Health Equity & Access Weekly Roundup: November 9, 2024

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Key Takeaways

Trump's presidency may alter federal health policy, targeting public health initiatives and domestic drug production, potentially reversing Democratic health reforms.
Physician compensation is influenced by medical system consolidation and Medicare Advantage enrollment, with nurse practitioners expected to grow as a cost-effective alternative.
Medicaid eligibility reviews post-COVID-19 have led to significant coverage losses, with procedural issues and systemic inequities disproportionately affecting minorities.
Cancer mortality disparities among Asian American and Pacific Islander populations persist, with rising death rates for certain cancer types, highlighting the need for targeted interventions.
Hospital facility fees for outpatient procedures are significantly higher than those at ambulatory surgery centers, suggesting potential cost-saving opportunities through expanded ASC use.

The health policy implications and ballot measures in the wake of the presidential election, new trends in physician compensation, lessons from the Medicaid unwinding, disparities in cancer mortality, and privately negotiated hospital fees.

Trump Recaptures White House, Spelling Uncertainty for Federal Health Policy

Former President Donald J. Trump is once again President-elect Trump after winning the 2024 presidential election. He is set to re-enter the White House with plans to overhaul federal agencies, including those in health policy. His campaign, while light on specific health proposals, hinted at “concepts” for health reform. Backed by Robert F. Kennedy Jr., Trump’s administration may target public health initiatives, including vaccine and fluoride regulations, if Kennedy assumes a key role.

Abortion ballot measures were decided as 7 out of 10 states voted to protect abortion access, while Florida, Nebraska, and South Dakota measures fell short. Trump’s Democratic opponent, Vice President Kamala Harris, promoted reproductive rights, Affordable Care Act expansion, and drug cost reforms, which could face reversals under Trump, who instead plans tariffs and incentives to boost domestic drug production.

Physician Compensation Changing in New Medical Landscape

New research suggests that physician compensation in the US may be impacted by the consolidation of medical systems and the rise in Medicare Advantage enrollment. Despite a 3% increase in average compensation for physicians from 2022 to 2023, factors like Medicare reimbursement cuts and a shift from fee-for-service to Medicare Advantage plans could drive down physician income, especially in major metropolitan areas. With fewer physicians entering private practice, employment models are evolving, often involving venture capital or private equity firms.

Concurrently, nurse practitioners are expected to grow by 40% by 2033, offering a lower-cost alternative for practices seeking to reduce expenses. However, this shift brings challenges in collaborative roles and supervision, as nurse practitioners are generally paid less but may be seen as more cost-effective despite often handling less complex cases.

Lessons Learned From Medicaid Unwinding as States Tackle Eligibility Checks

Following the end of the COVID-19 public health emergency, states resumed Medicaid and CHIP eligibility reviews, leading to significant coverage losses, with over 25 million people disenrolled by June 2024. The “unwinding” process has been challenging, as 69% of disenrollments stemmed from procedural issues, not eligibility, often due to staffing shortages and outdated technology. Disparities emerged, with racial and ethnic minorities disproportionately affected, highlighting systemic inequities in Medicaid policy. While some states, like Kentucky and Louisiana, implemented streamlined processes to mitigate coverage loss, others, like Florida, faced lawsuits over alleged procedural missteps. Federal policy changes aim to reduce “churn” and improve stability, yet debates continue over Medicaid spending and the need for technological integration to support equitable access.

Disparities in Cancer Mortality Among Asian Americans and Pacific Islanders

A recent study published in JAMA Network Open found that while overall cancer-specific mortality rates declined among Asian American and Pacific Islander (AAPI) populations from 1999 to 2020, certain cancer types showed rising death rates, underscoring significant disparities by cancer type, sex, age, and region. Uterine cancer and brain cancer mortality rose notably among AAPI women, while men aged 45 to 54 experienced increased colorectal cancer mortality. Mortality from liver and intrahepatic bile duct cancers increased for both sexes across all US regions. The study, based on CDC data, highlighted limitations like the aggregation of AAPI groups, which can mask differences among ethnic subgroups, and the lack of information on cancer stage and socioeconomic factors.

Privately Negotiated Facility Fees at Ambulatory Surgery Centers and Hospitals

A recent analysis published in The American Journal of Managed Care^® found that hospital facility fees for common outpatient procedures are, on average, more than double those at ambulatory surgery centers (ASCs), with mean fees at hospitals exceeding ASCs by $3077. The study utilized pricing data from private payers and analyzed high-volume procedures across four specialties, showing a significant cost difference that could help clinicians refer healthy patients to ASCs to reduce expenses. While hospital fees reflect costs associated with more complex care and market power, expanding ASCs, especially in states with certificate-of-need laws, could help curb spending and improve access to care. However, careful regulatory safeguards are necessary to ensure financial transparency and prioritize care for underserved populations.