The Evolving Coverage Landscape for Small Businesses: Opportunities and Challenges

The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For purposes of health insurance regulation, small businesses have traditionally been defined by states as businesses with up to 50 employees. The ACA defined the small group market as employers with 1-100 employees, while allowing states to limit small group participation to employers with 50 or fewer workers from 2014 through 2016. Every state chose to do so, but, for plan years beginning in 2016, the definition of small business is set to expand to include those with 100 or fewer employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.

Reporter Briefing: Small Business Health Coverage Changes in 2016- Opportunities and Challenge

Join us for a special breakfast for reporters to address major changes set to take place for small businesses and health coverage in 2016, and proposals to delay or reconsider those changes. The Affordable Care Act (ACA) created new health insurance marketplaces for small businesses, known as Small Business Health Options Program (SHOP) marketplaces, and made substantial changes to the regulation of health insurance for small businesses. For plan years beginning in 2016, the definition of a small business is set to expand from up to 50 employees to up to 100 employees—with potentially significant consequences for the small group health insurance market and the SHOP marketplaces.

King v. Burwell: The Facts and Implications

This briefing told you what you need to know about a major Supreme Court challenge to the Affordable Care Act (ACA). The Court is expected to make a decision in June, and a ruling for the King petitioners could mean that individuals will no longer be able to receive subsidies to purchase health insurance through the federal marketplace. The federal government is operating insurance marketplaces in more than 30 states. Currently, subsidies to buy health insurance are available to individuals with incomes between 100 percent and 400 percent of the federal poverty level (i.e., those with annual incomes between $11,770 and $47,080).

Biosimilars in the U.S.: Current & Emerging Issues

With Congress focused intently on the discovery, development, and delivery pipeline for innovative drugs and devices – and in the wake of the first-ever U.S. approval of a biosimilar medication– key policy and regulatory questions are being actively debated, with important implications for industry, patients, and the health care system

Issues and Future Directions for Medicare

Per capita spending growth in Medicare has slowed over the last few years, although economists disagree about whether that trend will continue. Meanwhile, the number of Medicare beneficiaries continues to increase. Medicare has made systematic changes over the course of its first 50 years, addressing everything from benefits and eligibility to quality of care measurement and provider payment.

21st Century Cures: Can Congress Come Together?

Join us for a special breakfast for reporters, where former FDA Commissioner Andrew von Eschenbach will give you the latest on the fast-moving 21st Century Cures legislation. Karen Riley, deputy director of strategy at the FDA’s Office of External Affairs, will also be available to answer questions. The briefing comes just a week after the House Energy and Commerce Committee unveiled bipartisan draft legislation. The committee may begin voting on the measure as early as next week.

Improving Health Care Delivery: Innovation in the Private and Public Sectors

This event examined innovative efforts in both the private and public sectors to move toward a health system that is more patient-centered, cost-efficient and delivers better outcomes. It will address efforts underway at the Center for Medicare and Medicaid Innovation (CMMI) and other federal agencies to spur innovation and prioritize a shift toward higher quality care, as well as the progress made by the private sector in improving quality and reducing costs through innovation.

Health Care Costs: What You Need to Know

The briefing explored the trends in health care costs in both the public and private sectors. It explained recent moderate growth rates, along with possible reasons and prospects for the future. This session was especially helpful to congressional staff members new to the issue, but also served as a useful review for anyone working on health care policy.

Medicare 101: What You Need to Know

Medicare provides health insurance coverage to 54 million people aged 65 and over and younger people with permanent disabilities. In 2013, Medicare spending accounted for 14 percent of the federal budget. This session was especially helpful to congressional staff members new to the issue and a useful review and update for staff working on a broad range of Medicare issues. This Medicare 101 answered basic questions, such as: What services does Medicare provide, and how does Medicare pay for these services? How is Medicare financed? What changes did the Affordable Care Act (ACA) make to Medicare? How fast is Medicare spending growing? What are current proposals to strengthen Medicare for the future, and what are prospects for action in the new Congress?

Medicaid 101: What You Need to Know

With some states grappling over whether to expand Medicaid, and Congress facing big decisions about the future of the Children’s Health Insurance Program (CHIP), this briefing reviewed the basics about both programs and discuss current issues.

Chronic Care Management: Is Medicare Advantage Leading the Way?

