The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowThis past October 1st uninsured Americans who qualify for coverage under the Affordable Care Act could begin choosing a health care insurance plan offered via their state's healthcare insurance marketplace or exchange.  The CBO estimates about 14 million Americans will buy health care insurance for 2014 and about 25 million will do so by the end of the decade (still leaving about 20 million Americans uninsured).  Those that make more than the Federal Poverty Level/FPL but less than four times that level, or $94,000 for a family of four, can buy subsidized insurance and for those making less that 133% of the FPL ($15,000 a year for a single adult or $31,000 a year for a family of four) can sign up for Medicaid if their state is participating in the ACA's Medicaid expansion program - currently 24 states.   Many American who can reasonably afford health care insurance do not buy it and approximately 40% of Americans who qualify for Medicaid do not subscribe.  Since policy is what policy does, the relevant question is how many Americans will sign up for health care insurance under the ACA.During this 22-minute interview, Ms. Barba Brown discusses Enroll America's mission, its various activites, moreover in 10 states, to advocate for coverage and to educate the uninsured about obtaining either private insurance or Medicaid coverage and how and why she believes Americans will substantially sign up for health care insurance under the ACA. Ms. Jessica Barba Brown currently serves as National Communications Director for Enroll America.  Previously she was Vice President for Program Development at Faith in Public Life and prior still Communications Director for former U.S. Representative Tom Perriello.  Ms. Barba Brown began her career managing communications and branding efforts for nonprofit social service organizations such as City Year New York and CancerCare in New York City.  She holds a B.A. in Gender and Sexuality Studies from New York University.  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 part of last year's "fiscal cliff" agreement the Congress created a Long Term Care/LTC Commission tasked to make recommendations to improve LTC delivery.   (The Commission was created largely as a result of the demise of the ACA's CLASS Act.  See the related August 5th interview with Connie Garner.)  Today more than 12 million Americans rely on LTC services and this number will grow dramatically as baby boomers age.  Currently however only impoverished older Americans and the disabled are covered via state Medicaid programs and because few companies offer LTC policies (and because annual premiums are expensive), only about 8 million Americans have private LTC insurance.  As a result LTC services are provided moreover informally by 42 million Americans at an AARP estimated out-of-pocket cost of $450 billion annually.  In mid-September the 15-member LTC Commission voted 9-6 in approving 28 recommendations.  The six dissenting votes were largely due to Commission's failure to address the most substantive LTC issue, how best to pay for LTC services. During this 22-minute interview Prof. Feder discusses the Commission's findings generally.  Moreover she details how/why the Commission failed to address structural financing for LTC.  She also discusses the views of the six Republican-nominated commission members, how/why private insurance policies are limited and/or inadequate, what a publically funded LTC insurance policy would look like and prospects for future work conducted by a subsequent national committee and the Congress.                Judy Feder is a Professor of Public Policy at the Georgetown Public Policy Institute.  Prof. Feder began her career at the Brookings Institution, continued at the Urban Institute, and, since 1984 has worked at Georgetown University.  She served as Staff Director to the Congressional Pepper Commission in 1989-90, served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services in President Bill Clinton’s first term; as a Senior Fellow at the Center for American Progress and today as an Institute Fellow at the Urban Institute.  Prof. Feder is an member of the Institute of Medicine, the National Academy of Public Administration, the National Academy of Social Insurance, she's a former chair and board member of AcademyHealth, the Hamilton Project’s Advisory Council and a senior advisor to the Kaiser Commission on Medicaid and the Uninsured.  She received her B.A. from Brandeis University and her master's and Ph.D. from Harvard University.The Commission's report can be found via: http://www.ltccommission.senate.gov/.  Prof Feder, et al., recommendations can be found at: http://www.medicareadvocacy.org/wp-content/uploads/2013/09/LTCCAlternativeReport.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

