Latino Health and National Health Reform

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.

Dental Health: Nurturing the Health Care System’s Neglected Stepchild

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.

Making the Grade: Improving the U.S. Health System

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?

Innovations in Patient Care: Lessons from the Field

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 and Its Future: More Than the Money

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.

Using Medicare as Part of Coverage Expansion?

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.

Racial and Ethnic Disparities: States and Feds to the Rescue?

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.

Comparative Effectiveness: Can We Get Better Health Value for the Dollars We Spend?

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.

Helping 125 Million Americans: Improving Care for Chronic Conditions

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.

Health Information Technology and Privacy: Is There a Path to Consensus?

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.

Health Reform Lessons Learned: Veterans of 1993-94 Offer Advice to Today’s Reformers

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.

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.

Medicare Part D: What Now, What Next?

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[1]; and the third open enrollment period is now upon us – November 15 through December 31, 2007.

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.

Changing the Culture and Improving Quality: Innovations in Long-Term Care

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-Based Coverage: Shore It Up or Ship It Out?

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.

Health Care and the ’08 Election: A Preview

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.

Quality Care and Comfort at the End of Life: Changes Needed?

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.

State Health Initiatives: What’s Next?

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.

Which Way To Turn? Options for Rebuilding the Gulf Region’s Health Infrastructure

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.

Medicare 101: What You Really Need to Know

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 101: A Primer on the Health Insurance Program for Low-Income Americans

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?

Health Coverage Revisited: Exploring Options for Expansion

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.

SCHIP and Beyond: Improving Health Care Coverage and Quality for Children

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.

Reaching Out: Enrolling and Keeping Kids in the SCHIP Program

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.

SCHIP: Let the Discussions Begin

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.

Pay-for Performance and Medicare: Moving from the Drawing Board to the Doctor’s Office

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.

Health Legislation 2007-2008: What’s Possible?

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.

Prospects for Health Care: Where Will New Congressional Leadership Take Us?

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.

Who Cares What Patients Think?

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.”

State Health Reform Initiatives: Are There Lessons for Federal Policymakers?

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.

46.6 Million and Counting: A Look Behind the Number of Uninsured Americans

The Census Bureau’s recently released figure on the number of uninsured in 2005 is 46.6 million, an increase of 1.3 million people over 2004. Two new studies by John Holahan and Bowen Garrett of the Urban Institute offer in-depth analyses of the economic and demographic factors that underlie this troubling statistic.

Measuring Up: A Comprehensive Scorecard for America’s Health System

A new assessment by The Commonwealth Fund finds that deficiencies in the nation’s health care system cost 100,000 to 150,000 lives and $50 to $100 billion annually. The scorecard compares national averages for the U.S. to national and international benchmarks for 37 indicators. The U.S. received a composite score of 66 out of 100. On one quality measure, mortality, the U.S. ranked 14th out of 19 countries.

Balancing the Promise and Cost of Biotechnology

Biotechnology accounts for only one percent of insurers’ costs, but those costs are growing at a double digit rate. As science produces increasingly sophisticated and expensive medical products and procedures based on the manipulation of living organisms, payers will increasingly struggle with managing their use.

Treatment of Severe Chronic Illness: What Explains Cost and Quality Variations? Should We Be Concerned?

Some Medicare beneficiaries receive significantly more hospital-based services during the last two years of life than do other beneficiaries. The number of physician visits for Medicare beneficiaries can also vary greatly. What accounts for this variation? Do patients receiving more services tend to get better care, or not? Should policymakers take steps to more closely examine the relationship between spending and the volume of services provided at different facilities?

Reviewing Prescription Drug Coverage: Policies and Practices Across Several Health Systems

The Medicare prescription drug program offers coverage for prescription drugs through competing private plans, within a framework established by law and through rules established by the Centers for Medicare and Medicaid Services. In contrast, other countries, including Australia, the UK, and Canada, provide similar prescription drug programs, but within different regulatory structures.

Improving Coverage Stability For Kids in Medicaid and SCHIP

One byproduct of the patchwork system of public and private health insurance coverage in the United States is that individuals can gain or lose health insurance as they gain or lose jobs, or gain or lose eligibility for public programs. This phenomenon, known as “churning,” can lead to gaps in health insurance coverage and unnecessary administrative costs for state governments that have to process the same individuals repeatedly.