Efforts are underway throughout the Medicare program to better manage beneficiaries’ chronic conditions, with the goal of improving quality and lowering the costs of care. With an estimated 31 million Medicare beneficiaries suffering from a chronic condition such as cardiovascular disorders, diabetes and cancer, many still do not receive the coordinated services they need to manage their chronic conditions, and beneficiaries with multiple chronic conditions incur higher-than-average spending. However, traditional fee-for-service Medicare, Medicare Advantage, and newer models such as Accountable Care Organizations (ACOs) differ in the tools and methods available to manage chronic care.

ACA 101: What You Need to Know

This session was especially helpful to congressional staff members new to the issue, but is also a useful review for anyone dealing with the Affordable Care Act (ACA). The briefing took place just as the second marketplace enrollment period ended and the Supreme Court heard oral arguments in a case challenging the law’s subsidies.

Preparing the Nursing Workforce for a Changing Health System: The Role of Graduate Nursing Education

The nursing profession, with nearly 3 million licensed and practicing nurses in the U.S., comprises the largest segment of the nation’s health care workforce. There is consensus among experts that nursing education should be modernized to train a greater percentage of nurses at the graduate level and provide the skills nurses need as today’s health care delivery system continues to evolve towards more team-based, data-driven, and coordinated care. What does the nursing workforce look like now, and how does it need to change to meet current and future health needs in the U.S.? How are nursing education and training currently financed? What is the role of federal policy in training a 21st century nursing workforce? How does the nursing workforce fit into today’s primary care workforce and the evolving health care delivery system?

Between Two Worlds: Adolescents and Our Health Care System

Adolescence is a time of physical, emotional, and cognitive transition between the worlds of childhood and adulthood. This time can include the onset of chronic conditions such as obesity, hypertension, and schizophrenia, yet teens may have difficulty accessing appropriate care for their physical and mental health needs. Emerging models around the country may be improving adolescents’ access to appropriate care, but the evidence suggests many needs are not being met.

Digital Health Innovations: Engaging the Patient and Transforming Health Care Delivery

Digital health technologies, particularly those designed to engage and empower patients, have the potential to address unmet health needs and deliver care in new, lower-cost ways. Information shared from electronic health records, the “cloud” and apps can help clinicians target conditions, measure and monitor patient outcomes, personalize treatments, and engage patients in their care. This briefing will examine innovative uses of digital health technology to engage patients and deliver care, with particular focus on high cost, high need patients.

Medicare Advantage in a Changing Health System

Almost three in ten Medicare beneficiaries are enrolled in the Medicare Advantage (MA) program, which offers a choice of competing private health plans – typically managed care plans such as HMOs and PPOs. The Affordable Care Act (ACA) made significant changes to the way Medicare Advantage plans are paid, including tying a portion of payments to a quality star rating system. Despite predictions that MA enrollment would drop in the wake of scheduled payment reductions to the program, the percentage of seniors who are choosing to enroll in MA plans is still growing. However, the impact of upcoming reductions remains the subject of much debate.

ACA Enrollment Round II: Do Consumers Have the Help they Need?

The Affordable Care Act’s second open enrollment period runs through mid February, and millions of people are already looking for help to find the best insurance fit. While many who signed up last year are expected to shop around for different health plans, millions more may become first time buyers. This briefing will explore the availability and usefulness of in-person assistance programs (navigators, assisters and brokers) that are intended to help individuals search and apply for coverage. After last year’s enrollment difficulties, we will look at the challenges of this second round, with a particular focus on the help available to consumers.

Webinar- Regulating Network Adequacy: The New NAIC Model

With the launch of the Affordable Care Act’s second open enrollment period this week, millions of people are again expected to flood marketplace websites to enroll or reenroll in health plans. At the same time, insurance commissioners are announcing draft regulations to help their states respond to an issue that was the subject of major controversy during the first round of enrollment: Some of the new health plans are offering consumers networks that exclude certain doctors, hospitals and other medical providers. Some claim that these networks hamper provider access and choice; others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs, without compromising the quality of care. The November 19 webinar will explain new draft regulations from the National Association of Insurance Commissioners. What are states already doing and must they adopt these regulations? How would this regulatory approach affect consumer costs and access to medical providers? How does it handle tiered networks? What is the effect on consumers, providers and health plans? Will there also be federal standards for health plan networks?

Curbing The Ebola Outbreak: Are We on the Right Track?

