Now that the Patient Protection and Affordable Care Act is law, what’s happening behind the scenes (as well as in public) to implement it? This briefing, cosponsored by the Alliance and the Robert Wood Johnson Foundation, provided an overview of federal policymaking and the efforts by stakeholders and others to affect final policies pertaining to the health reform law.
For reporters covering health reform, the subject can now seem more complicated than ever. Implementation timelines go on for page after page. Many questions appear to have no answers, at least not yet.
Young adults have some of the highest uninsurance rates in America. In 2008, three in 10 uninsured Americans– almost 14 million people – were between 19 and 29 years of age. As the health reform legislation was developed, it became evident that covering the uninsured in this age group would be a major component of the effort to improve quality and lower costs in our health care system.
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain a number of changes in the way health care is paid for, particularly in public programs. Delivery system changes intended to improve quality and contain costs will, at the same time, impact the revenues of health care providers.
As part of an ongoing series to explore what is in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, this briefing dealt exclusively with how the reform law affects Medicare. As this legislation was developed, proposed changes to Medicare were among the most hotly debated issues. The briefing illuminated what is really in the law and what its provisions will mean for administrators, beneficiaries and the health care sector in the U.S. Cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation.
As part of an ongoing series to explore the provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, this briefing dealt with how the new health reform law affects access to private coverage. A range of specific provisions were covered, including the new federal high-risk pools, tax credits for small businesses, health insurance exchanges, the individual mandate, and employer obligations. The law’s provisions governing private health insurance mark a dramatic change from past practice, and much attention has been paid by opposing sides to the potential implementation and legal issues.
This briefing is part of our ongoing series to explore the provisions of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). A panel of well-qualified experts explained how the two health reform laws affect Medicaid, and to answered a variety of questions about topics such as Medicaid eligibility, financing, and other implementation issues. The Kaiser Family Foundation cosponsored.
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 are now law. Whether you favored or opposed their enactment, a full understanding of the new laws is essential to further discussion of reform issues, including how implementation will be approached.
Ten years ago, a landmark study on patient safety, “To Err is Human,” was released by the Institute of Medicine. Patient safety has come a long way since then. Or has it? Since 1999, we’ve seen innovations in health information technology that have the potential to greatly enhance patient safety. There is growing evidence about the role of human factors, and the impact of seamless team work, checklists and safety bundles on safety.
Engaging consumers more directly in their care may improve health outcomes and help control the costs of care. This program will focus on the potential for changing consumer behavior to promote the use of effective interventions and discourage unnecessary care.
Medicaid programs are feeling the strain as enrollment grows while state revenues come in lower than projected. This briefing, cosponsored by the Kaiser Commission on Medicaid and the Uninsured, looked at the recession’s effect on Medicaid programs and low-income individuals and families.
Health insurance exchanges can potentially serve a variety of policy ends, from promoting transparency and competition among health plans, to pooling or reallocating risk and administering subsidies for those unable to afford health insurance premiums. Exchanges can also play a role in health insurance oversight. Many of these functions are being carried out by the Massachusetts Connector, the exchange set up by that state’s reform law. Both House and Senate reform bills include an exchange, but the proposals differ in several important aspects. This briefing, cosponsored by the Alliance and The Commonwealth Fund, considered those differences.
Unhealthy behavior is costing America billions in health care expenditures, and making us less healthy as a people. Many large employers, recognizing the impact on the health of their workers and the companies’ bottom lines, offer financial incentives to their employees to exercise regularly, improve their diets, lose weight and quit smoking, among other things. Many employers cite substantial savings from these programs in their health coverage costs.
Getting the Most Bang for Our Post-Health Reform Buck: Enrolling and Retaining Everyone Who’s Eligible
One of the main goals of health reform is to increase access to health care. Frequently overlooked in this effort is finding effective and efficient mechanisms for determining eligibility and enrolling those who are eligible for existing public programs, primarily Medicaid and the the Children’s Health Insurance Program (CHIP).
The health reform proposals being considered in both houses may impose responsibilities on both individuals and employers to have, and help pay for, coverage. Subsidies for some small businesses and for individuals with incomes up to 400 percent of the federal poverty level have been proposed. But will individuals and businesses be able to pay the amounts required of them above the subsidies? If those costs are onerous, Congress may exempt many people from the coverage requirement or significantly reduce the penalties for noncompliance.