Helping the Medicare Savings Programs Get Savings to Seniors

The Medicare Savings Programs provide assistance with premiums — and in some instances, cost sharing requirements — to Medicare beneficiaries of limited income and resources who do not qualify for full Medicaid benefits. Medicare Part B premiums currently amount to over $1,000 annually — which can be a large sum for some beneficiaries.

Medicare Advantage: Early Views and Trendspotting

Although it’s best known for introducing the Medicare prescription drug program, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 also made a number of changes to the Medicare managed care program – Medicare Advantage. Among the aims: Keep managed care plans from leaving the program by offering higher payments, and give beneficiaries more reasons to consider joining.

Rewarding Quality Performance: The Multidisciplinary Approach

In today’s health care system it is clear that there needs to be a multidisciplinary approach toward improving quality. Nurses are on the front lines of implementing this quality improvement. By using the highest quality measurements and optimizing the delivery of care, those outside the nursing community would understand the importance of their role in quality performance.

The Massachusetts Health Plan: How Did They Do It?

On April 4, the Massachusetts legislature approved a plan that requires all adults to purchase health insurance by July 2007, or face a fine. The plan is projected to expand coverage to 95 percent of the state’s uninsured residents over the next three years.

Ideas for Making Health Insurance More Affordable for Small Businesses

Congress has actively considered whether and how to reorganize the health insurance market for small businesses. In Spring 2006, the Senate debated a legislative proposal, offered by Senators Michael Enzi and Benjamin Nelson, which centers on Small Business Health Plans (SBHPs). SBHPs are a new category of group health plans sponsored by bona-fide professional and other associations. The House has debated and approved related legislation on association health plans.

Patient Safety: Why It’s Getting More Visibility

The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).

Where Are HSAs and High-Deductible Health Plans Headed?

Health savings accounts (HSAs) offered in conjunction with high-deductible health plans are on an upswing nationally. Simply stated, HSAs require an individual to use his or her own money (or money set aside by an employer for the individual’s use) to pay for medical expenses up to a fairly substantial deductible, at which point traditional insurance coverage begins. Established by the Medicare Modernization Act, the minimum deductible this year for individuals is $1,050; for families, $2,100.

Beyond the $10 Aspirin: How Well Does Our Hospital Financing System Work?

As health care tabs rise, every American feels the impact – on personal finances, company budgets, state coffers and federal entitlement programs. Rising demands for services from an aging population, medical advances, and quality imperatives all impact health care costs. Within this context, it is important to understand how various sectors of our health care system price services and account for costs.

Balancing the Equation: Ending Disparities in Health Care Delivery for Racial and Ethnic Minorities

Disparities in health care have been well documented: Nonwhites have higher rates of infant mortality, death from heart disease, incidence of diabetes and HIV/AIDS and are less likely to receive appropriate immunization than are whites. A recent study in the Journal of Racial and Ethnic Disparities indicates that between 1991 and 2000, five times as many lives could have been saved by ending health disparities than were saved by innovations in health technology over the same period.

Making Sense of Medicare’s Drug Benefit: Information and Resources to Help Beneficiaries

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Exploring Realistic Coverage Options for the Uninsured

The enactment of the Patient Safety and Quality Improvement Act last year sets the stage for health care providers to be able to report medical errors confidentially to designated entities known as “Patient Safety Organizations” (PSOs).

Toward A High Performance Health System: Public-Private Efforts to Make Health Care Safer and More Effective

The U.S. health care system is the most expensive in the world. Yet it is clear that by many measures, Americans are not receiving commensurate value for the health care dollars they spend. Is it possible to simultaneously improve health coverage and quality, while generating savings for health care consumers, employers, government and health care providers? What are the characteristics of a high performance health system? What realistic steps does the private sector need to take, contrasted with government bodies, to move the U.S. toward such a system? What policy changes would be most helpful to the most vulnerable populations – the uninsured, and those facing disparities in care or coverage due to income, race/ethnicity, health or age?