The World Health Organization (WHO) recently declared a public health emergency due to the Ebola virus outbreak in West Africa, which has accounted for over 13,000 reported cases and 4,800 deaths. Some imported and locally acquired cases in health care workers have also been reported in the United States. As a result, concerns about the further escalation of this epidemic and how to best prepare for and contain this deadly disease exist in both the U.S. and abroad.

Health Insurance Marketplaces, Round II: Results and Expectations

One day after this briefing, on November 15, the second open enrollment period begins for health plans sold in federal and state marketplaces. More than 7 million people who bought insurance for 2014 can shop around for new plans or stay where they are. Those who received federal subsidies will face a redetermination process to assess their current income and other eligibility factors. Experts estimate there may be millions of new enrollees.

21st Century Cancer Care: Will New Models Lead to Better Care at Lower Cost?

The United States spends more than $125 billion annually on cancer care. By 2022, there will be 18 million people with cancer and by 2030 cancer incidence is expected to rise by 2.3 million new cases per year. The high cost of cancer drugs and the “buy and bill” model of paying for them under Medicare have received significant attention. But other factors, such as highly-variable practice patterns and a lack of meaningful engagement of patients in care decisions, have also been called into question.

Incentives 2.0: Is Paying for Performance Enough?

Every day, health care professionals make complex decisions that directly affect the cost and quality of care. Increasingly, both private and public payers are implementing payment reforms to motivate quality improvement, reward providers for delivering high quality care, and, in some cases, impose penalties for sub-par performance, while bipartisan policy proposals to reform Medicare physician payment would modify existing provider incentive programs.

Prescription Opioid Abuse: Fighting Back on Many Fronts

According to the Centers for Disease Control and Prevention (CDC), drug overdose is the leading cause of injury death in the United States. In 2010, opioid pain relievers accounted for approximately 17,000 of overdose deaths— more than twice the number of deaths from cocaine and heroin combined. Despite the tremendous importance of prescription drugs in treating pain, some medications have a high risk of being misused or abused. Some researchers have voiced concerns that prescription painkillers could even be a gateway drug for heroin users. With the steady rise in prescription rates and drug overdose deaths, policymakers are coming to a consensus that this national problem must be addressed.

Network Adequacy: Seeking Balance

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Reporter Briefing: What’s Next for Obamacare?

The Association of Health Care Journalists’ Washington, DC Chapter and the Alliance for Health reform invite you to a discussion about how journalists can get ready for Round 2 of marketplace enrollment and uncover the next big issues related to the Affordable Care Act.

Network Adequacy Briefing for Reporters

Network adequacy experts will meet with reporters Wednesday, August 6 to provide the latest on the subject, including details about model regulations that the National Association of Insurance Commissioners plans to release in November.

Navigating the Health Insurance Landscape: What’s Next For Navigators, In-Person Assisters and Brokers?

Approximately 10.6 million people were aided by more than 4,400 in-person assistance programs in searching and applying for coverage in the first six-month enrollment period. Brokers also played a role in helping consumers sign up for coverage. Some believe that in-person, enrollment assistance programs are key to future enrollment success, while others voice concerns about the training of those offering assistance, and the security of applicants’ personal information. Many questions arise about their effect on coverage moving forward and the funding required to support the programs.

Health Care Behind Bars: A Key to Population Health?

This briefing explored innovations and challenges in delivering health care to a growing population of inmates, and also the prospect of health care in the correctional setting as a key to improving population health. This is an expensive group because of the large number of people with mental illness, addiction disorders, conditions associated with aging and Hepatitis C. Indeed, corrections spending is the second fastest-growing state expenditure, behind Medicaid, according to the Pew Charitable Trusts.

Disclosure and Apology: A Win-Win for Patient Safety and Medical Liability?

Policymakers, providers, and stakeholders have been debating various approaches to reforming our medical liability system to both protect patients who experience adverse medical events and to help practitioners provide the highest quality care possible. One innovative approach may well avoid some of the sharper policy differences on proposals in this area: encouraging the disclosure of unanticipated outcomes to affected patients. This disclosure may include an explanation and apology to the patient and family, as well as an offer of compensation in some cases. Some anecdotal data suggest that such communication-and-resolution programs can result in improved patient safety and decreased malpractice claims. However, questions arise about how well this approach really works, and whether it can be standardized and scaled up in our medical system.