Medical devices, everything from tongue depressors to pace makers and defibrillators, are regulated by the FDA.  How competently or effectively the FDA regulates these products has been questioned for several years in part due to the substantial increase in recent years in product recalls, for example the recall of certain hip implant devices.  More specifically is the question whether the FDA's 510(k) process, that reviews or “clears for the market” medical devices, is adequate.  An IOM study of the topic released in July 2011 reached the unanticipated and controversial conclusion that since, in part, 510(k) determines only “substantial equivalence” in clearing devices for the market, i.e., it does not evaluate device safety and effectiveness, the process should be scrapped and replaced.  (Listeners will recall Dr. Zuckerman was interviewed last December about the excessive use of anti-pshychotics in nursing homes.) During this 26-minute discussion, Dr. Diana Zuckerman defines what's meant by "substantial equivalence" and the three FDA classes of medical devices, she assesses what assurance the public has in knowing approved devices are safe, comments on her 2011 findings published in the Archives of Internal Medicine (see the link below) and the IOM report and what progress the FDA has made over the past two years in improving its medical device review process particularly in post-market surveillance.  Diana Zuckerman, Ph.D., has since 1999 been the President of the National Research Center for Women and Families, a nonprofit, nonpartisan research and advocacy organization promoting adult and child health and safety. After academic careers at Yale and Harvard, Dr. Zuckerman worked for many years as a Senate, House and Department of Health and Human Services staffer and as well serving as a senior policy advisor for First Lady Hillary Rodham Clinton and the White House Office of Science and Technology Policy. Presently, Dr. Zuckerman is also a fellow at the University of Pennsylvania Center for Bioethics and serves on the board of directors for two nonprofit organizations: the Congressionally mandated Reagan-Udall Foundation; and, the Alliance for a Stronger FDA.Dr. Zuckerman's article noted above, "Medical Device Recalls and the FDA Approval Process," can be found at: http://archinte.jamanetwork.com/article.aspx?articleid=227466. 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 NowToday nearly all large employers offer a workplace wellness programs and most small employers that offer health benefits also offer at least one wellness program.  Typically these programs consist of health risk assessments, biometric screenings, health coaching and lifestyle management education.  Program popularity is not surprising considering the epidemic in what's termed "lifestyle diseases" due to, in part, poor nutrition and tobacco use.   To encourage employee participation in these programs the Affordable Care Act will allow beginning in 2014 employers to discount up to 30% of successfully participating employee's insurance premiums and up to 50% if the additional 20% is due to a reduction in employee tobacco use.  However, do these programs work and more pointedly do they shift health care costs from healthier employees to those considered less healthy? During this 22-minute podcast, Ms. Darling briefly describes workplace wellness programs, their rationale, funding, program incentive payments (including loss aversion policies) and the difficulties in determining wellness programming effectiveness.  She also addressess cost shifting criticisms of wellness programs and other related issues.  The interview concludes with her thoughts concering whether employers will begin to drop employee benefits in 2014.         Ms. Helen Darling is President of the National Business Group on Health, a national non-profit, representing large employers' perspective on national health policy issues.  Its over 300 members, including 64 of the Fortune 100, purchase health and disability benefits for over 55 million employees, retirees and dependents.  Ms. Darling also currently serves on numerous boards including the Institute of Medicine's Roundtable on Evidence-Based Medicine, the Board of the National Quality Forum, the VHA Health Foundation Board and the Board of the Congressionally-created Reagan-Udall Foundation.  She is widely quoted in The New York Times, Wall Street Journal, The Economist, Washington Post and numerous other periodicals.  Previously, Ms. Darling worked at Watson Wyatt Worldwide, the Xerox Corporation, at William W. Mercer and served as an advisor to Senator David Durenberger.  Ms. Darling received her Master's and Bachelor's of Science fom the University of Memphis.For more on the debate regarding the effectiveness of wellness programs see, for the example, the debate between Ron Goetzel and John DiNardo via the Health Affairs Blog, at: http://healthaffairs.org/blog/.  