Implementing the Medicare Drug Benefit: The Stories Ahead

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Caring For the Elderly: Is There Any Answer to Rising Health Costs?

The costs of caring for the elderly have been growing steadily higher. Spending on Medicare benefits accounted for 17 percent of the nation’s total health care spending in 2004. With baby boomers retiring, and Medicare benefits changing, this percentage is expected to grow in the future. Americans spend approximately $140 billion on long-term care in the U.S., most of it on the elderly, and Medicaid picks up almost half of the cost. Even among large private firms, health care costs for older people have taken their toll with only one-third offering health benefits to their retirees today, compared with two-thirds in 1988.

Health Information Technology: Here, Now and Tomorrow

Wider use of health information technology has been touted as one way to improve the quality of care and reduce medical errors, while reducing the continued rapid growth of health care spending. Providers across the country are already adopting new health IT systems, and many patients have welcomed the trend. Other providers say they can’t afford the large upfront costs involved, and some analysts question whether health IT will save any money at all.

Safeguarding the Health of Katrina’s Victims

With New Orleans largely evacuated and hundreds of thousands of people separated from their regular health care providers, how will Hurricane Katrina’s evacuees attend to their health and health care needs?

Health Services for Children: The Role of Medicaid and Its Benefit Package

The National Governors’ Association recently made a series of recommendations that would give states more flexibility in administering Medicaid benefits. In addition, the Medicaid Commission has been tasked with the short-term objective of developing policy options to achieve program savings, and Congress will soon consider changes to Medicaid that could include modifications to Medicaid’s benefits as well.

Cash and Counseling: Part of the Long-Term Care Answer?

“Cash and Counseling” is a way of allowing individuals receiving personal assistance services through Medicaid to have more control over the services they get and who provides them. The program provides an individualized allowance that beneficiaries can use to hire a personal care assistant of their choice – often a family caregiver – or purchase items that help them live independently, such as chair lifts.

Pay-for-Performance: Taking Health Care Quality Improvement to the Next Level

Pay-for-performance programs have been touted by some as a way to improve the overall quality of care provided to patients, while being criticized by others who fear unintended consequences in attempting to change physician behavior. The Medicare Payment Advisory Commission has recommended that pay-for-performance be incorporated into Medicare reimbursement policy in a number of areas. Recent laws, including the Medicare Modernization Act, have mandated pay-for-performance demonstration projects, including one for chronically ill Medicare patients.

Medicare Basics From (Part) A to D

Medicare covers nearly 42 million beneficiaries who are elderly, or have a disability or end stage renal disease. Spending on Medicare benefits accounted for 17 percent of the nation’s total health care spending in 2004. The Medicare Modernization Act of 2003 made many changes to the program including the addition of a prescription drug benefit (“Part D”), which will begin full implementation in 2006.

How Good is the Quality of Care in Medicare?

The federal government’s responsibility to provide access to health care for the nation’s 41 million Medicare beneficiaries implies another obligation: to spend taxpayer dollars wisely. This means assuring that the $250 billion+ spent for Medicare goes for services that are safe, timely and effective.

Weighing the Evidence: Conducting Reviews of Pharmaceuticals in Four Countries

A worldwide discussion is under way on the role of evidence-based medicine in evaluating the relative effectiveness of prescription drugs. Publicly funded health programs, large employers and managed care plans all are working to learn more about how the costs and benefits of one drug compare with those of another. At the same time, these payers of health care want to make sure that their beneficiaries have access to new pharmaceuticals that offer measurable improvements over older products.

Checking Up: What Are Your Hospital’s Vital Stats?

A newly launched website known as “Hospital Compare” is the most comprehensive attempt yet by the Centers for Medicare and Medicaid Services (CMS) to display voluntary, self-reported information by hospitals on steps that can be taken to reduce the impact of three major causes of morbidity and mortality – heart attack, heart failure, and pneumonia – in a consumer-friendly format.

Understanding Medicaid

With rapidly rising health care costs and pressures on both federal and state budgets as a backdrop, lawmakers are considering a variety of changes to Medicaid this year. This briefing will offer a chance to learn more about the fundamentals of Medicaid, for those who would like to brush up on their knowledge as well as those new to the subject.