Network Adequacy: Balancing Cost, Access and Quality

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

Children’s Health Coverage: What You Need To Know

Approximately 8 million children with low to moderate incomes are covered under the Children’s Health Insurance Program (CHIP) and 39 million children are covered under Medicaid. (Most children who have coverage have private coverage). The number of uninsured children has decreased by half since the enactment of CHIP in 1997; however, with a new coverage landscape and CHIP funding set to expire in October 2015, questions arise about the current state and future of children’s health care coverage.

Health Insurance Marketplaces in 2014: Behind the Numbers

With the first open enrollment period for health insurance marketplaces now completed, an estimated 8 million people have enrolled in new private health insurance plans, with millions more newly enrolled in Medicaid. This briefing will look behind the enrollment numbers to take a detailed look at the demographics of marketplace enrollees, initial consumer experiences with health plans and lessons for next year’s open enrollment period.

Rates of Change: Putting 2015 Insurance Premiums into Context

Health insurance premiums have been one of the most closely-watched features of the new health insurance marketplaces. In 2014, insurers set rates based on limited data about who would sign up for coverage. Round II of open enrollment is fast approaching, allowing little time to process the first year’s data and to prepare for tomorrow. For 2015, some analysts anticipate increases of 10 percent or less, while others forecast growth of 20 percent or more.

Patient-Centered Medical Homes: The Promise and The Reality

While the Patient-Centered Medical Home (PCMH) model has increasingly been embraced by providers and payers as a way to improve health care and lower costs, many questions remain about its effectiveness. Definitions of medical homes vary, but they are generally known as a model that aims to transform primary care through increased coordination and communication among a team of providers. Recent medical home initiatives have encouraged primary care practices to invest in capabilities such as patient registries and electronic health records, and to achieve medical home recognition. Health plans offer to pay more to the practices that achieve recognition.

Health Centers at the Launch of the Coverage Expansion

The coverage expansion under the Affordable Care Act brings new pressures and opportunities for health centers, including the potential to serve newly-insured patients while continuing as a cornerstone of the primary care safety net for the uninsured. At the same time, health centers are in the midst of rapid transformation brought about in part by recent federal investments in health center capacity and delivery system improvements, even as they face uncertainty about future state and federal funding.

State Medicaid Expansion: The Third Way

To date, about half of states have moved forward with the Affordable Care Act’s optional Medicaid expansion. Now, additional states are pursuing an altogether different path that would allow them to use federal Medicaid funds to help low-income residents buy private coverage. Arkansas, Michigan and Iowa have already received federal Medicaid waivers and launched programs. Others are in various stages of drafting and negotiating. A few are considering block grants.

Is the Mind Part of the Body? The Challenge of Integrating Behavioral Health and Primary Care in a Reform Era

As more people gain coverage that includes behavioral health benefits, and given a limited supply of mental health professionals, analysts and advocates are raising concerns over how and whether new laws and regulations will be able to change that situation. One option being explored in many settings is the integration of behavioral health services with primary care. There is early evidence that coordinating care in this manner may deliver high-quality care more efficiently.

What’s Preventing Prevention?

Preventive services were a priority in the Patient Protection and Affordable Care Act (ACA), which required that a set of services be available to consumers with no cost sharing. This has improved access for some people to some services. But persistent barriers for consumers are limiting the utilization of preventive services. These barriers include the variability of insurance coverage, the affordability of out-of-pocket costs, the challenges of education and outreach, and the funding of public health initiatives.

Beyond the SGR: Alternative Models

Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services.

Healthier and Wealthier, or Sicker and Poorer? Prospects for Medicare Beneficiaries Now and in the Future

Although Medicare reform is not currently a front-burner issue, proposals to reduce Medicare spending appear regularly on the policy agenda. Various Medicare savings proposals have recently emerged in the context of efforts to control the national deficit and debt, and could arise in the next few months when Congress considers how to modify Medicare’s physician payment policy to avoid a precipitous reduction in physician fees. The recently passed bipartisan budget deal delayed a reduction in Medicare payments to physicians until April, and any effort to permanently replace the existing system by which Medicare pays physicians will be costly.

Intellectual and Developmental Disabilities in the ACA Era

The Patient Protection and Affordable Care Act (ACA) contains several provisions that address access to community based services for the 4.5 million people in the U.S. with intellectual and developmental disabilities (I/DD). Many of these provisions are aimed at balancing the array of services between those offered in institutions and those in the community.

