Affordable Care Act (ACA) implementation was associated with 2 million fewer adults with catastrophic expenditures each year, researchers write in JAMA Open Network. Catastrophic medical expenditures are defined as those that force people to spend more than 40% of their income on health costs (out-of-pocket plus premium) after accounting for subsistence items (e.g., food and housing). Nevertheless, each year, 11 million U.S. adults, including 6 million with private insurance, experience catastrophic health expenditures. The numbers are likely to grow during the pandemic, according to the researchers. “Health reform should move beyond expanding insurance coverage alone to address persistently high out-of-pocket spending among the insured.”

Amid raging debate over the cost of insulin, a new report finds prices in the U.S. were often five to 10 times higher two years ago than in all the other countries in the Organization for Economic Cooperation and Development (OECD), an intergovernmental group that was created to stimulate economic progress and world trade. In 2018, the average U.S. price per standard unit across all types of insulin was $98.70, compared with $6.94 in Australia, $12.00 in Canada, $7.52 in the U.K. and $8.81 across all other OECD countries combined, according to the report by the RAND Corp., which conducted the analysis on behalf of the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation.

Principal Authors: Keith Mueller, PhD; Hannah Rochford, MA

Prepared by the RUPRI Health Panel: Andrew F. Coburn, PhD; Alana Knudson, PhD; Jennifer P. Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; Timothy D. McBride, PhD

Throughout the unprecedented challenges associated with the COVID-19 pandemic, telehealth has been a pillar of federal response policies aiming to position healthcare and public health entities to continue providing necessary services. While the core aims of rural health systems remain unchanged amidst COVID-19 circumstances, unfortunately, so too do many of the challenges they face in reaching these aims. This paper’s discussion summarizes the elements recognized as necessary for effective use of telehealth, identifies the challenges the federal policy response has addressed well, points to where opportunities for continued progress remain and speculates as to what barriers to progress may exist for actors in rural healthcare and public health. Recommendations for the expansion of telehealth made prior to the pandemic by the Bipartisan Policy Center (BPC) offer structure to this discussion.

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Medicare Advantage Enrollment Update 2019

Abdinasir K. Ali, MPH; Fred Ullrich, BA; and Keith Mueller, PhD

 The 2019 edition of the RUPRI Center’s annual report on Medicare Advantage (MA) enrollment shows that as of March 2019, 35.0 percent of eligible Medicare beneficiaries were in an MA plan. The proportion of metropolitan enrollment (37.0 percent) is higher than that in nonmetropolitan counties (25.6 percent) but the rate of growth in enrollment has been higher in nonmetropolitan counties for the past two years.

Although well over half of metropolitan MA enrollment has been in HMO plans over the past 10 years (65.0 percent in 2019), since 2012 the plurality of nonmetropolitan MA enrollment has been in local PPO plans. However, nonmetropolitan enrollment in both HMO plans and local PPOs has grown consistently since 2009 (2019 enrollment: 32.7 percent and 45.2 percent, respectively). Growth in these two plan types has come largely at the expense of nonmetropolitan PFFS plans which accounted for 54.5 percent of nonmetropolitan MA enrollment in 2009, but only 2.0 percent by 2019.

Please click here to read the brief.

The U.S. Bureau of Labor Statistics reports that there were 574 private sector agricultural workers fatally injured on the job in 2018, and charts other workplace-related injuries, illness, and fatalities. Read more here.

This study from the North Carolina Rural Health Research and Policy Analysis Center addresses three types of specialty hospitals: long-term acute care hospitals, inpatient psychiatric facilities, and inpatient rehabilitation facilities. The research compares urban and rural specialty hospitals by percent of inpatient days for rural residents and for Medicare beneficiaries, among other factors, and also looks at operating expenses, Medicaid days, and profitability.

The Robert Wood Johnson Foundation’s (RWJF) State Health Access Data Assistance Center (SHADAC) reports on the trend of increasing suicide rates in the United States.  Data details compare rates by age, race, gender, and urbanization from the years 2000 to 2018;  a companion brief includes state-level trends.

A new data brief from the Centers for Disease Control and Prevention (CDC) reports that, among adults aged 25 and older, deaths caused by alcohol were stable from 2000 to 2006, but then increased 43 percent between 2006 and 2018. During that same time, death rates increased for men and women at all levels of urbanization. For women in rural areas, the death rate was among the lowest in 2000; by 2018, rates for women in noncore areas had more than doubled.