Outreach and Enrollment for Kids

Millions of children are eligible for Medicaid and the State Children’s Health Insurance Program (SCHIP), but remain without coverage. How have state budget constraints affected outreach and enrollment in Medicaid and SCHIP? What are the goals of the Administration’s proposed “Cover the Kids” campaign?

Health Care in the 2006 Budget: What’s Next? What to Watch for in the Coming Debates

President Bush’s FY 2006 budget could have long-lasting effects on several health programs. If enacted as is, the budget would trim $60 billion in the growth in Medicaid spending over the next 10 years. At the same time, the budget offers $11 billion in new money to enroll children in Medicaid and the State Children’s Health Insurance Program. It would provide $74 billion in tax incentives to help the uninsured buy coverage. Some congressional budget leaders have signaled their intention to find budget savings in another entitlement program – Medicare.

Understanding Resolutions, Reconciliation, and Other Budgetary Rules of the Road

The budget season is upon us. The Congressional Budget Office’s January 2005 “Budget and Economic Outlook” provides an overview of where Congress will start, and the President’s budget request will arrive next week. The journey down the sometimes bumpy, sometimes difficult-to-understand road to a federal budget for FY 2006 is beginning.

The Reality and Potential of Evidence-Based Medicine

Evidence-based medicine offers a win-win proposition: improve the quality and effectiveness of care while at the same time identifying opportunities to reduce waste of valuable health care resources. But what evidence should employers, health care providers and consumers pay attention to? And how should this information be disseminated to those who need it?

Bioterroism and the States: How Much Improvement?

In 2003, the Trust for America’s Health released a report on state preparedness in the age of bioterrorism. The study found that despite nearly $2 billion in federal funding, state public health systems were insufficiently prepared to handle a bioterrorist attack.

Health Care in the New Congress: Insiders Look Ahead

The 2004 election featured debates on major health issues including costs, access, and affordable prescription drugs. These issues will likely be subjects of continued focus during the upcoming Congress.

Examining Medicare’s Two-Year Waiting Period for Individuals with Disabilities

In addition to providing health insurance coverage for 35 million seniors, Medicare covers about 6 million disabled beneficiaries under age 65 who are entitled to cash benefits under the Social Security Disability Insurance (SSDI) program. SSDI is designed to assist adults who are unable to work due to severe, long-lasting disabilities. However, disabled people who wish to receive coverage under Medicare must first qualify for SSDI cash benefits and wait five months before receiving the benefit. These individuals must then wait an additional two years before becoming eligible for Medicare.

Children’s Care and Coverage: Where Do We Go from Here?

Despite vigorous efforts in recent years to insure more uninsured children, the number of kids without coverage is stuck at 8.4 million. Public coverage of children is on the rise – up 1.7 million between 2002 and 2003. But employer-sponsored coverage is shrinking – down 1.2 million during the same period. One reason: Firms are subsidizing coverage for individual employees to meet insurers’ minimum participation requirements, but aren’t as likely to subsidize family coverage.

Previewing Medicare Advantage

Congress made major changes in the Medicare managed care program, now named “Medicare Advantage,” affecting plans and beneficiaries in 2005 and 2006. The Department of Health and Human Services (HHS) has proposed regulations to implement this part of the new law, and comments on the draft regulations are due by October 4, 2004.

The New Health Insurance Numbers: Whither the Public – Private Coverage Mix?

In August 2004, the U.S. Census released its most recent figures, showing that the number of Americans without health insurance increased to 45.0 million in 2003, up from 43.6 million people in 2002. Those covered by government health insurance programs increased between 2002 and 2003 — from 73.6 million to 76.8 million, largely as a result of greater coverage by Medicaid. At the same time, employer-based coverage shrank. The number of people covered by employment-based insurance fell from 175.3 million to 174.0 million from 2002 to 2003, and the share of the population covered declined from 61.3 percent to 60.4 percent.

Health Care as Campaign Issue: Ready to Rally?

After being buried under stories about the war in Iraq, terrorism and joblessness, health care seems poised to make a comeback as a campaign issue. President Bush has announced that his goals for a second term will include making health care more available and affordable. Details are expected in August. Sen. Kerry and running mate Sen. John Edwards mention the Kerry health proposals often in their appearances.