Tackling Health Care Costs: Finding Common Ground

Despite slower health care spending growth over the last few years, long-term forecasts for overall health spending – and for public programs like Medicare – signal continuing concern. The idea behind numerous recent proposals is to find lasting solutions, and some areas of consensus are beginning to emerge.

Health Insurance Marketplaces: The First 8 Weeks

Health insurance marketplaces, or exchanges, opened October 1, and while states have released some enrollment data, and much of the attention has been on the initial technical challenges, there has been less information about overall consumer experience.

Reference Pricing: Will Price Caps Help Contain Healthcare Costs?

Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge.

Quality Care: Getting More Bang for the Buck?

Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds.

Pioneer ACOs: Lessons Learned from Participants and Dropouts

More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to a recent Centers for Medicare and Medicaid Services (CMS) report. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent.

Telehealth and Telemedicine: Adopting New Tools of the Trade

With millions of people projected to obtain health insurance coverage under the Patient Protection and Affordable Care Act (ACA), access to care is expected to be an issue. Efforts to promote telehealth and telemedicine could help.

Public Health Preparedness: Are We Ready for Disaster?

Following the terrorist attacks of September 11, 2001 and the subsequent anthrax assaults, the federal government began to reevaluate the nation’s preparedness for public health emergencies. Since then, the nation has been hit by massive floods, hurricanes and other disasters, and last year Hurricane Sandy swept up the east coast, crippling several states and nearly exhausting emergency services. Despite the continued need for a strong emergency response infrastructure to combat natural disasters, reemerging diseases, pandemics and food-borne illnesses, state health department budgets have been shrinking.

“Rate Shock” — Or Not?

This Alliance for Health Reform webinar gave you the latest on what insurance rates will look like when state insurance exchanges open for enrollment on October 1.

Health Insurance Marketplaces: Different Strokes for Different States

The Patient Protection and Affordable Care Act (ACA) sets October 1, 2013 as opening day for enrollment in health insurance plans through marketplaces, or exchanges. The law allowed states to choose between running their own exchanges or having the Department of Health and Human Services (HHS) run a federally facilitated exchange.

Rural Reality: More Coverage, Enough Care?

Sixty-two million Americans live in rural areas and they have higher rates of mortality, disability and chronic disease than their urban counterparts. With high poverty and unemployment rates, low rates of health insurance coverage and an undersupply of health care providers, the ills of the health care system are especially notable in rural communities. The Patient Protection and Affordable Care Act (ACA) contains provisions relating to access to care, coverage and delivery system reform. But the impact of these provisions is uncertain in rural America, with its unique challenges.

Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.

Recent proposals to combine the two main parts of Medicare would mean streamlining deductibles and other cost-sharing for beneficiaries. But health care policy experts are cautioning that such a change is complicated and requires analysis. A July 22 briefing explored the impact on beneficiaries.

Chronic Disease Prevention: Saving Lives, Saving Money

With a continued focus on the need to control the high and rising cost of care, Congress is looking for low cost, high yield policy solutions. Chronic illnesses are among the biggest drivers of growing health care costs, and a drain on worker productivity in our nation. For example, researchers note that per person health care spending for obese adults is 56 percent higher than for normal-weight adults. Diabetes and other chronic illnesses can be prevented or greatly delayed with solutions beyond or outside of medical care. Many fall into the category of health-related behaviors, such as whether we smoke, get exercise, eat a healthy diet– factors that are newly falling into the spheres of public health or population health.

Shifting Challenges: Mental Health in the ACA Era

Provisions of the 2010 health reform law, combined with mental health parity legislation, promise to make mental health care available to millions more Americans in 2014 through both private insurance and Medicaid. But, the sweeping changes that these laws make to financing for mental health care will require states, mental health providers, private insurers and patients to make major adjustments. As more people gain coverage, mental health experts fear that access to care could become an issue, and members of Congress already are introducing legislation to address this concern.

State Health Law Implementation: Race to the Starting Line – Philadelphia

The Philadelphia chapter of the Association of Health Care Journalists and the Alliance for Health Reform on Tuesday, June 18 held a special event to explore the challenges that Pennsylvania and New Jersey face this year leading up to the 2014 health law changes. This year the giant health law begins to move into its most climactic phase. Tens of millions of people are about to get health insurance, and this meeting will help reporters understand the epic challenges ahead.

The Future of Medicare Advantage: Are We on the Right Path?

Big changes are coming to Medicare Advantage, through which 28 percent of Medicare beneficiaries now get coverage in such private health plans as HMOs and PPOs. A June 10 Alliance briefing looked at the program’s chances for survival and growth.

