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Health Reform

IN THE STATES: Full Steam Ahead on Exchanges

October 27, 2010
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The headlines lately are full of stories about the touchy politics of health reform or the legal challenges in the courts. So from time to time it's useful to check on how implementation is actually going in the states, even states pursuing legal challenges.  If you poke your head outside of the Beltway (or talk with those intrepid voyagers who do), you’ll see that -- while their stories might not be grabbing headlines at the moment -- the on-the-ground implementation efforts are by and large moving ahead quite nicely.

A few days ago at the Alliance for Health Reform event, “Designing a Marketplace that Works: Steps to Affordable Coverage,” Joel Ario (from HHS) and Michael McRaith (from the Illinois Insurance Department), amongst others, surveyed the current status of exchange development.  Their message, echoing what you’ve heard from anyone from NAIC since the insurance commissioners began tackling MLR (medical loss ratio) during the last couple of months, is that January 1, 2014 is the shortest 3-plus years away you’ve ever seen. But both Ario and McRaith, returning from “the field,” seemed confident that states are on track, that they are focused and in sufficiently high gear to make the deadline to have functioning insurance exchanges.

IN THE STATES: Don't Stop Thinking About Tomorrow

October 25, 2010

In the wake of California’s first-in-the-nation passage of legislation creating a health benefit exchange under the terms of the Affordable Care Act, our readers asked, in effect, “What’s the fuss”? After all, federal regulations on exchanges are still being written. And federal law provides for fallback authority to create state-based exchanges should states fail to act on their own by 2014, when the exchanges are required to be up and running.

Indeed, health expert Jacob Hacker, in an important piece, has argued that “reform’s strongest advocates at the state level should be willing to encourage state leaders not to set up their own exchanges, pressing instead for state officials to conserve resources and enlist the federal government to contract with and oversee private plans directly.” Hacker believes that direct federal action will make exchanges cheaper to establish, ensure that the exchanges offer a robust set of benefits, and prevent insurers from bending the rules in their favor.

HEALTH INSURANCE: The Final Word (Sort Of) on MLRs

October 21, 2010

The votes are in. State insurance regulators, from the National Association of Insurance Commissioners (NAIC), voted unanimously Thursday morning on definitions for the Medical Loss Ratio (MLR). The “medical loss ratio” refers to the amount of money insurers spend on providing actual health and medical care to their customers. The Affordable Care Act sets minimum standards for the MLR -- large, group insurers have to spend at least 85 percent of their money on medical care (it’s 80 percent for small group or individual policy insurers). That means that only 15 percent can go to expenses that don’t specifically improve patient health, like administrative overhead and advertising costs.

The NAIC spent the week in Florida trying to reach a consensus on MLR policy -- answering questions like: what counts as “medical” spending? Will the MLR calculation take place at the state or national level? And how do we account for changes in the role of brokers in the new insurance marketplace? HHS will rely heavily on the NAIC recommendations to craft final regulations.

COST: Spiraling Costs and Striking Differences for Hospital Systems in California

October 21, 2010
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Jordan Rau of Kaiser Health News has penned a must-read on rapidly rising hospital prices in California that lays out in compelling detail some of the factors that drive sharp differences particularly within local communities. If you are concerned about provider costs continuing to rise in the wake of reform (as you must be if you care about health policy) you should go over and read the whole thing.  

One of the things that jumped out for me was further documentation of the connection between market share and payment rates. We hear a lot about this issue as it relates to differences across regions but this dynamic plays out within local communities as well:

POLITICO ARENA: Can Tenthers Block Health Care Law?

  • By
  • Kavita Patel,
  • New America Foundation
October 19, 2010 |

State government officials should not step in and block portions of the health care reform law that they disagree with. The law was intentionally designed to empower state and local authorities; they have the power to adapt and transform the law according to their unique market needs. If governors and their appointees refuse to implement the law, then the millions of Americans who have been waiting for solutions for their health care to improve will need to exercise their democratic ability to influence the process.

HEALTH POLITICS: The View From 1966?

October 18, 2010
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Jim Abrams of the AP has a good overview piece on the remarkably productive Congress -- everyone may yell about gridlock but this Congress has passed a historic health care bill, the economic stimulus package, Wall Street accountability (not to mention making college loans more affordable, Cash for Clunkers to help revive the auto industry, credit card consumer protection, tax credits for first-time home buyers, and regulation of tobacco, to name a few).

It’s the most productive Congress, Abrams quoted several experts as saying, since the Great Society years, when a Democratic-led Congress created Medicare, Medicaid and passed civil rights laws -- and then got hammered in the next election.

HEALTH POLITICS: So Just How Popular is This Repeal Thing After All?

October 15, 2010

The expert public opinion analysts over at the Kaiser Family Foundation took a deeper look into the polling numbers on the repeal of health reform, and it turns out we are not the only ones skeptical about the supposed clamor for repeal:

When it comes to understanding public opinion on the new health reform law, poll watchers might be forgiven for being confused as to whether repeal is actually a popular option or not. Over the course of the past month, at least eight well-respected polls have asked Americans whether they support the idea of repealing health reform, and, as the chart [here] shows, responses have been all over the map, ranging from a high of 51 percent in an NBC News/Wall Street Journal poll to a low of 26 percent in our September Kaiser Health Tracking survey.

IN THE NEWS: Health Wonks Love a Good Rescue

October 14, 2010

This week's Health Wonk Review is up over at the Healthcare Economist, where -- inspired by the daring rescue in Chile -- Jason Shafrin has MINED the Internet for the best in health policy writing. Joanne Kenen's continuing campaign for a rational discussion of palliative care makes the list. Aaron Carroll breaks down why the U.S. hasn't hit the health spending "sweet spot" like other OECD countries, but John Goodman doubts the ACA's three major cost cutting measures will succeed in getting us there. Meanwhile, the Notwithstanding Blog is skeptical of a government fighting obesity (a major indirect cost driver) while still subsidizing high fructose corn syrup. If you've been glued to your TV, you missed some great health policy blogging this week. Head over to the Healthcare Economist blog now and check it out!

COST: Long Term Care and the Revolving Door

October 15, 2010
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So just how fast does that revolving door spin? The Kaiser Family Foundation this week released several reports on Medicare spending for people in nursing homes or other long-term care facilities.  Of course it's no surprise that these patients are expensive -- they wouldn’t be in nursing homes if they were in perfect health. But the reports shed a lot of light on just how expensive their care is -- and just how often they go in and out of emergency departments, the hospital, and skilled nursing facilities.

These patients cost Medicare $14,538 -- nearly twice the annual cost of the average Medicare beneficiary. (Remember that Medicare pays for doctors and hospitals and the like -- whether the person lives at home or in a long-term care (LTC) setting. Medicare does not pay for long-term care. Medicaid pays for the long-term care of low-income people.)

HEALTH REFORM: Making 'Meaningful Use' Meaningful for Patients and Health Care Providers

October 8, 2010
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This post was originally published in iHealthBeat, www.ihealthbeat.org.

HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, andwhile not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

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