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).
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 (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.
It’s been said that the Supreme Court’s ruling on the Patient Protection and Affordable Care Act will keep legions of lawyers employed for years to come. The same could be said for health reporters, political writers, bloggers, editorialists, talk show bookers, TV news producers and documentary makers.
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.
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.
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.
Safety-net hospitals 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.
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.
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.
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.
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?
The health care overhaul law passed by Congress in 2010 sets out national goals and requirements. But many of the key decisions implementing the law are left to the states.
The constitutional challenges to the Patient Protection and Affordable Care Act finally come to a head the week of March 26.
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?
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.
The 9 million beneficiaries dually eligible for Medicare and Medicaid are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of spending in both programs. Many deficit reduction plans under recent discussion have recognized the need to improve care for this population and provide care in a more cost-effective way.
The Budget Control Act of 2011 tasked six senators and six representatives, from both sides of the aisle, to find at least $1.2 trillion in deficit reduction over the next decade. After weeks of deliberation, members of the “Super Committee” did not reach an agreement by the November 23 deadline. As a result, automatic spending cuts to defense and social welfare programs are set to kick in beginning in January 2013, leaving many questions about the short-term and long-term consequences of the committee’s failed negotiations.
Medicaid currently provides health and long-term care to 68 million Americans, and the Patient Protection and Affordable Care Act would significantly expand Medicaid beginning in 2014. As a countercyclical program, Medicaid typically faces increased enrollment at the same time that states are looking to cut their budgets. Although the Budget Control Act of 2011 exempts safety-net programs like Medicaid from across-the-board cuts, Medicaid has remained a keenly debated topic in discussions of how to reduce the deficit.
Spending on prescription drugs in the U.S. rose at a faster clip in 2009 than spending for hospital and physician care, a trend that is expected to continue through 2020. By some estimates, prescription drugs account for 15 cents of every health care dollar spent. Thus, federal and state budget cutters – as well as private health plans and hospitals – have a keen interest in restraining drug costs.
According to a recent survey, a number of states have expressed interest in expanding managed care approaches within their Medicaid programs. But while managed care may present an opportunity for better delivery of care, it presents challenges within certain populations and geographic areas.
According to figures released last month by the U.S. Census Bureau, some 50 million Americans lacked health insurance in 2010. That number is almost a million higher than for 2009, though the percentage of people uninsured remained largely unchanged.
Medicare has been a keenly debated topic in discussions of how to reduce the deficit. It accounts for a large and growing share of both federal spending and of the national economy, although the projected pace of growth is now at a historic low. Its policies often set the pace for the rest of the health care system.
The ongoing debate over the federal budget and deficit reduction presents a balancing act for policy makers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a “rebalancing act” in progress. The aim is to serve more people at home and in the community, and fewer people in institutions.
After much heated debate on the U.S. debt limit, the Budget Control Act of 2011, containing more than $900 billion in spending reductions over 10 years, was passed on August 2. The members of the Super Committee created by that law are hard at work, and the process is in gear to achieve at least $1.2 trillion in additional deficit reduction — either through Congress adopting the committee’s recommendations or through further automatic spending cuts.
The high and rising cost of health care is a central concern for governments at all levels, employers and families. A large portion of the cost problem can be traced to the care received by persons with chronic conditions like asthma or diabetes. Treating those with multiple chronic conditions, including the elderly and disabled populations, accounts for 30 percent of total U.S. health care spending as of 2010. Half of this amount is spent by Medicare and Medicaid on behalf of beneficiaries eligible for both programs.
Strengthening Medicaid with Health Information Technology: Are Providers & States Up to the Challenge?
Under the American Recovery and Reinvestment Act of 2009, providers can receive Medicare and Medicaid payment incentives when they adopt electronic health records and demonstrate their “meaningful use.” Additionally, the Patient Protection and Affordable Care Act requires states to establish a website by 2014 for Medicaid beneficiaries to electronically enroll and renew coverage. Yet many challenges remain so that health information technology (HIT) can help the Medicaid program operate more effectively.
The Patient Protection and Affordable Care Act (ACA) authorized the creation of the Center for Medicare and Medicaid Innovation (CMMI) under the Centers for Medicare & Medicaid Services. CMMI seeks to test innovative health care payment and service delivery models that can potentially enhance quality of care for beneficiaries while reducing costs. From 2011 to 2019, the ACA provides $10 billion in funding to support the Innovation Center’s goals.
There is a national epidemic of chronic disease. Though it does not get the news coverage devoted to floods and tornadoes, it deserves attention and is starting to get it. There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play – at their schools, worksites, restaurants and more.
This was an introductory session designed to inform the staff of new members of Congress both in Washington and in district or state offices about the people who receive benefits from both the Medicaid and Medicare programs (often called “dual eligibles”). The briefing was designed to be helpful to staff members unfamiliar with this important issue.
When fully implemented, the Patient Protection and Affordable Care Act will increase the number of insured Americans through two primary strategies – expanding Medicaid and providing insurance through state-based insurance exchanges. As an individual’s household income exceeds the maximum for Medicaid eligibility, he or she will be eligible for subsidies to buy coverage through an exchange, up to a household income of 400 percent of the federal poverty level (FPL). This switch in eligibility also works in reverse. If a person’s household income shrinks below 133 percent of the FPL, he or she will become eligible for Medicaid.
In addition to expanding coverage to 32 million previously uninsured Americans, the health reform law of 2010 aims to improve the health of the population and the quality of health care delivery, while reducing costs. One tool to pursue these goals is the creation of a national voluntary program for accountable care organizations (ACOs). The law authorizes Medicare, beginning next year, to contract with accountable care organizations in a Medicare Shared Savings Program. ACOs provide financial incentives to improve the coordination and quality of care for Medicare beneficiaries, while reducing costs.
