Public Charge and the Expressive Effects of Immigration Law

In early October, the Department of Homeland Security published a proposed redefinition of the Immigrant and Nationality Act’s “public charge” provision, stirring serious concern among health-care and immigrant advocacy groups.

The “public charge” provision of the INA currently allows immigration officers to deny green cards to legal immigrants who are likely to become “primarily dependent on the government for subsistence.”

DHS’s proposed rule would widen the scope of “public charge” to include any legal immigrant who uses cash or non-cash government benefits. In expanding the scope of the public charge inadmissibility determinations, DHS would empower immigration officers to consider immigrants’ current or prior use of programs like Medicaid and SNAP in evaluating applications. Read More

A row of colored medical records folders

The Troubling Prevalence of Medical Record Errors

With plenty of potential healthcare concerns and complications arising out of medical diagnoses and treatments themselves, errors in medical records present an unfortunate additional opportunity for improper treatment.

A recent article from Kaiser Health News (KHN) discussed several examples of dangerous medical record errors: a hospital pathology report identifying cancer that failed to reach the patient’s neurosurgeon, a patient whose record incorrectly identified her as having an under-active rather than overactive thyroid, potentially subjecting her to harmful medicine, and a patient who discovered pages someone else’s medical records tucked into in her father’s records. In addition to incorrect information, omitting information on medications, allergies, and lab results from a patient’s records can be quite dangerous.

The goal of “one patient, one record” provides a way to “bring patient records and data into one centralized location that all clinicians will be able to access as authorized.” This enables providers to better understand the full picture of a patient’s medical condition. It also minimizes the number of questions, and chances of making errors, that a patient must answer regarding their medical conditions and history when they visit a provider.

Other benefits, such as cost and care coordination, also add to the appeal of centralized records.

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Some takeaways from Montana’s Medicaid expansion ballot initiative

As Nicholas Terry wrote in his recent blog post, the 2018 midterm elections produced some big wins for Medicaid. Voters in Idaho, Nebraska and Utah decided to expand Medicaid coverage under the ACA. These states followed the lead of Maine, where Medicaid was expanded by ballot initiative in November of 2017.

One exception to this trend is Montana. On November 6, Montanans rejected I-185, a ballot initiative proposing to fund the state’s Medicaid expansion through a tobacco tax. The ballot initiative would have removed a sunset provision that automatically terminates funding for the expansion in 2019. The outcome of the initiative has not necessarily killed Montana’s expanded program. The Republican legislature may still act to appropriate funding for the program, and—given that the expansion was originally passed with bipartisan support in the state legislature—this route to securing financing is not foreclosed. In August, the oversight committee in charge of the expansion bill recommended that the state fund the program regardless of the outcome of the ballot initiative.

However, even if the future of the Montana expansion remains unclear, there are still some important immediate takeaways from the result of I-185. Read More

Man pictured from the back, sitting on a roof, looking at a full moon.

Towards Human Bioprogress

Bioethical debates are often something of a dialogue of the deaf. A fundamental reason for this is that so much of bioethical theorizing is just rationalizing intuitions. But part of this problem is that we’re talking about different things. For a long time, bioconservatives have laid claim to a deeper understanding of what life is really about. These new technologies might look exciting to you, they say, but if we adopted them, we would lose the things about our lives that make them valuable, that make them human. Bioprogressives basically ignore these claims. They respond with statistics about how helpful technology X will be. They assume without explaining that life is about something else.

The bioconservatives are right that these questions matter, and it has been a mistake for bioprogressives to neglect them. It’s a mistake because if the bioconservatives are right about the meaning of life then they are right about the policy issues. Engaging on this question at least takes their argument seriously. Perhaps more importantly, it’s a mistake because the bioconservative theory of the meaning of human life is so obviously wrong. Read More

A doctor in Mtimbwani, Tanzania helps a woman and child.