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 NowDuring this 21-minute interview, Professor Nichols discusses the reasons for the decline in health care cost growth and whether its slowing will persist, alternative payment models (to fee for service) that contribute to this decline, how worrisome or not health care market consolidation is as well as the prospect of employers dropping employee health care coverage, why Congressional Republicans (moreover House Republicans) oppose the ACA, ways of improving the law via moroever price transparency provisions and whether states, specificallly Virginia, will take advantage of the ACA and expand its Medicaid coverage in 2014.Since 2010 Dr. Len Nichols has been Professor of Health Policy and the Director of the Center for Health Policy Research and Ethics at George Mason University.  Previously, Dr. Nichols served as the Director of the Health Policy Program at the New America Foundation, as Vice President of the Center for Studying Health System Change, as a Principal Research Associate at the Urban Institute, as a Senior Advisor for health policy at the Office of Management and Budget during the Clinton Administration's health reform effort, and as Chairman of the Economics Department at Wellesley College. He has advised the World Bank and the Pan American Health Organization, as well as various state governments and departments of the US Government.  Because of his reputation as an honest and knowledgeable health policy analyst, Dr. Nichols has testified on numerous occasions before Congress and is frequently interviewed by major media outlets including The New York Times, The Washington Post, The Wall Street Journal, Congressional Quarterly, National Public Radio, the British Broadcasting Service and ABC, CBS and the NBC's nightly news.  He received his Ph.D. in economics from the University of Illinois at Champaign-Urbana.Professor Nichols most recent Congressional testimony was before the US Senate Budget Committee this past July 30th, see: http://www.budget.senate.gov/democratic/index.cfm/files/serve?File_id=4dd8a8b5-c123-44e6-b13e-34b6e825c3f0Among other noted publications Prof. Nichols co-authored (with John Bertko) in 2009 "A Modest Proposal for a Competing Public Health Plan".  See: http://www.newamerica.net/files/CompetingPublicHealthPlan.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

Listen NowThe most expensive Medicare beneficiaries are not those with multiple chronic conditions.  They are those with chronic conditions AND functional impairment (i.e., those needing help with routine life activities).  For example, the 15% of Medicare enrollees with both chronic conditions and functional limitations disproportinally account for one-third of Medicare spending.  Alternatively, Medicare enrollees with three or more chronic conditions but no functional impairment (48%) account for roughly the same percent of spending (51%).  The challenge therefore both in improving quality care for the chronically ill and reducing costs (via, for example, reduced hospitalizations) is in improving long term care supports and services (LTSS). During this 26-minute podcast Dr. Alkema defines "functional limitation" and "care coordination", explains the current lack of care coordination for Medicare patients with chronic conditions and functional limitations, describes three exemplary models of care coordination and what Medicare can or should do to improve care for these patients.Dr. Gretchen Alkema currently serves as Vice President of Policy and Communications for The SCAN Foundation.  Prior to joining SCAN Dr. Alkema was the 2008-09 John Heinz Health and Aging Policy Fellow serving in the office of Sen. Blanche Lincoln.  Dr. Alkema earned her PhD at the University of Southern California’s Davis School of Gerontology and and completed her post-doctoral training at the VA Greater Los Angeles Health Services Research and Development Center of Excellence.  Her academic research focused on evaluating innovative models of chronic care management and translating effective models into practice.  She is a Licensed Clinical Social Worker and has practiced in government and non-profit settings including community mental health, care management, adult day health care, residential care and post-acute rehabilitation.For background information concerning this topic see this paper by Georgetown's Harriet Komisar and Judy Feder: http://www.cahpf.org/docuserfiles/georgetown_trnsfrming_care.pdf  See also too SCAN's "10 Conversations to Plan for Aging with Dignity and Independence" at: http://www.thescanfoundation.org/10-conversations-plan-aging-dignity-and-independence. 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 NowIn 2009 the Congress overwhelmingly passed landmark legislation (commontly termed the "Tobacco Control Act") that included banning flavored cigarettes - except menthol.  