One state currently considering a wavier is Colorado, i.e., Colorado voters will be asked to approve a state constitutional amendment that would create in part, a financing plan that would provide universal health care to all eligible Colorado residents.       During this 20 minute conversation Dr. Butler discusses the genesis of Section 1332, why states (blue and red) would be motivated to submit a waiver, the benefits of such waivers, how the next administration might revise current 1332 regulations and state efforts to date, for example, Colorado under its ColoradoCare initiative. Dr. Stuart Butler is a Senior Fellow in economic studies at the Brookings Institution.   He is also currently an AdjunctProfessor at Georgetown, a Visiting Fellow at the Convergence Center for Policy Resolution, a member of the editorial board of Health Affairs, a member of the Board on Health Care Services of the Institute of Medicine and of the Advisory Group for the Academy of Medicine's Culture of Health program.   Prior to Dr. Butler spent 35 years at the Heritage Foundation.   Among other previous positions he was an Institute of Politics Fellow at Harvard and a member of Housing Secretary Jack Kemp's Advisory Commission on Regulatory Barriers to Affordable Housing.  Dr. Butler was educated at St. Andrews University in Scotland where he received his undergraduate degree in physics and mathematics, his Masters of Arts in economics and history and his Ph.D. in American economic history.  Dr. Butler's JAMA Forum essay, noted during this conversation, is at: https://newsatjama.jama.com/2016/09/14/jama-forum-action-on-the-aca-next-year-maybe/See also Dr. Butler's most recent November 30th JAMA Forum essay titled, "Repeal and Replace Obamacare: What Could it Mean?"  At: https://newsatjama.jama.com/2016/11/30/jama-forum-repeal-and-replace-obamacare-what-could-it-mean/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowUnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable.  Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider.  For example, in 2016 30 percent of counties throughout the US had only two insurers participating in state marketplaces (10 percent of counties had one). Beyond consumer choice, the absence of marketplace competitors threatens premium affordability.   Creating new and stable insurance marketplaces, that is by definition challenging to accomplish, has been made additionally difficult by Congressional Republican opposition to the ACA's risk corridor program, that along with risk adjustment and reinsurance, is designed to mitigate unavoidable plan financial losses in trying to appropriately price premiums for a population with an unknown health history.             During this 25 minute conversation Professor Hoadley discusses contributing factors to state marketplace instability andmoreover four methods by which the insurance marketplaces can be stabilized: a "fall back plan;" state participation requirements; extending risk corridors and reinsurance; and, methods to improve marketplace enrollment. Dr. Jack Hoadley is a Research Professor at Georgetown University's Health Policy Institute where he studies health financing topics including drug pricing, out-of-pocket costs and the dynamics of insurance making decisions.   In 2015 Professor Hoadley was reappointed to a second, three-year term as a Medicare Payment Advisory Commissioner (MedPAC) member.  Prior to his work at Georgetown, Dr. Hoadley held staff positions at DHHS, i.e., within the Assistant Secretary for Planning and Evaluation (ASPE) office, at MedPAC, the Physician Payment Review Commission and at the National Health Policy Forum.   Professor Hoadley has published widely on health care financing and pharmaco-economics topics and has provided testimony to numerous federal Congressional and other government panels.  He earned his Ph.D. in political science. Jack Hoadley and Sabrina Corlette's August 2016 paper, "Strategies to Stabalize the Affordable Care Act Marketplaces: Lessons from Medicare," is at: http://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowFor this, my 101st interview, I discuss with the author, Daniel L. Hatcher, his new work, "The Poverty Industry, The Exploitation of America's Most Vulnerable Citizens."  The work is aptly summarized by Columbia University Professor Jane Spinak.  She notes on the book's dust jacket, "In the tradition of great muckracking, Hatcher has exposed how states and localities misdirected and misused public funds envisioned to benefit the most vulnerable among us." During this 26 minute conversation Professor Hatcher discusses his motivations for writing the book, defines "poverty's iron triangle," explains how state foster care and Medicaid agencies, with the help of private contractors, monetize poverty for state financial gain, explains how states attempt to reason this behavior and offers solutions for how this malfeasance can be "reeled in."  Daniel L. Hatcher is Professor of Law at the University of Baltimore School of Law, teaching a civil advocacy clinic and other classes.  Before joining the faculty in 2004, Hatcher was with the Maryland Legal Aid Bureau, serving as the assistant director of advocacy for public benefits and economic stability.  