During 2009, 730,000 prisoners were released from federal and state prisons.  This is a 21 percent increase from the number of prisoners released in 2000. Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community and find work. Discuss  are the challenges and the likely effect of recent federal legislation, including the Second Chance Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act.

It is estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually—more than 245,000 people in 2009—could enroll in Medicaid.   Similarly, it was estimated that up to 23.5 percent of prisoners released annually—more than 172,000 people in 2009—could be eligible for federal tax credits to defray the cost of purchasing insurance from state health exchanges.

This health insurance, combined with new substance abuse services and patient-centered medical home models, could dramatically improve the health and success of former inmates as they return to the community. States should consider several policy changes to ease prisoners’ transitions, including suspending rather than terminating Medicaid benefits for offenders; incorporating corrections information into eligibility determination systems; aiming Medicaid outreach and enrollment efforts at prison inmates; and designing comprehensive approaches to meeting former prisoners’ health care needs.

Proposals to move toward reducing geographic differentials in health care spending have focused on patterns of spending in Medicare. We show in this article that when considering each state as a whole, there is almost no relationship between the level of spending for Medicare beneficiaries and that for other populations. In sharp contrast to these state-level results, there is a strong relationship between Medicare and Medicaid spending in comparing Hospital Referral Regions within each state. We suggest that the strong intrastate regional correlations demonstrate the importance of the supply of hospital beds, specialists, and other health care resources as determinants of use and spending. In contrast, the lack of correlation at the state level suggests that other factors, such as state-level poverty rates, influence use and spending at the state level, and that these other factors influence Medicare and non-Medicare use and spending differently. These findings demonstrate that it is important to broaden our analytic focus from Medicare beneficiaries to the larger population, and to consider the likely effects of changes in Medicare payment policy on the care received by other state residents.

Roughly half of Medicare beneficiaries under age sixty-five are also eligible for Medicaid. These “dual eligibles” have been the subject of much research because of their low income and poor health status. Previous studies suggest that some states seek to shift costly health care services for this group out of state-run Medicaid programs and into the federally funded Medicare program—for example, replacing nursing home care with hospital care. Using state-level data on dual eligibles under age sixty-five, we found support for this hypothesis. In states with below-average per capita Medicaid spending, corresponding Medicare spending was above average. These state-level estimates also revealed a nearly threefold difference in total—Medicare plus Medicaid—price-adjusted spending per person, ranging from $16,309 in Georgia to $43,587 in New York. Such large variations among people with serious diseases suggest inefficiency. Some states may be spending too little for Medicaid, meaning that some patients’ needs are not being met, or some states may be spending too much, meaning that more services are being provided than needed. Such inefficiency exposes patients to unnecessary risk, drives costs up unnecessarily, and highlights the large potential gains arising from improved care coordination for dual eligibles.

Under the Affordable Care Act, individual health insurance will probably become more generous and more like employment-related insurance. Currently, individual insurance typically has less generous benefits than employment-related insurance. This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance, including important subgroups—adults with chronic conditions, the near-elderly (ages 55–64), and low-income populations. If adults who had individual insurance during 2001–08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.

For the last several years, Washington Democrats have been demanding a “balanced” approach to deficit reduction that consists of spending cuts and more revenue from tax increases. With the president’s re-election in November and the Democrats picking up additional Senate and House seats, they feel the wind at their backs and are now claiming an electoral mandate for balanced debt reduction. Today, three months after the election, how have they done so far in implementing this alleged mandate?

In just three months, we have seen a “fiscal cliff” deal that increased spending by $330 billion and raised taxes by $600 billion, a $50 billion Hurricane Sandy relief bill that included billions of pork that was completely unrelated to Sandy, and a debt ceiling deal that empowers the federal government to take on an unlimited amount of new debt for almost four months without any new spending restraint.