Instead, the Congress called upon the FDA to first study the use of menthol before taking action.   In 2011 the FDA released an initial report, the conclusions of which were widely interpreted.  Two weeks ago the FDA released a subsequent report again finding the menthol/mint flavor helps people acquire the tobacco/nicotine addiction but did not increase the risk of disease compared to smoking non-menthol cigarettes.  Neither report recommended banning or restricting the use of menthol. During this 24-minute podcast Andrea Villanti and Diane Canova discuss why menthol was exempted in the 2009 legislation, the findings of the 2011 Tobacco Products Scientific Advisory Committee, why the FDA chose to follow up with a report of their own (released July 23rd) and what it found, various confounding factors including an international trade dispute concerning the importation of clove cigarettes and ultimately their take on whether and when the FDA will either ban or regulate menthol's use.       Dr. Andrea Villanti is an Associate Director for Regulatory Science and Policy at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy Foundation and holds an adjunct faculty appointment in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health.  Her work concerns translational research to improve tobacco control policy and program decision-making with a specific focus on young adult cessation.  Since the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, she has been actively engaged in research on the impact of menthol cigarettes on tobacco use behaviors.  Dr. Villanti received her doctorate in Social and Behavioral Sciences the Johns Hopkins Bloomberg School of Public Health and she received both her Master’s in Public Health and BA in Medical Ethics from Columbia University.Ms. Diane Canova is currently Vice President of Government Affairs at the Legacy Foundation. Previously, Diane served as Vice President of Policy and Programs with the Partnership for Prevention.  Prior still she served as Vice President of Advocacy for the American Heart Association and as Director of Government Relations for the American Red Cross.  Ms. Canova is a founding board member and immediate past chair of the Center for Lobbying in the Public Interest (CLPI) and frequent lecturer on nonprofit leadership and advocacy.  She received her JD from the Brandeis School of Law at the University of Louisville and her BS in Education from Kent State.   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 NowWhile the vast majority (70%) of people turning 65 will need long term care services for an average of three years, only 7 million Americans own a long term care insurance policy.  Medicare does not provide for long term care and Medicaid only covers long term care costs for those with very limited financial means.   The CLASS Act, a provision within the ACA, would have created a voluntary and public long term care insurance policy for employees but the ACA provision, as written, was unworkable such that the Obama adminstration abandoned its efforts to implement the CLASS Act in late 2011.  (The Congress offically repealed the provision in early 2013.)     During this 25-minute interview Ms. Garner discusses the need for long term care insurance (both for the elderly and younger disabled), the origins of the CLASS Act and why the provision was ultimately unsuccessful and the continuing need for related reforms to both entitlement programs, i.e., Medicare and Medicaid, and the long term care insurance market.Ms. Connie Garner is currently the Executive Vice President for Public Policy at United Cerebral Palsy.  Previously, Ms. Garner worked at Foley Hoag where she served as Policy Director in the Government Strategies Practice Group and as Executive Director of Advance CLASS, Inc., a position she still holds.  For 17 years prior she was Policy Director, Disability and Special Populations, to the U.S. Senate Committee on Health, Education, Labor and Pensions Committee.  In that role, she was the lead Democratic Committee architect for the CLASS Act, the major long-term care legislation that was a part of the ACA.  Ms. Garner also served in the U.S. Department of Education.  She received her B.S. in Nursing from the University of Pennsylvania, a M.S. in Nursing form George Mason, and an Ed.S. in Special Education from George Washington.  She is certified as a Pediatric and Neonatal Nurse Practitioner and is the mother of seven children.For a primer on long term care insurance see this DHHS Assistant Secretary for Planning and Evaluation (ASPE) research brief: http://aspe.hhs.gov/daltcp/reports/2012/ltcinsRB.shtml.  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 NowRecently the French government fined Sanofi $53 million for what it called a smear campaign against a competitor drug manufacturer.   