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.

Integrating Care for Dual Eligibles: What Do Consumers Want?

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.

Inside Deficit Reduction: What Now?

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.

Inside Deficit Reduction: What it Means for Medicaid

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.

Pharmaceutical Policy and Pricing: Are Other Countries Getting Greater Value?

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.

Medicaid Innovations: Can Managed Care Cut Costs and Improve Value?

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.

50 Million Uninsured: The Faces Behind the Headlines

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.

Inside Deficit Reduction: What It Means for Medicare

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.

Long-Term Services and Supports: A Rebalancing Act

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.

Inside Deficit Reduction: What It Means for Health Care

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.

Managing Costs and Improving Care: Team-based Care of the Chronically Ill

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 Innovation Center: How Much Can It Improve Quality and Reduce Costs – and How Quickly?

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.

Preventing Chronic Disease: The New Public Health

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.

Keeping Coverage Continuous: Smoothing the Path between Medicaid and the Exchange

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.

Accountable Care Organizations: A New Paradigm for Health Care Delivery?

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.

Public Reporting of Quality Outcomes: What’s the Best Path Forward?

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.

Community Coalitions: Pursuing Better Quality Health Care One Locality at a Time

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.

The State of Children’s Health, Care and Coverage

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.

Medicare: A Primer

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: A Primer on the Federal-State Partnership

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.

Shared Medical Decision Making: We’re in This Together

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.

Boomers Come of Age: Covering Early Retirees and Other 50-64 Year-Olds

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.

Innovations in Primary Care: What’s in the ACA?

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.

Trends in Health Insurance Coverage in the U.S.: The Impact of the Economy

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.

The Health Workforce Dream Team: Who Will Provide the Care?

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.

Physician Workforce: The Next Generation

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.

Investing in Health IT: What the U.S. and Other Countries Are Learning

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.

Designing a Marketplace that Works: Steps to Affordable Coverage

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.

More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

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.

50 Ways to Implement Health Reform: State Challenges and Federal Assistance

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.

The $174 Billion Question: How to Reduce Diabetes and Obesity

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.

Health Reform Implementation: When Sausage-Making Moves Downtown

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.

The New Health Reform Law and Young Adults

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.

Pathways to Payment Innovation in a Post-Health Reform Era

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.

What’s in There? The New Health Reform Law and Medicare

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.

What’s in There? The New Health Reform Law and Private Insurance

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.

The New Health Reform Law and Medicaid

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.

What’s in There? An Ask-the-Experts Overview of the Health Reform Law

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.

“To Err is Human” — 10 Years Later

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.

From Crunch to Crisis: State Budgets, Medicaid and the Economy

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: House or Senate Style?

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.

Workplace Wellness Programs, Healthy Behaviors and Health Reform

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.

Affordability and Health Reform: If We Mandate, Will They (and Can They) Pay?

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.

Children’s Health Coverage: Medicaid, CHIP, and Next Steps

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.

Rural Health: Laying the Foundation for Health Reform

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 Opinion on Health Reform: What Do the Polls Mean?

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.

The Uninsured: What Do the New Numbers Mean for Health Reform?

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?

Ask the Experts About Reform: Where Are We Now and Where Are We Headed?

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?

Expanding Access to Care: More than Just an Insurance Card?

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?

Show Me the Money: Options for Financing Health Reform

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.

Healing Mind and Body: Behavioral Health and Reform

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.