Medicaid and the Children’s Health Insurance Program (CHIP) play a crucial role in the U.S. health insurance system by providing coverage for more than one in four children. The number of children in CHIP is at an all-time high, having grown 15 percent over the past year alone. About half of Medicaid’s enrollees are children. And yet, more than 8 million children remain uninsured today, 70 percent of whom are eligible for Medicaid or CHIP.
The experience of other countries may help inform the debate as U. S. policymakers grapple with health reform and the regulatory mechanisms needed to contain costs while improving quality, efficiency and coverage.
Health care delivery poses unique challenges in rural communities. Provider shortages are particularly acute in rural America, where levels of educational achievement are generally lower and there are fewer opportunities to receive medical training. Unemployment and uninsurance rates are higher in rural areas than elsewhere. Join us for a discussion about how some aspects of pending reform proposals — coverage expansions, subsidies, delivery system improvements and health information technology including telemedicine — may have a substantial impact on rural health care.
Public support for health reform waxes and wanes depending, not only on what’s being proposed in the reform proposals, but also on who asks the question and how it is asked. Some recent polls indicate a majority of Americans support health care reform now; is that still the case? Do people want to pay for covering the uninsured – and if so, how much? What do seniors think about paying for health reform partly through changes to Medicare? Some polls indicate that most people like their physician but not the system. What if health reform means changing the system Americans now enjoy?
Where You Live Matters: Results from The Commonwealth Fund Commission on a High Performance Health System’s 2009 State Scorecard
The cost and quality of health care, as well as access to care and health outcomes, continue to vary widely among states according to the Commonwealth Fund Commission on a High Performance Health System’s second state scorecard. The report, Aiming Higher: Results from the 2009 State Scorecard on Health System Performance, is a follow-up to the Commission’s 2007 State Scorecard report; ranking states on 38 indicators in the areas of access, prevention/treatment quality, avoidable hospital use and costs, healthy lives, and equity.
As Congress hashes out proposals to expand coverage to tens of millions of uninsured Americans, the latest count of the number of uninsured is a significant factor. Though some believe economic recovery is underway, Americans are still losing jobs by the hundreds of thousands each month. With the loss of jobs, so goes health insurance. How does this reality affect health reform and the notion of building on the current system? Has the complexion of who is uninsured changed? What has been the role of public programs in the recession?
Before the Congressional summer recess began, four committees approved major reform bills; negotiations continue among some members of another. Now Congress returns having heard an earful from constituents about health care. We are clearly at a crucial stage in our consideration of how, and to what extent, we should reshape our health care system. What is the status of major reform bills?
Health care access, particularly access to primary care, is on the minds of all who are following health reform efforts in Congress. President Obama has said that expanding access to health care to more Americans is one of the main goals of reform. Democrats and Republicans from both houses agree that any reform plan must increase access. But how can that goal be accomplished, particularly in a time when reducing health care costs and increasing quality are also priorities?
As the key congressional committees draft health reform legislation, they are keenly mindful of the costs of various provisions. Congress will look to an array of options, including both savings from the health care system and new revenues, to finance coverage expansions and reforms to both the delivery system and insurance markets. What options hold the most promise? How do the Congressional Budget Office (CBO) and the Office of Management and Budget (OMB) go about “scoring” various financing options? Are there credible options for financing reform? Is there room for bipartisan cooperation in paying for reform? This July 31 briefing, cosponsored by The Commonwealth Fund, addressed these and related questions.
The health reform debate has heated up, featuring proposals from both the House and Senate. However, little of the discussion has focused on the area of mental health and substance use disorders. More than 33 million Americans are treated annually for mental health and substance use disorders. Mental illness and substance use disorders can have a profound impact on a person’s overall health and well-being. The passage of the Wellstone-Domenici Mental Health Parity and Addiction Equity Act in 2008 indicated that access to mental health and substance use disorder services is a priority. Yet there are concerns that the cost of accessing this care could rise as mental health parity regulations are implemented concurrent with the possibility that health reform legislation might include expansion of access to mental health services.