Two Reasons Why Wealthy Nations Ought to Address Medical Brain Drain

African governments spend millions of dollars every year training physicians who will leave their home countries to live and work in wealthier nations. The result is that for countries like Ethiopia, Kenya, and Sierra Leone, more of their native physicians are now in the United States and Europe than at home. This massive movement of physician has likely contributed to health crises in many African nations, where citizens die of easily curable diseases each year.

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Literally Sick (and Tired) of Daylight Saving Time

Healthcare was at the top of many voters’ minds in last week’s election, with a range of health-related issues appearing on ballots across the country. Among other health-related measures, three states voted to expand Medicaid, Massachusetts rejected a ballot measure that would limit nurse-to-patient ratios, and Nevada exempted menstrual products from the state sales tax. But a California measure regarding daylight saving—less clearly health-related on its face—could also have some important implications for health.

Proposition 7 asked California voters whether they supported allowing the State Legislature to establish permanent, year-round daylight saving time (DST). It received about 60 percent of the votes. Following the vote, in order for California to actually end the tradition of turning clocks back in the fall and forward in the spring, the State Legislature would first have to approve this decision by a two-thirds majority. It would then need to be approved by Congress.

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Prosecuting Healthcare Fraud: The Need for Statutory Guidance on Costs and Benefits

The Trump Administration launched the largest healthcare fraud takedown in history in June, charging over 600 individuals responsible for over $2 billion in fraud losses. This takedown, along with the previous summer’s (which had previously been the largest when it happened) has allayed concerns that the Justice Department would ease off healthcare fraud prosecutions as a form of white-collar, rather than violent, crime.

Indeed, former Attorney General Sessions committed to aggressive prosecution of healthcare fraud as part of the Administration’s response to the opioid epidemic. One change does seem clear, however: the Administration is prioritizing the prosecution of individuals, and scaling back on the prosecution of corporations. Read More

a stethoscope tied around a dollar bill, with a bottle of pills nearby

Drug Pricing Controls and the Power of Familiar Ideas

Eight in ten Americans think that prescription drug prices are unreasonable, according to a March 2018 Kaiser poll. That same poll found that more Americans considered passing legislation to lower drug pricing to be a top priority than passing legislation to improve infrastructure or to address the prescription painkiller epidemic, among other things.

Effectively addressing drug pricing is a complex task that will require the diligent efforts of many actors. On October 24, the Petrie-Flom Center held a full day’s programming to this important and timely topic. What I want to state here is a simple point—namely, that the very discussion of potential solutions can play a role in turning creative innovations into implementable solutions.

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The leaked HHS memorandum and transgender health rights

At the end of last month, the New York Times reported on a leaked internal memorandum from Health and Human Services proposing to narrowly define “sex” as “biological sex,” a move made with the purpose of excluding transgender people from a variety of civil rights protections.

The memorandum stirred concerns about the future of Section 1557 of the Affordable Care Act, which provides for an anti-discrimination cause of action in health care settings and has been the basis of a number of private lawsuits by transgender patients. The HHS memorandum reinforces that the Trump administration plans to reinterpret Section 1557 to stem this litigation.

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Congress’s opioids package and the politics of the IMD exclusion

At the end of September, the Senate passed a final version of an expansive legislative package designed to tackle the United States opioid epidemic. The package contains a broad range of policy approaches to the crisis, including enhanced tracking of fentanyl in the U.S. mail system, improved access to Medication Assisted Treatment and addiction specialists, and lifted restrictions on telemedicine and inpatient addiction treatment. The package, which now sits on President Trump’s desk, is widely expected to be signed into law.

The legislative effort has been lauded as a rare act of bipartisanship in an otherwise-polarized Washington.

The Washington Post called the set of bills “one of the only major pieces of legislation Congress is expected to pass this year.” A Time headline declared that “Opioid Bill Shows Congress Can Still Work Together.” Praise of this across-the-aisle effort is merited: the Senate voted for the set of bills 98-1, and the House voted for it 393-8.

While critics have rightfully pointed out that the package does not provide for enough increased spending to address the crisis, with more than 72,000 people dying from drug overdoses in 2017, the time is ripe for a collaborative approach to the opioid crisis, and any effort helps.

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