Members of a consortium of leading US health care systems, known as the High Value Healthcare Collaborative, used administrative data to examine differences in their delivery of primary total knee replacement. The goal was to identify opportunities to improve health care value by increasing the quality and reducing the cost of that procedure. The study showed substantial variations across the participating health care organizations in surgery times, hospital lengths-of-stay, discharge dispositions, and in-hospital complication rates. The study also revealed that higher surgeon caseloads were associated with shorter lengths-of-stay and operating time, as well as fewer in-hospital complications. These findings led the consortium to test more coordinated management for medically complex patients, more use of dedicated teams, and a process to improve the management of patients’ expectations. These innovations are now being tried by the consortium’s members to evaluate whether they increase health care value.

With the presidential and congressional races approaching full swing, the American people are being bombarded with one campaign slogan after another. The problem is that peppering voters with clever catchphrases in stump speeches and television ads does nothing to secure America’s energy or economic future.

With outrageous gasoline prices being matched only by the nation’s troubling unemployment rate, it is time for Republicans and Democrats to dispense with the political jockeying and get serious about an energy policy that can improve the lives of all American families.

The good news is that there is plenty of common ground on which to build a principled compromise.

In a story that should be a wake up call to policy-makers, outsourcing has gone public. As David Barboza of The New York Times reported on Saturday, seeking out low-wage workers off shore isn’t just for iconic American brands such as Apple, General Electric and Levi-Strauss; the phenomenon is increasingly prevalent among public agencies across the nation.

To illustrate the point, Barboza focuses on efforts to replace the eastern span of the San Francisco-Oakland Bay Bridge in California.  After the bridge was damaged in the 1989 Loma Prieta earthquake, officials decided a major overhaul of the Depression-era structure was necessary. The course of action for the 8.4 mile crossing was two-fold: strengthen the iconic double suspension four-tower west span and entirely replace the cantilever box east span.

Initial cost estimates said strengthening of the east span would cost about $700 million, but that for only $200 million more, a new bridge could be built that would withstand a major earthquake and act as a ‘lifeline’ for emergency services.

Some 22 years after the Loma Prieta quake, construction is still underway (it began about a decade ago) and the price tag is now an estimated $7.3 billion.

During the extended, decade-long planning phase, with projected costs soaring and a public outcry against profligacy, the State of California began looking for ways to economize. It opted against accepting any federal money for the project (even though the bridge span is, in fact, the final miles of Interstate 80) on the grounds that federal aid would trigger ‘Buy America’ provisions, driving up the costs further.  Instead, as Barboza writes, construction of major parts of the bridge were contracted out to Chinese companies.

At the time, it sort of made sense — the housing bubble placed a premium both on building materials and the labor needed to turn girders and rebar into a useable structure. A few years later, taxpayers aren’t griping about costs, they’re livid about the thousands of jobs and cutting edge industrial knowhow that sailed across the Pacific.

Reading James Bovard’s screed on food stamps as a “magnet for abuses and absurdities” in yesterday’s Wall Street Journal, I immediately thought, “Wow, he’s targeting food stamps the way conservatives in the 80s and 90s attacked welfare.” By the end of the piece Bovard makes it explicit: “Decades after liberals derided Ronald Reagan’s reference to a Cadillac-driving ‘welfare queen,’” Bovard writes,”Obama administration policies could easily permit Trust Fund Babies driving Rolls Royces to get free food courtesy of Uncle Sam.” Is there a valid argument behind this overheated rhetoric?

Not really.Bovard catalogs a bunch of sensational anecdotes, such as the story of Leroy Flick of Michigan who won the lottery but stayed on food stamps, because his lottery winnings counted as assets, not income. Ok, so the U.S. Dept. of Agriculture — which funds and administers food stamps in conjunction with states — failed to police Leroy Flick. But in a December 2010 Slate article, Annie Lowrey reported that the food stamp program has a 95 percent accuracy in properly subsidizing food purchases to the people below or near the poverty level who need such assistance.

More out-of-context alarm: Bovard cites a Milwaukee Journal-Sentinel investigation from this April stating that 2,000 food stamp recipients lost their food stamp cards at least six times last year. The freewheeling Wisconsin government issued them replacement cards each time. Since cards reported lost are immediately voided (and you have to report your card is lost, of course, to receive a new card), it’s unclear how the taxpayer is swindled — aside from the potentially outrageous costs of printing up new food stamp debit cards.  Also, there are 800,000 people in Wisconsin on food stamps — so the big-sounding 2,000 number represents .25 percent of all state recipients.

