Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

The Affordable Care Act (ACA) requires that most Americans have health insurance that meets minimum federal requirements.  Under the controversial mandate, starting in 2014, most individuals under 65 must purchase minimum essential health insurance coverage or pay a penalty to the IRS.  One practical concern is that healthy individuals...
As part of the Affordable Care Act (ACA), Medicaid coverage could be expanded to cover nearly 400,000 currently uninsured American Indians and Alaska Natives (AI/AN). This population, particularly sensitive to health disparities, suffers from elevated disease burdens and poorer overall health than that of the general population. The AI/AN...
As part of the Health Reform Toolkit Series, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority have published Effective Education, Outreach, and Enrollment Approaches for Populations Newly Eligible for Health Coverage. The series offers resources for health...
A new report examines individual eligibility for federal premium subsidies in Health Insurance Exchanges when employer-sponsored or public coverage is not available to them.  Both federal premium subsidies and state or federally-run Health Insurance Exchanges are features starting in 2014 under the Affordable Care Act (ACA). While most individuals will be required to...
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking...
In February 2012, The Hospital Community Benefit Program, established by the Hilltop Institute at the University of Maryland, Baltimore County (UMBC), published the third issue brief in a series, Hospital Community Benefits after the ACA: Partnerships for Community Health Improvement. The series, published across a three-year span, is funded...
Are you ready to be an Accountable Care Organization (ACO)? Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization. Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is...
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers. In...
Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans.  Research shows that a high proportion of hospital readmissions are preventable.  Most hospital payment methods, most notably the Medicare Part A inpatient prospective payment system (IPPS), create strong financial incentives for hospitals to discharge patients...
Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial.  Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by the Food and Drug Administration (FDA).  Is this a good idea or is it...

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