As the health reform debate heats up in summertime Washington, discussions center around how to make our current system more efficient, provide better value for the dollars spent, and extend coverage to those without it. The Senate Finance Committee options papers and the House tri-committee report devote whole sections to proposals to reduce health care costs. These proposals consider ways to find savings from working more efficiently, and slowing the growth curve — savings that could help pay the substantial cost of comprehensive health reform.
For reporters who normally cover topics other than health reform, today’s reform debates can mean playing catch-up. They may be facing a new vocabulary – public plan option, health insurance cooperative, employer mandate, individual mandate. Maybe they’re trying to figure out what all this means for readers, viewers or listeners.
Consumer Choice in Health Care: How Could Reform Affect Our Choices? How Could We Make Better Choices?
The idea of choice has long been a hallmark of the American health care system. We pride ourselves in believing that we – not government bureaucrats – choose our doctors, hospitals and health plans.
To improve the health of communities and the general population, an array of health reformers, states and businesses alike are all looking to a range of prevention measures such as chronic disease management, alcohol and smoking cessation, and obesity programs. The hope is that these measures will also improve value and control costs.
Where we live, learn, work and play can have an enormous influence on our health and well being. Yet millions of working men and women and their families face almost insurmountable barriers to better health on a daily basis. Many of these hurdles can’t be cleared simply by choosing a healthy path. For example, many inner city and rural families have virtually no access to healthful foods. Many neighborhoods are unsafe for walking, let alone exercise. Children who do not receive high-quality services and education run a higher risk of becoming less healthy adults.
Various proposals to expand coverage to uninsured Americans and reform the health insurance market include the establishment of a health insurance exchange. The most widely discussed example of such an exchange is in Massachusetts, and it arrived recently with Massachusetts’ 2007 health reform efforts. Many are looking to the Connector, as the Massachusetts program is known, to inform their discussions of a national insurance exchange. But is that the only model?
One of the various proposals to expand coverage to the more than 45 million uninsured Americans is referred to as the “public plan option.” Though proposed only as part of a broader effort to expand coverage, the option is viewed in varying lights. Some see it as a tool for providing consumers affordable coverage by stimulating competition on the basis of quality and efficiency. Others see it as unfair competition for private insurers and, in the extreme, as a path to a single-payer system.
The Alliance for Health Reform and the Kaiser Family Foundation sponsored a luncheon briefing on the basics of the Medicare Advantage program.
Reforming the American health care system is a front-burner topic for many policymakers. One main reason is the desire to extend coverage to some if not all of the more than 45 million uninsured in this country. But there is an emerging consensus that reform must also encompass ways to improve quality and value in the system, and one of the prime targets for reform is the way care is delivered. Advocates, analysts, policymakers, consumers and the business and labor communities are all looking for ways to get more value for their health care dollar – delivering better care at lower cost.
Provider payment policy is a hot topic again with the Medicare physician payment system due for a fix and value-based payment and other cost containment/quality schemes on the table as part of the health reform debate. This briefing sponsored by the Alliance and The Commonwealth Fund examined cost containment options in payment reform.
Medicare covers nearly 45 million beneficiaries, including 38 million seniors and 7 million younger adults with permanent disabilities. The program is expected to cost the federal government approximately $477 billion in 2009, accounting for 13 percent of federal spending and 19 percent of total national health expenditures.
Almost every day, we learn of a new hearing or briefing about ways to improve our health care system. The White House, Congress, advocates and stakeholders are fully engaged. The elephant in the room during those discussions is long-term care. Despite being so large, it suffers from the possibility of being ignored. This March 9 forum, supported by the SCAN Foundation, brought together opinion leaders and stakeholders to explore options for the future of long-term care in the reform debate. Participants considered key policy questions on how to move from testing models at the edges to implementing feasible options through health reform.
Forty-five million Americans were uninsured in 2007. They may have worked for an employer that didn’t offer coverage, or were eligible for coverage on the job but could not pay their share of the premiums. Perhaps they were denied coverage in the individual market. Whatever the reason for not having coverage, their lack of insurance limited their access to care, contributed to poorer health outcomes, and may have led to personal bankruptcy.