Medicare for the 21st Century

The federal government currently spends about 15 percent of its budget on Medicare, and the program faces substantial growth in beneficiaries as baby boomers continue to age into eligibility. A June 3 briefing, “Medicare for the 21st Century,” addressed the sustainability of Medicare under its current design.

Worker Wellness Programs: Do They Work?

Starting in 2014, employers will be allowed to charge their workers up to 30 percent more for health insurance premiums if they don’t meet certain health goals, under the Patient Protection and Affordable Care Act (ACA). An Alliance for Health Reform briefing, “Worker Wellness Programs: Do They Work?” explained the provisions in the law, and examined employer efforts to improve worker wellness, along with evidence about savings.

Medicare-Medicaid Coordination for Dual Eligibles: What’s it All About?

Over nine million Americans receive benefits from both Medicare and Medicaid costing over $315 billion in health care services in the two programs combined. The dual eligibles account for 15 percent of the Medicaid population and almost 40 percent of all Medicaid expenditures for medical services; and 20 percent of the enrollees in Medicare, but 30 percent of the expenditures.

Patient-Centered Medical Homes: Do They Work?

The federal government has launched demonstration projects to test whether patient-centered medical homes (PCMHs) can tackle some of the biggest problems facing the nation’s health care system. Advocates are holding out hope that medical homes will help to slow the growth of health care spending while improving the quality of care. The medical home is a model that aims to transform the organization and delivery of primary care. The PCMH model focuses on personalized care, teamwork, and coordination of care to ensure that patient needs are met effectively and efficiently. The Patient Protection and Affordable Care Act (ACA) provides opportunities for the PCMH model by supporting nationwide medical home demonstration projects administered by the Center for Medicare and Medicaid Innovation (CMMI).

ACA 101: What You Need to Know

An April 26 briefing, ACA 101: What You Need to Know, was intended to be especially helpful to congressional staff members and others with limited knowledge of the Patient Protection and Affordable Care Act (ACA), but also to be a useful review for anyone dealing with the complex issues leading up to major changes scheduled to take effect in 2014.

Price and Quality Transparency: Tools for Informing Health Care Decisions

The Patient Protection and Affordable Care Act (ACA) calls for increased consumer involvement in health care decision-making. Transparency in price and quality as a tool for consumer engagement is a critical component of that process. One does not buy food, clothing or housing without comparison shopping. Yet in health care, equally important and typically a large part of the family budget, consumers have not had the tools to compare prices and quality of the product they are buying. The data are spotty and the little data that are available are not consumer friendly.

The Health Care Workforce: Prescription for the Future

The Patient Protection and Affordable Care Act (ACA) has the potential to greatly increase the number of insured people and change how health care services are delivered. What the additional coverage will mean regarding access to providers, who those providers will be and what services they will deliver are issues that affect all segments of the health care workforce.

The Doc Fix: What Happens Next?

Proposals to fix the Sustainable Growth Rate (SGR) abound and there is agreement that policy makers must take action, but the question of how to reach a permanent solution remains. The SGR originated as part of the Balanced Budget Act of 1997 to control federal Medicare spending. Congress began overriding the SGR in 2002 and has continued to delay scheduled physician reimbursement cuts ever since. Medicare physician payments were maintained at their current rates in 2012 as a result of The Middle Class Tax Relief and Job Creation Act of 2012. Most recently, Congress extended payment rates until January 2014 as part of the “fiscal cliff” negotiations.

Medicaid 101: What You Need to Know

A March 1 briefing, Medicaid 101: What You Need to Know, was especially helpful to congressional staff members and others new to the issue, but it was also a useful review for anyone dealing with Medicaid issues, particularly as many states prepare to expand their programs.

Medicare 101: What You Need to Know

A February 11 briefing, Medicare 101: What You Need to Know, was especially helpful to congressional staff members and others new to the issue, but it also was a useful review for anyone dealing with Medicare issues, particularly as pressure intensifies to slow the growth of program spending.

Approaches to Bending the Health Care Cost Curve

Health spending in the U.S. climbed to $2.7 trillion and constituted 17.9 percent of the nation’s gross domestic product (GDP) in 2011. A recent report released by actuaries at the Centers for Medicare and Medicaid Services (CMS) found that health spending as a share of GDP remained steady at 17.9 percent from 2009 through 2011. Despite that stability, some analysts warn that, as the economy improves and the population ages, cost increases could again accelerate. Effects of cost constraining provisions in the Patient Protection and Affordable Care Act (PPACA) are largely unknown, since major provisions will not be implemented until 2014.

