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J Health Polit Policy Law ; 46(4): 535-547, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1334768


Given the close division of power in Washington, DC, how might health reformers pursue their bolder aims? In particular, how might they pursue the robust public option that was a centerpiece of Joe Biden's health plan during the campaign? This new iteration of the public option-far more ambitious than anything seriously considered during the debate over the ACA-is not in the cards right now. But instead of giving up on it, advocates should recast it in an inspiring vision that can structure immediate initiatives designed to make its achievement more feasible. This strategy, which might be called "building power through policy," would involve using the openings for policy change that are likely to exist in the near term to reshape the political landscape for the long term. Three interim steps in particular could advance the public option's prospects: (1) pursuing immediate improvements in the ACA that are tangible and traceable yet do not work against the eventual creation of a public option, (2) building the necessary foundations for a public option within Medicare while encouraging progressive states to experiment with state public plan models, and (3) seeding and strengthening movements to press for more fundamental reform.

Health Care Reform , Health Policy , Insurance Coverage/standards , Insurance, Health/standards , Politics , Consumer Advocacy , Medicare , United States
Am J Manag Care ; 27(4): e101-e104, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1194879


In public health insurance programs, federal and state regulators use network adequacy standards to ensure that health plans provide enrollees with adequate access to care. These standards are based on provider availability, anticipated enrollment, and patterns of care delivery. We anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. Regulators will need to ensure that plans adjust their network size should there be increased enrollment or increased utilization caused by forgone care. Regulators will also require updated monitoring data and plan network data that reflect postpandemic provider availability. Telehealth will have a larger role in care delivery than in the prepandemic period, and regulators will need to adapt network standards to accommodate in-person and virtual care delivery.

COVID-19 , Health Planning , Health Services Accessibility/standards , Insurance Coverage/standards , Insurance, Health/standards , Public Sector , Health Insurance Exchanges , Humans , Insurance Coverage/legislation & jurisprudence , Insurance Coverage/organization & administration , Insurance, Health/legislation & jurisprudence , Insurance, Health/organization & administration , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , United States
Psychiatr Serv ; 72(1): 100-103, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1059742


Because of the COVID-19 pandemic, many mental health care services have been shifted from face-to-face to virtual interactions. Several health policy changes have influenced telehealth uptake during this time, including changes in technology, Internet connectivity, prescriptions, and reimbursement for services. These changes have been implemented for the duration of the pandemic, and it is unclear if all, some, or none of these new or amended policies will be retained after the pandemic has ended. Accordingly, in the wake of changing policies, mental health care providers will need to make decisions about the future of their telehealth programs. This article briefly reviews telehealth policy changes due to the COVID-19 pandemic and highlights what providers should consider for future delivery and implementation of their telehealth programs.

COVID-19 , Drug Prescriptions , Insurance, Health , Mental Health Services , Telemedicine , Continuity of Patient Care , Drug Prescriptions/standards , Humans , Insurance, Health/legislation & jurisprudence , Insurance, Health/organization & administration , Insurance, Health/standards , Insurance, Health, Reimbursement/legislation & jurisprudence , Insurance, Health, Reimbursement/standards , Mental Health Services/legislation & jurisprudence , Mental Health Services/organization & administration , Mental Health Services/standards , Telemedicine/legislation & jurisprudence , Telemedicine/organization & administration , Telemedicine/standards , United States