Community health centers (CHCs) play a key role in the U.S. health care safety net. They provide primary health care and other health services for medically underserved populations, including 1 in 8 Medicaid beneficiaries, 1 in 7 uninsured persons, 1 in 3 people in poverty, 1 in 10 minorities, and 1 in 9 rural Americans.
As a state-run program with broad federal guidelines, Medicaid covers health and long-term care services for scores of millions of low-income Americans. Conversations are well underway about the role of Medicaid as a vehicle for economic stimulus, and about its role in health coverage expansion proposals. In that context, a grounding in current Medicaid basics will be essential to congressional health staff, reporters covering health issues and others concerned about health coverage.
Medicaid and the State Children’s Health Insurance Program (SCHIP) play a crucial role in the U.S. health insurance system by providing coverage for more than one in four children. During 2005, about 29 million children were enrolled in Medicaid at some point in the year and more than 6 million were covered through SCHIP. Though more than 65 percent of children in the U.S. are covered by private insurance (most through their parents’ employers), Medicaid and SCHIP have helped to increase health care coverage for millions of children.
Because of the way Medicaid is financed, a recession means double trouble. States have reduced revenue, and thus less money to spend on Medicaid, just as more people are losing their jobs and their health coverage, and need the program. States have little choice but to cut Medicaid spending. Unlike the federal government, they are required by their constitutions to balance their budgets annually, and Medicaid is one of the largest budget components.
Now that we know the next occupants of the White House and the composition of the next Congress, many Americans expect to see an effort to enact significant reform of America’s health system. Congress isn’t waiting for the White House green light. Sens. Ron Wyden and Bob Bennett, as well as Sen. Max Baucus have already released health reform plans. Sen. Edward Kennedy is poised to do so.
The United States tax system subsidizes the purchase of employer-sponsored health insurance for more than 160 million non-elderly people at a “cost” of approximately $200 billion a year. This tax subsidy is a major reason why most Americans have health insurance coverage through either their own employer or that of a family member. In recent months, the tax treatment of health insurance has gained a lot of attention – both during the presidential campaign and in health reform debates in Congress.
The pre-election debate put health care reform ideas front and center. Now policymakers have to deal with translating theory into action under challenging economic conditions. Why completely reinvent the wheel when there are existing universal coverage systems that may have components the U.S. can learn from? This briefing, cosponsored by The Commonwealth Fund, provided an in-depth look at the very different approaches of Switzerland, Germany and Holland to providing near-universal coverage to their citizens.
The upcoming presidential election and the domestic economic scene have captured the top-of-mind attention of both voters and the media. But not far below the top is a profound concern about health care. Will I lose my job and with it my health insurance? Can I afford the ever-increasing costs of rising premiums, higher deductibles and copays? Which candidate’s health plan will best alleviate my concerns?
We expect that the coming debate on health reform will involve proposals to reshape the role private insurance plays in our health care system. But to evaluate proposals for change, one must first understand how private insurance works currently.
It is widely accepted that the U.S. health care system, although touted by some as the “best system in the world,” has room for improvement. Many people have no regular health care provider. Care is often fragmented and lacks coordination, which compromises quality and efficiency. Incentives for providers have not caught up with the demographics of chronic care. Some 75 percent of Medicare spending is on beneficiaries with five or more chronic conditions – and those people see an average of 14 different physicians a year.
If you think that all poor Americans can get health coverage through Medicaid, think again. Except in a few states with federal waivers, adults must not only meet income and asset requirements, but must fit into a category of persons for which coverage is available.
By 2050, the U.S. Latino population, already the nation’s largest minority group, will triple in size and will account for most of the population growth in the U.S. over the next four decades. Hispanics will make up almost three out of every 10 people in the U.S. by 2050. This growth will have important implications for health care in the U.S., and for national health reform.
This toolkit, supported by the Robert Wood Johnson Foundation, will help you understand trends in U.S. health spending, and some of the reasons why spending is going up. We also cover some ideas for restraining health care costs. In addition, this resource offers story ideas, selected experts with contact information, selected websites, and a glossary.
The recent deaths of two children due to preventable dental conditions focused attention on the importance of improving access to dental coverage for low-income Americans. With SCHIP reauthorization on the horizon and the chance that elements of last year’s vetoed SCHIP proposal—which included provisions for dental care—may be revived, oral health issues are front and center.