Raising Medicare’s Eligibility Age: A Complex Proposition

With Americans living longer, some policymakers are proposing to gradually raise Medicare’s eligibility age from age 65 to 67 as part of a broader package to reduce the federal debt. The later starting point is projected to reduce federal spending by $113 billion over the next decade, according to the Congressional Budget Office, which estimates that most people would gain insurance coverage through other sources.

Illinois Health Law Implementation: Race to the Starting Line

We submitted our blueprint application to Federal Health and Human Services last month, in November, for the Partnership Exchange. That means that the federal government will be operating the exchange, they’ll be administering the bulk of the functions, the enrollment, the eligibility, the premium assistance. The state [Illinois], we have indicated that we want to retain some functions, particularly around the plan management.

Medicaid Expansion Briefing: What’s at Stake for States?

Following the Supreme Court’s decision this summer on the Patient Protection and Affordable Care Act, the nation’s governors and state leaders face the choice to participate or opt out of the Medicaid expansion. Currently, twelve states have decided to participate in the expansion, seven states have decided to opt out, and the remaining states have yet to announce their participation status. As state officials move forward with selecting an approach, a November 30 briefing examined the economic impact of expanding Medicaid to 138 percent of the federal poverty level.

Health Care on the Brink of the Fiscal Cliff

As Washington attempts to steer clear of the “fiscal cliff,” it is important that policymakers, stakeholders and the public have a clear understanding of the components of this key policy crossroads and the likely consequences of inaction – on everything from expiring tax cuts to debt ceiling increases to scheduled budget reductions. The goal of a Nov. 16 briefing was to foster that understanding.

A Dose of Reality in the Virtual World of Health IT

Electronic devices are pervasive throughout our culture. Still, they are a relatively new phenomenon in the physician’s office, even though electronic health records (EHRs) can help consumers stay connected with their care managers, monitor their health, and get reminders that it’s time to take their medicine. They can also help to better coordinate care, avoid duplication of services and eliminate medication errors.

Webinar: Making Sense of the Census Uninsured Numbers

The Census Bureau announced today that the number of people without health insurance dropped from 50 million to 48.6 million in 2011, marking the first decrease since 2007. That information came from the Current Population Survey, but it isn’t the only data that Census is releasing on the uninsured.

The Alphabet Soup of Care Delivery Transformation

There is widespread agreement that the current health care delivery system is fragmented. Your primary care physician may be the last to know what your cardiologist is doing, or your radiologist or pharmacist, for that matter. Though the providers may be well trained and supplying good care, they are part of a system that is less than efficient, a problem that could only get worse as the population ages and chronic conditions become more prevalent.

Oral Health: Putting Teeth into the Health Care System

We don’t often associate crowded emergency departments with dental complaints. But according to The Pew Center on the States, preventable dental conditions were the primary diagnosis in over 800,000 visits to ERs in the U.S. This makes sense, as more than 100 million Americans lack oral health coverage, and therefore have impaired access to dental care. What’s more, poor oral health is an integral factor in physical health, associated with conditions such as diabetes, heart and lung disease, stroke and preterm birth. So regular detection and treatment of oral health problems – which are received more regularly by those with coverage – can improve physical health and quality of life.

A Different Way of Thinking About Health Information

A consumer walks down the street using a smartphone – but rather than texting a friend, calling home or checking email, she is reporting data that will inform a clinician about the status of her asthma management. Is this scenario real or fantasy? As Americans grow more and more comfortable with technology in daily life – at work, at home and at play – one wonders why personal technology isn’t more widely used in health care. Patients are frustrated that they can’t access many of their providers through email; that they have to fill out paper forms multiple times, even in the same office; and that they must endure an office visit to their provider to have their progress monitored when they can visit their relatives across the ocean through Skype.

Medicaid Managed Long-Term Services and Supports: Are More Caution and Oversight Needed?

Medicaid can be as much as 25 percent or more of a state’s expenditures — a share that appears to be rising, not shrinking. In 2011 Medicaid accounted for 24 percent of total state spending, including federal grants. To address their budgetary challenges, an increasing number of states are turning to Medicaid managed care. As of 2009, 47 percent of all Medicaid beneficiaries were enrolled in a managed care plan. Looking to save money in categories where the most is being spent, more states are starting to enroll older beneficiaries and those with disabilities in such plans, not just for acute care services, but for long-term services and supports (LTSS).