More than 25 years have passed since what is now the Centers for Medicare and Medicaid Services (CMS) began publishing hospital mortality data. Great strides have been taken since then in collecting and making public more and better information about the quality of care delivered by hospitals and other providers. CMS’s websites, like www.hospitalcompare.gov, make much of this information available to a wide audience.
The fact that health care costs vary sharply around the country is becoming well known; less understood is that there is also wide regional variation in health care quality. Some regions enjoy low cost, high quality care while others report high cost, lower quality care. Some people have ready access to providers and good care; others may not be receiving necessary care or may be receiving unnecessary, health-endangering care. The root cause of these differences has been the subject of many studies and discussions.
Although the rise in unemployment in this recession has resulted in lost health insurance coverage for many adults, a record 90 percent of children now have coverage – one-third of whom are covered by public programs, Medicaid and CHIP. About 7.5 million children remain uninsured, including 5 million who are eligible for Medicaid and CHIP but not enrolled.
Understanding how Medicare works is essential to understanding federal health policy. Medicare is the federally administered health insurance program for individuals ages 65 and older and for younger people with permanent disabilities. In 2010, the program covered an estimated 47 million people. It comprised an estimated 15 percent of the federal budget and over one-fifth of total national health expenditures.
Medicaid will play a major role in extending coverage to millions of uninsured people in 2014 through provisions in the Patient Protection and Affordable Care Act. More than 16 million newly qualified individuals are expected to enroll as a result of the law.
The relationship between patients and doctors has been changing from the traditional model in which a doctor decides on a treatment course without significant patient input. In recent years, awareness of the importance of the patient’s role in managing his or her own care has been steadily growing–fed not only by such trends as the proliferation of health information on the internet and direct-to-consumer advertising, but also by the emerging science of patient-centered decision making.
Unemployment has hit everyone hard since the economic downturn began in 2007. And while workers age 50-64 tend to have lower rates of uninsurance than other age groups, they are especially hard hit by losing their jobs and with them their employer-sponsored health benefits. About 8.6 million adults ages 50 to 64 were uninsured in 2009, 1.1 million more than in 2008, a bigger percentage increase than other age groups.
One of the goals of the Affordable Care Act is improving the quality of health care while also slowing the growth of spending. This will not be easy as 30+ million individuals gain insurance and the need for chronic care coordination increases with an aging population. In order to meet this challenge, the law aims to move the health care system away from an episodic, fee-for-service approach and towards a coordinated, preventive model of care delivery.
The rising number of uninsured, who they are and how they might obtain health insurance coverage were much debated during the consideration and passage of health reform in the last year. In the meantime, rising unemployment rates and an economic recession have exacerbated the declines in health insurance coverage. According to the Current Population Survey, 50 million Americans were uninsured for all of 2009. The Medicaid and CHIP programs have offered a safety net of coverage for some of those facing financial hardship and have helped to prevent more people from being uninsured. Even as they continue to face severely strained budgets, states are enrolling record numbers of beneficiaries in Medicaid.
In today’s evolving health care system, many providers and policymakers envision team-based care as an important component of the plan to improve quality, maximize resources, promote wellness, expand preventive care and enhance the value of the health care dollar. The health workforce “dream team” includes physicians, nurses, nutritionists, physical therapists, social workers, nurses’ aides, direct care workers, home health aides and others who contribute to coordinated care in a high quality system.
For years, there have been concerns about whether the supply of physicians can meet the demand of our nation’s population – a population that is growing in size, age and diversity. One consideration: The physician workforce is aging as many physicians approach retirement. And physicians are increasingly looking for opportunities that allow them to balance their professional and family obligations.
Health reform is law. But how the law is implemented, and how quickly, depend in part on the results of the midterm election.
Health information technology can help prevent medical errors, improve care coordination, increase access to providers in rural areas and improve the quality and value of care. At the same time, questions have been raised about the cost of implementation, personal privacy considerations and potential disruption to the business of health care, especially for providers in individual and small group practices.
The Affordable Care Act (ACA) enacted in March 2010 calls for the establishment of state health insurance exchanges – marketplaces through which individuals and small businesses can purchase affordable insurance. These exchanges must begin operation by January 1, 2014.
All states, even those with large centers of urban population, have rural communities and rural residents among their citizens. Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health IT.
Most of the emphasis during the health reform debate centered on affordable health coverage for the uninsured, strategies to control the growth in health care spending, and delivery system reforms. Relatively little attention was given to the many provisions of the new law that deal directly with long-term care.
The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA) made a series of changes that will significantly affect the way employers provide health coverage to their employees, and transform many of the choices and protections consumers have in the marketplace.
As the second in a series to explore implementation of the Patient Protection and Affordable Care Act, this briefing provided an overview of how the states and the federal government are working together to implement various provisions of the new law. For example, while the law allows for flexibility in the way states set up exchanges, states will likely need technical assistance from the federal government to get the job done.
Diabetes and obesity have evolved from a national public health concern to a problem of epidemic proportions. Type 2 diabetes, which is linked to obesity and physical inactivity, accounts for 90 to 95 percent of diabetes cases for people over 40. Moreover, in 2007 an estimated 57 million American adults had “pre-diabetes,” the precursor to diabetes. Childhood obesity, which has more than tripled in the last three years, impacts these numbers because obese children are at greater risk of developing diabetes as an adult.
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.
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.