The U.S. health care system is often touted as a model for the rest of the world. We are clearly a leader in costs, but how well are we performing in return for our high investment? How do we do compare to benchmarks of achievable performance? And is performance getting better?
With the health reform discussion in full swing, improving value for the money we spend on health care is an essential part of the debate. Nurses can play a prominent role in improving quality. A growing body of research points to the positive impact of nurses on coordinating care, reducing hospital readmissions and improving clinical outcomes – all with a potential to reduce costs.
Health information technology (IT) wins many honorable mentions. It is viewed by respected analysts and presidential candidates in both parties as a tool with the potential to save lives, improve efficiency and increase the overall quality of our health care delivery system.
A new proposal by The Commonwealth Fund suggests, as a major component of moving toward coverage for all, a Medicare-like program that uninsured adults below the age of 65 could purchase voluntarily. Reform proposals offered by Senators Clinton and Obama as part of their presidential campaigns feature similar options, as do some state reform plans.
Putting the Brakes on Health Care Costs: Would the Candidates’ Plans Work? Are There Better Solutions?
Polls show that health care is the #2 domestic issue facing the next president and Congress. But drilling down, it’s clear that for many consumers, business leaders and government decision-makers, this means: “Reduce my health care costs first, then let’s talk about covering the uninsured.”
Many have proclaimed the Massachusetts health care reform plan a success, noting the greater than expected enrollment rates in the program’s first 18 months. But some observers sound notes of concern.
With a substantial body of evidence showing that racial and ethnic minorities receive poorer quality care than others, state and federal policy makers are looking for ways to reduce disparities. Some states have begun to experiment with strategies for reducing health disparities.
While the United States delivers some of the best medical care in the world, there are major inefficiencies in our system. We have high rates of medical errors, millions without health insurance coverage, and lower utilization of advanced health information technology than most western European nations. Our costs are the highest anywhere, by any measure.
Comparative effectiveness research holds out the tantalizing prospect of making it easier for patients and their doctors to choose the best treatment, thus improving quality. At the same time, it could also justify denying or reducing payment for a host of treatments or procedures that may be clinically ineffective or unworthy of their high price.
An estimated 125 million individuals in the United States have a chronic illness, disability or functional limitation. Chronic diseases are the number one cause of death and disability in the United States and account for three quarters of the nation’s health spending.
Promoting health information technology (IT) has been a common thread in the campaigns of the 2008 presidential candidates’ health reform proposals. It is proposed as a means of achieving efficiency, improving quality and cutting costs in the delivery of health care. In addition, there is bipartisan support in both houses of Congress for expanding health IT. Yet, one bill that would do so remains stalled in the House, another in the Senate.
No matter who wins the White House and control of Congress in November, health reform legislation will likely be a front-burner issue for both House and Senate in 2009. The debates about reform, and the behind-the-scenes meetings, of 1993 and 1994 produced a wealth of knowledge on what should be done differently the next time Congress takes up this issue. What derailed health reform in 1994? What tactical and strategic decisions, in areas such as timing and content, affected the outcome? What part did outside groups play? How should the issue be approached differently the next time around? What are the appropriate roles for congressional and executive branch leadership in getting reform done? This briefing, cosponsored with the Robert Wood Johnson Foundation, addressed these and related questions.
This toolkit, supported by the Robert Wood Johnson Foundation, will help you understand how health information technology (IT) is slowly changing health care, and how analysts disagree about the value of some technologies. We offer an introduction to issues such as protecting patient privacy and the cost of new technologies. This resource also offers story ideas, selected experts with contact information, selected websites of interest and a glossary.
Health Reform Do’s and Don’ts: Veterans of the Early 90s’ Health Reform Debate Offer Advice to Today’s Reformers
Many of today’s reporters are too young to remember the last time Congress vigorously debated health coverage for all – 1993 and 94. For other reporters, that period feels “like yesterday.” Whichever camp a person is in, that debate produced a wealth of knowledge on what should be done differently the next time Congress takes up national health reform, a time that could be coming soon after the next election.
This toolkit, supported by the Robert Wood Johnson Foundation, offers links to resources that will help you understand how children in the U.S. get health coverage, and the importance of employer-sponsored coverage and public programs to children. We offer an overview of the State Children’s Health Insurance Program (SCHIP), with an update on congressional reauthorization of the program. This resource also offers key facts, story ideas for reporters, selected experts with contact information, selected websites, and a glossary.
