Thought Leadership

Our wide array of published insights drive the debate in Washington.

Medicare for All: What it Means, and Where it’s Headed

Medicare for All is the titular banner carrying the promise of comprehensive healthcare coverage for every U.S. resident and, along with it, reduced costs, improved quality, and patient-focused care. While phrases like “universal coverage” and “single-payer” have traditionally been reserved to the fringe of American politics, the idea of a single, government-run insurance plan is now taking center stage. But what does it really entail? And can we reasonably expect its fruition? We seek to provide some clarity on both questions. ...
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The Final Public Charge Rule Is Out. Here’s How It Affects Immigrants.

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The US Department of Homeland Security (DHS) has finalized significant new restrictions to reduce immigration by creating a preference for wealthy, English-speaking, insured, and educated immigrants and putting up new hurdles for impoverished immigrants and their families....
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Accelerating Primary Care Redesign: CMS’ Innovation Center Announces Five New Transformative Models

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Primary Cares Initiative (PCI), a suite of five voluntary payment models aimed at overhauling primary care. Marking the Trump Administration’s latest investment in Medicare value-based reform, PCI focuses on the role of primary care providers as the central coordinators of patient health, with the goal of enhancing patient care while lowering overall Medicare fee-for-service (FFS) costs. Once implemented, CMS estimates that more than a quarter of all Medicare FFS beneficiaries – nearly 11 million individuals – will be included in these transformative primary care delivery models....
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A Tell-All on Telehealth: Where Is Congress Heading Next?

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The Centers for Medicare and Medicaid Services (CMS) recently enacted modest but important expansions in Medicare’s telehealth policy. Telehealth, which uses telecommunications to support virtual health care delivery to improve access to and quality of health care, is moving from promise to reality. The benefits are appealing: Patients can interact with their providers remotely, which improves access to care and can help providers manage chronic conditions from afar....
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Medicare Direct, A Blueprint For Public Option Waivers, Part 1: Introduction, Administration, And Financing

There is a reason that Medicare for All has captured the enthusiastic support of a large majority of the public: The status quo for our health care system is unsustainable economically and unforgiveable morally. An honest assessment of the probability of Congress enacting Medicare for All–related legislation, however, demonstrates it is highly unlikely in the foreseeable future. ...
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Medicare Direct, A Blueprint For Public Option Waivers, Part 2: Benefit Design, Provider Networks, And Reimbursement

In all of the discussion and debate regarding Medicare for All and public option proposals, three essential considerations often get short shrift: the benefits enrollees will receive, the network of providers they will have access to; and the rates providers will be paid for delivering these services. These elements, however, really are the guts of any meaningful initiative of this scope. ...
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Medicare Direct, A Blueprint For Public Option Waivers, Part 3: Waiver Design, Legal Authority, And Conclusion

Perhaps the greatest weakness of the Medicare for All, Medicare for More, and public option proposals issued thus far is the fact that they require Congress to pass new legislation. That is certainly true for Medicare for All, it’s true for a Medicare buy-in, and it’s likely true for federally run public options. The biggest strength of Medicare Direct, by contrast, is that it requires no such action. ...
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These Four Federal Proposals Would Have Major Health Implications for Immigrants

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The Trump administration is seeking to modify federal regulations with harmful changes that could dramatically affect immigrants’ access to health care and other public benefits and weaken the health and social safety net. These policies affect access to health coverage, food assistance, housing, protections against discrimination, and more. These proposed changes could have major consequences for the health and well-being of immigrants across the country and especially in California, which has more immigrants than any other state....
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The Drug Pricing Debate Part II: The Many Acts of Congress

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As we outlined earlier this spring, congressional action on drug pricing continues to intensify. Key committees have advanced an array of reforms, demonstrating Congress’ intent to finalize legislation this year. We aim to clarify what that might include....
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Public Option 1.0: Washington State Takes An Important Step Forward

On Sunday, the Washington State legislature passed a bill to create standardized health plans in the state’s Exchange and establish new public option-ish plans that contract directly with its Health Care Authority, which operates the state’s Medicaid program. The hallmark of these new plans, and the foundation of their claim to the title “public,” is they are required cap provider reimbursements at Medicare-based levels....
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The Drug Pricing Debate: Sizing Up Recent Actions and What May Come Next

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What goes up must — or rather, should — come down. Such is the thinking of the Trump administration when it comes to prescription drug pricing, at least. Over the past five years, 12 of the 20 most commonly prescribed brand-name drugs have seen price increases of more than 50 percent. To date, most of what we’ve seen from the federal government is messaging and some initial proposals, with the majority coming from the administration. Congress, for its part, has initiated a series of drug pricing hearings and begun introducing meaningful legislation. The result is a wide array of policy alternatives, some of which stand a chance of being enacted....
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Medicare For All Can Begin In 2021: Here’s How

While Democratic presidential candidates and the newspaper headlines hash out the ideological nuances of a Medicare-based single payer coverage scheme, work is underway to consider how coverage can be expanded to those in need within a realistic timeframe at minimal cost or disruption to the existing system....
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