He previously worked as a staff attorney for Legal Aid representing abused and neglected children, and he represented adult clients all poverty law matters – including public benefits, housing, consumer and family law issues.  He was also a senior staff attorney with the Children's Defense Fund.  Hatcher has testified before Congress, the Maryland General Assembly and in other governmental proceedings regarding several issues affecting children and low-income individuals and families.  Professor earned his law degree at the University of Virginia and his undergraduate degree at the University of Texas at Arlington. For more on Hatcher's work go to: https://www.amazon.com/Poverty-Industry-Exploitation-Americas-Vulnerable/dp/1479874728.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowSince the passage of the Affordable Care Act in 2010 CMS has been working to reform Medicare reimbursements from "fee for service" to "fee for value."  (Earlier this year Secretary Burwell noted 30% of traditional or "fee for service" Medicare reimbursements are now tied to quality or value.)  The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 accelerates this transition by incenting Medicare providers to participate in "fee of value" or pay for performance agreements, termed Alternative Payment Models (APMs) under MACRA, with a 5% annual bonus.  To date, commercial Medicare Advantage (MA) plans (Medicare Part D) have been immune from these reforms.   However, under MACRA beginning in performance year 2019 MA plan providers can potentially count their MA reimbursements and MA beneficiaries toward qualifying for the 5% MACRA APM bonus - if they meet the financial risk and other qualifying MACRA APM criteria.  To what extent MA plans, that now account for nearly one-third of all Medicare beneficiaries, will work with their provider partners to meet the MACRA APM qualifying criteria is unknown.      During this 23 minute conversation Ms. Turco discusses expectations for MA plan participation under MACRA as qualifying APMs, how MA stakeholders are thinking about moving the program outside of MACRA toward improved value or reduced spending growth, CMS's MA Value Based Insurance Design (VBID) demonstration scheduled to begin in January and anticipated MA reforms under a new White House administration next year.   Ms. Molly Turco is presently Director of Policy and Research at the Better Medicare.  Previously, Ms. Turco was a Senior Healthcare Policy Analyst with the Marwood Group.   Ms. Turco also worked as a Healthcare Policy Researcher in the State of Vermont Office of Health Reform, within the University of Pennsylvania Health System and at Dartmouth Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth.  Ms. Turco holds a MPH from the Dartmouth Institute for Health Policy and Clinical Practice and a BA from Middlebury College.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowExcluding from taxable income the moneys employers spend in providing employees with health insurance dates back to WWII-era wage and price controls.  Today, this tax policy, that amounts to over $250 billion in lost federal tax revenue, effectively constitutes the third largest federal government expenditure on health care after Medicare and Medicaid.  Few tax experts would disagree that the tax exclusion constitutes bad policy.  Beyond lost tax revenues, the policy is, among other things, highly regressive, causes lower or stagnant wage growth, reduces health plan competition, contributes to excessive health care spending, incents the over-utilization of health care services, limits job mobility and negatively influences retirement decisions.   During this 25 minute conversation Dr. Antos discusses the extent to which the tax exclusion is responsible for employers providing employees with health care insurance coverage, what effect would capping or phasing out the exclusion have on coverage, how best can the policy can be reformed via a Cadillac tax or otherwise, what might be done to reform the tax exclusion under a Secretary Clinton administration and how the exclusion may play into future tax reform may legislation.   Dr. Joe Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute (AEI).  Before joining AEI,  Dr. Antos served as the Assistant Director for Health and Human Resources at the Congressional Budget Office (CBO).  Dr. Antos has also held senior positions in the US Department of Health and Human Services, the Office of Management and Budget and the President's Council on Economic Advisers.  He recently completed a seven year term as Health Adviser to CBO and two terms as a Commissioner of the Maryland Health Services Cost Review Commission.  In 2013 he was named Adjunct Associate Professor of Emergency Medicine at George Washington University.   Dr. Antos earned his Ph.D. and MA in economics at the University of Rochester and his BA in mathematics from Cornell University.   For more background information about the exclusion and micro-simulation data on reforming the exclusion, see Jonathan Gruber's 2011 article in the National Tax Journal, at: http://www.ntanet.org/NTJ/64/2/ntj-v64n02p511-30-tax-exclusion-for-employer.pdf.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com