Ranbaxy was fined $500 million, in part, for making false statements to the FDA.   Last year the pharamaceutical industry in sum paid out $5.5 billion to resolve fraudulent marketing practices.  These included $3 billion in fines against GlaxoSmithKline (GSK) and $762 million against Amgen.   When these settlements were reached eight of the top 10 global pharmaceutical companies were under "corporate integrity agreements"  (that require companies to report compliance activities via an independent monitor for five years).   With governments recouping only a portion of drug company profits via these marketing practices many say pharma simply views the fines as a cost of doing business.  (The day the GSK fine was announced, the largest of its kind in history, GSK's stock price actually closed up).During this 23-minute interview Dr. Fugh-Berman discusses the types and pervasiveness of pharmaceutical marketing abuses, the public health consequences thereof, the adequacy of corporate integrity agreements and other efforts that promise to curb abuse (e.g., the Physician Payment Sunshine Act), her views regarding direct to consumer advertising, Pharmed Out's efforts to better educate (or insulate) physicians, patients and other consumers from marketing manipulation.    Dr. Adriane Fugh-Berman is an Associate Professor in the Department of Pharmacology and Physiology and in the Department of Family Medicine at Georgetown.   She is also Director of PharmedOut a research and education project that promites rational prescribing and exposes the effect of pharmaceutical marketing on prescribing practices.  Previously, Dr. Fugh-Berman was a medical officer in the Contraception and Reproductive Health Branch of the National Institute for Child Health and Human Development at the NIH.  Dr. Fugh-Berman is the former chair of, and currently writes a column for, the National Women’s Health Network and she has appeared on 20/20, the Today Show and every major news network.  Dr. Fugh-Berman graduated from Georgetown University School of Medicine and completed a family medicine internship in the Residency Program in Social Medicine at Montefiore Hospital in the Bronx.For information regarding PharmedOut see: http://www.pharmedout.org/. 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 NowThe lowlight during the 2009-2010 ACA debate was Governor Palin's invention of "death panels" (PolitiFact's 2009 "Lie of the Year") in response to a proposal to allow Medicare to pay physicians whom voluntarily counsel patients about advanced care planning or directives.   The fear mongering was so convincing the proposal was dropped by the Congress and later, via rule making, by the White House.  The facts remain that while far and away most Americans die of a long term chronic, eventually fatal ilness/es, according to AHRQ, Pew and others only approximately twenty to thirty percent of Americans have an advanced directive or a living will including those severely or terminally ill.  During this 28-minute discussion Mr. Sabatino discusses the importance and benefits of advanced care planning and the various types of advanced care directives (living wills, durable power of attorney, POLST, and others), reasons for our hesitancy in planning for advanced illness and completing directives, limitations (e.g., portability problems) and operational challenges.  He notes specifically advanced care planning is not a one time conversation or a check the box exercise.  He describes what steps are being taken to improve advanced care planning, for example through opportunities presented via the movement towards electronic health/medical records.        Charlie P. Sabatino is the Director of the American Bar Association’s Commission on Law and Aging where he is responsible for research and education in health law, long‑term care, guardianship and capacity issues, surrogate decision‑making, legal services delivery for the elderly and professional ethics.  He has written extensively on capacity issues, surrogate decision-making and advance care planning.  Mrs. Sabation is also an Adjunct Professor at Georgetown University Law Center, currently serves as a legal consultant to the National POLST Paradigm Task Force and is a board member of the Coalition to Transform Advance Care.  Mr. Sabatino is a Fellow and former president of the National Academy of Elder Law Attorneys.  He received his A.B. from Cornell, his J.D. from Georgetown and is a member of the Virginia and D.C. bars.For ABA information on advanced care planning and directives see:  http://www.americanbar.org/groups/law_aging/resources/consumer_s_toolkit_for_health_care_advance_planning.html and for Respecting Choices information see: http://www.gundersenhealth.org/respecting-choices. 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