One strong point Bovard makes is that food stamp use has gone up while the number of USDA food stamp fraud inspectors has gone down. “The USDA’s Food and Nutrition Service now has only 40 inspectors to oversee almost 200,000 merchants that accept food stamps nationwide,” Bovard writes. If the Obama administration is spending more on the food stamp program, it would make sense for more of that money needs to be allocated to policing waste and abuse on the part of recipients, merchants, and even government employees.

Overall, though, a big plus about food stamps is how easy it is to apply — needy people do not have to go through a long bureaucratic process to get assistance. Bovard warns of “loose federal rules” — but isn’t a streamlined bureaucracy precisely what conservative commentators want more of from government?

Generous coverage of specialty drugs for cancer and other diseases may be valuable not only for sick patients currently using these drugs, but also for healthy people who recognize the potential need for them in the future. This study estimated how healthy people value insurance coverage of specialty drugs, defined as high-cost drugs that treat cancer and other serious health conditions like multiple sclerosis, by quantifying willingness to pay via a survey. US adults were estimated to be willing to pay an extra $12.94 on average in insurance premiums per month for generous specialty-drug coverage—in effect, $2.58 for every dollar in out-of-pocket costs that they would expect to pay with a less generous insurance plan. Given the value that people assign to generous coverage of specialty drugs, having high cost sharing on these drugs seemingly runs contrary to what people value in their health insurance.

Until now, illicit drug use has not been common in older people. However, it is likely to become more common as generations that use drugs more frequently reach an older age.

In the April 18 issue of JAMA, a study comparing traditional radiation therapy to treat localized prostate cancer with intensity-modulated radiation therapy (IMRT) and proton therapy reveals thats IMRT was linked to fewer gastrointestinal side effects, receipt of additional cancer treatments and hip fractures but to more erectile dysfunction, whilst those who received proton therapy reported more gastrointestinal side effects. Results of the study were presented at a JAMA media briefing at the National Press Club by Ronald C. Chen, M.D., M.P.H.

The ADA Network will host an audio conference on Febraruy 19th, 2013, reviewing the accessibility requirements set in 2010 for newly constructed pools and spas. This audio session will be provided through two options, a telephone connection or through a webinar platform. For further assistance, call (877) ADA-1990 or (877) 232-1990  

According to a study published in the journal Neurosurgery, using a new device called mechanical tissue resuscitation (MTR) to prevent cell death has been demonstrated to reduce the size and extent of damaged tissue caused by traumatic brain injury. The finding was made by researchers at Wake Forest Baptist Medical Center. The study was funded by a $1.5 million grant from the Department of Defense. Tested in rodents, MTR uses negative pressure in order to create an environment that encourages cell survival. Louis C. Argenta, M.D., and Michael Morykwas, Ph.D.

Health technology assessment organizations evaluate medical therapies and technologies to help inform coverage and reimbursement decisions for payers around the globe. Even as they establish strict review processes, these organizations—and the reimbursement authorities that use their assessments—have sometimes handled cancer interventions with special care. We found that some countries have created separate health technology assessment pathways for cancer treatment, while others have eased access to cancer treatments through end-of-life or disease-severity exceptions within health technology assessment policies. In the United States, although no separate evaluation pathways exist for cancer, cancer drugs receive special status by virtue of unique Medicare rules covering off-label indications. Worldwide, we demonstrate that health technology assessment organizations are struggling with cancer’s “exceptionalism.”

An interesting announcement at the American Association of Neurological Surgeons (AANS) meeting in Miami,  17th April, looked at the effectiveness of a vaccine against brain cancer, which showed promising results. The multicenter phase 2 clinical trial included more than 40 patients at UCSF’s Helen Diller Family Comprehensive Cancer Center, at the Seidman Cancer Center, University Hospitals Case Medical Center in Cleveland and the New York-Presbyterian Hospital/Columbia University Medical Center in New York City.