Alison K. Hoffman discusses state voting initiatives, federal law, and the role of private equity in America's health care system.
in the discussion with regulatory review; Alison K. Hoffman, associate dean and professor of law at the Carey School of Law at the University of Pennsylvania, shares her thoughts on the complexities surrounding access to health care, state and federal policy dynamics, and private sector involvement in health care delivery. Masu.
Mr. Hoffman emphasizes the importance of federal intervention to improve access to care by increasing funding for long-term care services provided in nursing homes and homes. She also highlights the limitations of state ballot initiatives in addressing systemic health issues, especially in the wake of the COVID-19 pandemic.
Additionally, Hoffman noted the disparity between states that have expanded Medicaid to low-income people under the Affordable Care Act and those that have not, and noted that policy decisions have limited access to health care services for vulnerable populations. It sheds light on the impact on She discusses the Medicaid gap in so-called non-expansion states, draws out the implications of allowing Medicaid disenrollment, and provides a critical perspective on private equity firms in health care.
Hoffman's research and publications focus on the legal and policy context of healthcare, health insurance regulation, and policy formation. Hoffman's work has been published in respected law reviews and peer-reviewed medical and health policy journals, and she provides commentary on health law and policy issues in the following media outlets: the hill, new york times, philadelphia inquirerand washington post.
Prior to joining the faculty at the University of Pennsylvania Carey School of Law, Mr. Hoffman taught at UCLA School of Law and was a Petrie Fromm Fellow at Harvard Law School. She gained private practice experience in medical law at Ropes and Gray LLP. She then worked as a strategy consultant at Bridgespan Group and Boston Consulting Group.
Review of regulations We are pleased to share the following interview with Alison Hoffman.
Regulatory review: recently article in Review of regulations, you and your coauthors discussed the limitations of state ballot initiatives to improve access to care in the absence of federal action. What do you think is the most important federal action that could improve access to care nationwide?
The most important action is something not mentioned in that article: creating adequate funding for long-term care that can be used flexibly. This funding should enable care by professional caregivers and family members, as well as care in nursing homes and homes. The lack of a consistent, well-funded public insurance program for long-term care creates an immense obligation for families and friends. Nearly a decade ago, I wrote about the need for policy solutions to long-term care needs that adequately considered the risks faced by informal caregivers. Since coming to Pennsylvania seven years ago, I have worked with my colleagues here to address challenges such as the horrific toll on nursing homes during the COVID-19 pandemic, where our collective commitment to long-term care funding is failing. We have called attention to the consequences of being enough.
TRR: as you I got it. in your recent essay review, All but 10 states in the United States have adopted Medicaid expansion under the Affordable Care Act (ACA). How would you characterize access to health services, and how does it impact health in holdout and expansion states, especially for vulnerable populations?
In our essay, we point out that voters in seven states used referendums to expand Medicaid, despite inaction by Congress and governors to make the program available to all low-income residents. doing. However, referendums are not possible in most of the remaining non-expansion states. The tragedy of these states is that millions of their poorest residents remain without adequate health care. These states, which are mostly in the South and also include Texas and Florida, have created Medicaid disparities that leave people with incomes below the federal poverty level unable to buy health insurance; Federal subsidies are available to people with incomes above the federal poverty level to purchase insurance. On ACA's Marketplace.
Exacerbating this problem is the current Medicaid “rollback.” During the coronavirus pandemic, and until March of this year, states were not allowed to remove people from Medicaid. In return, they received increased funding for the program from the federal government. The ban was lifted in March, and millions of people now lose Medicaid coverage. Living in an unexpanded state, some people find that they have no other options.
The larger issue that both de-expansion and retrenchment highlight is the inequity that arises when health care coverage for the poorest people is left to the discretion of states.
TRR: Acquisitions and consolidation of healthcare systems and provider groups by private equity firms; sparks scattered Quite a controversy. Chairman of the Federal Trade Commission; Lina Khanrecently raised concerns about this trend as part of an intergovernmental exchange. inquiry Enter private control over health care. Do you think private sector actors, such as private equity firms, are adding value to healthcare?
I am skeptical that patients will benefit from the entry of private equity into healthcare, but this phenomenon has greatly accelerated in recent years. Private equity investments are not the first form of corporate investment in healthcare delivery. It started decades ago with the rise of for-profit hospitals and the growing role of private insurance companies. I am currently writing about this trend in a chapter of my upcoming book, and how it has been shaped by medical professionals and, in turn, the profession and the care we all receive. is shown. There is growing evidence that private investment in health care benefits industry without providing sufficient benefits to patients. For example, recent studies show that hospitals make more mistakes and nursing homes have more deaths after private equity acquisitions.
Ironically, through the growth of value-based payment reform models over the past decade, governments have created incentives for enterprising private investors who can understand these complex models and maximize payments based on them. I've accelerated it. In effect, the Department of Health and Human Services has created the conditions that will accelerate this trend, and now, along with other agency partners, must address the consequences.
Sunday Spotlight is a regular feature. Review of regulations We regularly share conversations with leaders and thinkers in the regulatory field, and in doing so, highlight important regulatory topics and ideas.
