The Essential Scan: Top Findings in Health Policy Research | Edition 86

What’s the latest in health policy research? The Essential Scan aims to help keep you informed on the latest research and what it means for policymakers. It is produced by the USC-Brookings Schaeffer Initiative for Health Policy, a collaboration between the Brookings Institution and the USC Schaeffer Center for Health Policy & Economics. To sign up to receive the Essential Scan straight to your inbox, sign up here.

Out‐of‐Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions

Study by: Erin C. Fuse Brown, Erin Trish, Bich Ly, Mark Hall, and Loren Adler

Surprise billing for air ambulance services is a growing problem for consumers. While many states have developed policies to limit surprise medical bills, they have been unable to act on air ambulance services because they are regulated under the Federal Airline Deregulation Act. A new study analyzes 36,312 air ambulance claims from a large commercial health insurance claims database from 2014 to 2017, finding more than three quarters were out-of-network. The researchers estimate that in about half of cases, the commercial insurer paid the air ambulance’s billed charges in full. In 40 percent of cases there were potential balance bills, which in the later years of the period studied averaged more than $20,000 or 369 percent of the Medicare rate. The researchers point to two possible federal policy solutions: benchmarking to a national payment standard or create a functioning market for air ambulance services through a model that combines competitive bidding and public utility regulation. Full study here.

Changes in Opioid Prescribing Patterns Among Generalists and Oncologists for Medicare Part D Beneficiaries from 2013 to 2017

Study by: Ankit Agarwal, Andrew Roberts, Stacie B. Dusetzina, and Trevor J. Royce

In the United States, the opioid epidemic has increasingly shed a light on the dangers of misuse and abuse of opioids. But opioids are also essential therapies for pain relief. Thus there is concern that policies aimed at reducing the misuse and abuse of opioids could unintentionally disincentivize the prescription of opioids for patients who would otherwise benefit. A new study examines prescription trends from 2013 to 2017 among generalists and oncologists. The researchers found that the annual adjusted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists and from 77.8 to 58.8 among oncologists. This finding of both generalists and oncologists behaving similarly by prescribing less opioids raises the concern that access to otherwise appropriate and necessary opioid-based cancer pain management may be unintentionally restricted during the opioid epidemic. Full study here.

Fiscal Federalism and the Budget Impacts of the Affordable Care Act’s Medicaid Expansion

Study by: Jonathan Gruber and Benjamin D. Sommers

The Affordable Care Act encouraged states to expand Medicaid through offering more generous federal subsidies. Currently, the federal government spends roughly $400 billion annually on Medicaid, accounting for roughly 60% of the program’s total costs. State spending makes up the difference. As of early 2020 there were 14 states that had chosen not to expand Medicaid, pointing to state budgetary effects as a barrier. Examining state budget data from 2010-2018, the researchers found that total Medicaid spending in expansion states increased by eight percent by 2018, compared to non-expansion states. Almost all of the increase is spending came from the federal government, with state funding changing less than one percent annually in the most recent years (2017 and 2018) from the baseline. Furthermore, there was no evidence that the expansion led to reductions in spending on education, corrections, transportation, or public assistance. The researchers estimated that $43 billion in federally subsidized program funds were passed up by states that didn’t expand Medicaid by 2018. Full study here.

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The Essential Scan is produced by the USC-Brookings Schaeffer Initiative for Health Policy, a collaboration between the Brookings Institution and the USC Schaeffer Center for Health Policy & Economics.