A Reporter’s Toolkit: Medicaid This toolkit, supported by the Robert Wood Johnson Foundation, will help you understand who the Medicaid program covers, how it is financed, how it differs from Medicare, how states can alter Medicaid through federal waivers, and what the future holds for the program. This resource also offers key facts, brief background, story ideas, selected experts with contact information, selected websites and a glossary.
Close to 24 million Medicare beneficiaries enrolled in Part D coverage for prescription drugs in the first two enrollment cycles. According to the Centers for Medicare and Medicaid Services (CMS), more than 75 percent of beneficiaries are satisfied with the program. However, evidence suggests that seniors who were uncovered in 2005 benefited more than other enrollees in 2006. HHS has announced that more than 90 percent of Medicare beneficiaries in a stand-alone prescription drug plan will have access to at least one plan with a lower premium in 2008; and the third open enrollment period is now upon us – November 15 through December 31, 2007.
This toolkit, supported by the Robert Wood Johnson Foundation, is designed for reporters covering health issues during Campaign 2008, but will be useful for others looking for up-to-date resources on the uninsured. The toolkit features dozens of links to useful websites and articles, including links to websites tracking presidential candidates’ health reform plans. It also includes key facts, background, story ideas, lists of experts and websites, and a glossary.
State Coverage Initiatives: Will Moving Toward Universal Coverage Make the System Work Better for Everyone?
There is mounting evidence that the U.S. system is often financially inefficient and delivers poor quality. There is also research suggesting that having so many people without insurance can adversely affect the quality of care for everyone, even those with insurance. A new report by The Commonwealth Fund sets forth principles for providing universal coverage in ways that could promote a high performance health care system. Several states are already trying to reform their health care systems.
Culture change in the long-term care world involves many players – residents, administrators, workers, lawmakers, policy analysts – sharing a common vision. One such vision attracting attention has been developed by a group of citizens, providers and advocates known as Pioneers who are exploring alternatives to traditional nursing facilities. Their goal: facilities that are resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources.
Employer-sponsored coverage rates have been steadily falling, from 66 percent of non-elderly Americans in 2000 to slightly below 60 percent in 2006. Experts cite rising premium costs and workforce changes as factors driving the erosion in such coverage.
As presidential candidates of both major parties woo the American public, particularly in early caucus and primary states, they are gravitating toward a common public concern: the U.S. health care system. Potential voters are well aware of rising premiums and higher out of pocket costs to families, the impact of high health care costs on America’s economic competitiveness and on federal and state budgets, and the ever-growing number of uninsured – now nearly 45 million. A Kaiser Family Foundation poll released in March shows that health care ranks as the second most important issue that the public would like discussed by presidential candidates for the 2008 election.
The American health system is focused on curing, and spends billions of dollars on treatment at the end of life. But now more than 40 million adult Americans suffer with life-altering, chronic health conditions. They and their families are often more concerned with pain management, comfort care, and coordinating care as they transition from setting to setting. As people live longer with grave chronic illness are they getting quality care? Where in the delivery of care spectrum should palliative care come into play? Sponsored by the Alliance and the Robert Wood Johnson Foundation.
New initiatives are cropping up in one state after another aimed at helping the uninsured. The most comprehensive efforts have been in Massachusetts, Vermont and Maine. California Gov. Arnold Schwarzenegger has attracted national attention for his plan to cover virtually all in that state, and legislative leaders have their own plans. But many other states are also moving toward expanded coverage.
More than two years after hurricane Katrina devastated the Gulf region and destroyed large swaths of New Orleans, local and federal officials are trying to determine the appropriate approach to rebuilding the health care system. Prior to Katrina, Louisiana’s health care infrastructure was a two-tiered system. The middle class relied largely on the private health care system while the poor relied on a state-sponsored hospital network known as the “Charity” system.
There is mounting research highlighting poor quality of care and inefficient spending in our health care system. At the same time, diagnostic and treatment options proliferate at an accelerating pace.