Health Insurance Exchanges: Can States and the Federal Government Meet the Deadline?

According to the health reform law, health insurance exchanges are to begin covering people in every state by January 2014. While some states have made progress toward establishing their own exchanges by this deadline, others have displayed little activity in this arena. Now that the Supreme Court has ruled on the constitutionality of the law, many states are just now beginning to think about their options for state-run exchanges and federal-state partnerships to run them. With implementation and evaluation deadlines rapidly approaching, state governments face the challenge to decide and act quickly.

Community Health Centers: Can They Plug the Gaps in the Safety Net?

Community health centers (CHCs) play a critical role in providing care to vulnerable populations, especially at a time when employer-sponsored coverage has declined and the demand for safety-net services has gone up. Currently, there are more than 1,100 community health centers providing care to approximately 20.2 million people in every state across the U.S.

Health Care After the Supreme Court Decision: What’s Next?

The Supreme Court has ruled on the constitutionality of the health reform law. Now it remains for stakeholders, policymakers, analysts and taxpayers to take it from here. Shifts in health care delivery towards more coordinated care to improve quality and efficiency are already taking place in the public and private sector. But many provisions in the law require specific actions to be taken and deadlines to be met by states, providers and others in order to implement various aspects of health reform scheduled to take effect in January, 2014.

The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

Urgent care centers and retail clinics are rapidly emerging within the health care system — a partial response to rising health care costs and a possible flood of new demand for care as the Patient Protection and Affordable Care Act is fully implemented. The number of patient visits to retail health clinics grew by 1,000 percent in just the last two years, according to a RAND Health study.

Health Care Costs: What Can Be Done?

Though there is still disagreement about the extent to which various cost drivers contribute to the troubling trajectory of health care spending in the United States, there are success stories. This briefing took a look at some of the innovative strategies in both the public and private sectors that have bent the cost curve downwards and some that may hold promise for lowering the rate of growth of national health care spending. The briefing also featured Dr. Paul Ginsburg presenting a paper that was commissioned especially for this series. The paper examines a range of policy strategies that might promote changes in health financing and delivery that would encourage higher quality and more efficient care delivery.

Health Care Costs: The Role of Technology and Chronic Conditions

This is the second event in a three-part series of discussions on costs, the factors driving them up and what (if anything) can be done about them. The series marks the Alliance for Health Reform’s 20th year of promoting informed and balanced discussion of health policy issues.

Behavioral Health: Can Primary Care Help Meet the Growing Need?

An estimated one out of five adults in the U.S. suffers with mental illness. Some 11 million adults reported an unmet need for mental health care in the past year, a situation no doubt made worse by the recent recession and higher-than-normal unemployment.

Health Care Costs: The Role of Prices and Volume

This was the first event in a three-part series of discussions on costs, the factors driving them up and what (if anything) can be done about them. The series marks the Alliance for Health Reform’s 20th year of promoting informed and balanced discussion of health policy issues.

Coping with Fragmented Payment in the Real World

Many analysts and policymakers agree that the fragmentation of the health care delivery system results in uncoordinated care, frustrated patients, higher costs, wasted administrative dollars and lost opportunities for rapid improvement in our health care system. There is less agreement as to how to reform health care payments in order to harmonize health care delivery and reduce this fragmentation. How do institutions, communities and practitioners transform their organizations to deliver high-quality, patient-centered care when different payers pay at different rates, and some patients have no one paying at all?

Program Integrity: How Much Money Can Combating Health Care Fraud and Abuse Save?

Headlines regularly call attention to pockets of fraudulent activity in the health care area–scams that amount to millions and potentially billions of dollars. The stories typically focus on catching the “crooks” but not so much on efforts to prevent fraud, waste and abuse in health care programs. Both types of efforts are important. With continued concerns about rising health care costs and the current focus on deficit reduction, how much money can be saved and put to better use by reducing waste, abuse and outright fraud?

Essential Health Benefits: Balancing Affordability and Adequacy

Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges – as well as non-grandfathered plans offered in the individual and small group markets – will be required to cover a set of health benefits and services called the “essential health benefits” package. Guidance issued last month by the Department of Health and Human Services will give each state some discretion to specify benefits within the 10 categories specified in the law.