Nicholas Bagley

Protection or Harm? Suppressing Substance-Use Data

The CMS policy of withholding from research data sets any claim with a substance-use–disorder diagnosis or related procedure code impedes research evaluating policies and practices meant to improve care for patients with such disorders.

Three Words and the Future of the Affordable Care Act

As an essential part of its effort to achieve near universal coverage, the Affordable Care Act (ACA) extends sizable tax credits to most people who buy insurance on the newly established health care exchanges. Yet several lawsuits have been filed challenging the availability of those tax credits in the thirty-four states that refused to set up their own exchanges. The lawsuits are premised on a strained interpretation of the ACA that, if accepted, would make a hash of other provisions of the statute and undermine its effort to extend coverage to the uninsured. The courts should reject this latest effort to dismantle a critical feature of the ACA.

Small Change, Big Consequences — Partial Medicaid Expansions under the ACA

The Trump administration may decide to permit states to partially expand their Medicaid programs to cover people with incomes up to 100% of the federal poverty level. Arkansas has requested a waiver to do so, and if it is granted, other states may follow suit.

The Legality of Delaying Key Elements of the ACA

The recent delays of ACA provisions appear to exceed the scope of the executives traditional enforcement discretion. A future administration less sympathetic to the ACA could invoke them as precedent for declining to enforce other provisions that it dislikes.

Why it’s so hard for insurers to compete over technology

We are awash in choices about health insurance. Affordable Care Act (ACA) marketplaces offer about 40 plans, on average. Medicare beneficiaries can choose from among about 2 dozen to 3 dozen Medicare Advantage and prescription drug plans, respectively. At least half of all US workers are offered multiple coverage options by their employers. And many Medicaid enrollees can choose among managed care plans. What’s the point of all these choices? In theory, customers will be drawn to those plans that offer good value for the money. That’s why plans offer different levels of cost sharing, for example, and differ in which and how many doctors and hospitals are included in their networks. Apart from requirements mandated by the federal government or the states, they also vary in the classes of care they cover. Some may offer more coverage for optical or dental care, for example. Customers can then shop for the plans they prefer most at a cost they can afford. But for al l this compe tit ion and choice, there is very little on the most important driver of health care spending: new technology.

Transparency and the Supreme Court — Can Employers Refuse to Disclose How Much They Pay for Health Care?

Eighteen U.S. states have all-payer databases on the prices insurers pay for medical care, providing transparency for regulators, policy researchers, and consumers. But an impending Supreme Court case, Gobeille v. Liberty Mutual threatens to cripple such initiatives.