Medicare covers nearly 44 million beneficiaries who are elderly, including 37 million seniors and 7 million younger adults with permanent disabilities, and end stage renal disease. The program cost the federal government approximately $375 billion in 2006, accounting for 13 percent of federal spending. Why is Medicare important for congressional staffers to know about?
Medicaid is a joint state and federal program. It covers nearly 55 million individuals – children, adults with children, elderly and disabled individuals and cost nearly $300 billion in combined state and federal spending in 2006. Whom does Medicaid serve? What benefits does Medicaid cover? How is it financed? What is the nature of the federal and state partnership?
Providing health insurance coverage to the 46 million Americans without it has been receiving more attention in recent months. Several polls have shown rising public interest in the topic. Coverage is fast becoming an issue in the 2008 presidential campaign, for both Democrats and Republicans. President Bush offered an uninsured proposal in his January State of the Union address. Bills dealing with the uninsured have been introduced by members of Congress from both parties. A number of states have also laid out ambitious coverage plans.
Dollar for dollar, providing better health care for children represents one of the best returns on investment available in the U.S. This involves not only better monitoring of quality and making quality improvements, but also enrolling eligible children in health programs such as SCHIP and Medicaid. And it means ensuring that health care systems – including safety net providers and health insurers – are responsive to the unique health needs of children.
By some estimates, almost three-fourths of America’s nine million uninsured children are eligible for either State Children’s Health Insurance Program (SCHIP) or Medicaid. As Congress begins debating the reauthorization of the program in earnest, policymakers are examining what is keeping these children from enrolling.
Authorization for SCHIP expires this September, and, in the coming months, Congress will be debating the program’s extension. Established in 1997 with an authorized 10-year funding level of $40 billion, SCHIP’s accomplishments in providing coverage to an estimated six million children are now widely acknowledged. SCHIP pursues its relatively simple goal – broader coverage for low- and moderate-income children – through a relatively complicated structure. So before key decisions can be made about the program’s future, it is important to have a baseline understanding of what makes the program work.
A growing body of evidence shows disparities in quality of care among Medicare beneficiaries of different racial and ethnic backgrounds. These disparities are particularly noteworthy in Medicare, which provides nearly universal access to care to the elderly without regard to race or ethnicity.
As the nation’s largest payer for health care services, the Medicare program has a major effect on payments to providers. Its ability to align incentives through pay-for-performance will have implications for the health delivery system at large. A recent Institute of Medicine report made recommendations for implementation of “P4P” under Medicare.
Suddenly, Capitol Hill is talking about health issues again. Incoming House Speaker Nancy Pelosi promises that Democrats will roll back the prohibition against the federal government negotiating drug prices on behalf of Medicare beneficiaries. (A Kaiser Family Foundation poll released today found broad bipartisan support for this idea.) Incoming Senate Majority Leader Harry Reid says one of his three top priorities will be more funding for stem cell research. Others want to revisit the importation of prescription drugs from Canada. Additionally, the 110th Congress will consider whether to continue the State Children’s Health Insurance Program in its present form.
Come January, we can expect to see some new approaches to health legislation. Sen. Harry Reid, incoming Senate majority leader, says one of his top three priorities will be more funding for stem cell research. House Speaker-to-be Nancy Pelosi wants a vote early on to roll back the prohibition against the federal government negotiating prescription drug prices for Medicare beneficiaries. And these are just two of the health issues likely to be debated in the new Congress. The White House too will have a definite voice in the debates to come.
The growing complexity of our health care system, and time demands on providers, can cause patients’ non-obvious needs to get lost in the shuffle. Sometimes, the result can be less-than-optimal care. In response, providers are trying to be more responsive to patients’ cultural traditions, family situations, personal preferences and values. Some have tagged this movement “patient-centered care.”
Polls consistently show that addressing problems in our health care system remains a top concern for most Americans. But while major health care reform efforts have stalled in Washington, many states are attempting to address the rising number of uninsured on their own. This briefing focused on such efforts in three states – Massachusetts, Vermont and Utah.
The Long-Term Care Partnership Program allows purchasers of private long-term care insurance to qualify eventually for Medicaid coverage of long-term care services without having to meet the same asset requirements as other Medicaid applicants. Partnership programs began in 1987 in four states – New York, California, Connecticut, and Indiana.