Looking Under the Hood of Prescription Drug Reimportation

Congressional interest in prescription drugs was by no means exhausted once the Medicare drug bill passed in December 2003. A continuing focus on the Hill is whether to encourage reimportation of drugs to the U.S. from other countries, notably Canada. The secretary of Health and Human Services has had the right to authorize reimportation since the Clinton administration, but no secretary has yet exercised the right, citing safety concerns.

Consumer-Directed Health Care: The Next Big Thing?

Some market-oriented economists have long contended that the best way to get a handle on rising health care costs is to give patients more control over the type of services they consume and the prices they pay for them. There are increasing signs that the market is gravitating in this direction. In the last several years employers have been setting up so-called “consumer-directed” plans, which put more responsibility for selecting the appropriate provider at the right price in the hands of employees—in exchange for potential financial gains.

The Olmstead Decision Five Years Later: How Has It Affected Health Services and the Civil Rights of Individuals with Disabilities?

For decades, it was routine in the U.S. to house individuals with disabilities in institutions. Those with mental illnesses, for instance, were placed in “insane asylums,” as they were once called. The U.S. Supreme Court took a firm step toward ending this practice five years ago. In the Olmstead v. L.C. decision, the court found that institutional isolation of individuals with disabilities was, under certain circumstances, a violation of the Americans with Disabilities Act.

Evaluating Proposals to Expand Health Insurance: Find the Right Balance

After passing a Medicare drug benefit in 2003, a number of key lawmakers have turned their sights to expanding health insurance coverage, to reduce the 43 million Americans who remain uninsured. Proposals to expand coverage vary widely, including tax credits and limited public coverage expansions.

Reversing a Super-Sized Epidemic: Policy Options For Dealing With Obesity

With nearly 130 million people obese or overweight, America is truly facing an epidemic. The proportion of Americans who are overweight or obese rose to 64 percent of the population in 2000 from 60 percent in 1990. Moreover, nearly 17 percent of preventable deaths in 2000 were attributable to poor eating habits and sedentary lifestyles, up from 14 percent in 1990, according to the Journal of the American Medical Association.

Medicare Drug Discount Cards: How Do They Work?

On June 1, 2004, Medicare beneficiaries were able to use their new drug discount cards for the first time. But around the country, many Medicare beneficiaries, family members and service organizations were asking questions about how to choose a card and exactly how the cards will help beneficiaries reduce their drug costs.

How Can Information Technology Improve Health Care Quality?

The health care sector has languished behind almost all other industries in adopting information technology, which has the potential of vastly improving quality. For example, a variety of studies have found that prescribing drugs through a system known as computer physician order entry, compared with a handwritten prescription, greatly reduces the incidence of the wrong medication being prescribed or the wrong dose dispensed. There are significant barriers to the adoption of information technologies in health care. These barriers include technical and infrastructure obstacles, initial implementation costs, provider resistance, current reimbursement structures and a lack of more uniform standards that would allow products from different vendors to work together.

Key Principles for Covering the Uninsured

More than 43 million U.S. residents lacked health coverage in 2002 and unless private or public coverage programs expand, the number of uninsured could continue to rise over the next decade. To address this growing problem, the Institute of Medicine (IOM), with support from The Robert Wood Johnson Foundation, has been conducting a three-year study of the uninsured to assess and consolidate evidence about the health, economic and social consequences of uninsurance for those without insurance, their families, health care systems and institutions, and communities as a whole.

Medicare Prescription Drugs and Low-Income Beneficiaries

Low-income Medicare beneficiaries are a vulnerable population because of their disproportionately high medical and long-term care needs. Among low-income beneficiaries are nearly seven million individuals who are considered “dual-eligibles,” with coverage from both Medicare and Medicaid. They represent around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.

Preparing for Bioterrorism: A Report Card on State Efforts

September 11 and subsequent anthrax attacks demonstrated clearly that our public health system was not prepared to cope with a large-scale emergency. Congress responded by appropriating $1.8 billion to help states and communities better prepare. Another $1.12 billion is contained in the omnibus appropriations bill for 2004 awaiting final action.