Health Reform

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ADVANCING NATIONAL HEALTH REFORM

ADVANCING NATIONAL HEALTH REFORM

It is worth emphasizing that all of the California proposals were developed within the constraints of the federal Employer Retirement Income Security Act of 1974 (ERISA), which places limitations on states’ ability to regulate employer-sponsored health benefits. Furthermore, in California raising state taxes requires a two-thirds vote in the legislature or a ballot initiative. Since fees may be increased by a majority vote, policy makers sought to craft proposals in ways that would qualify as fees rather than taxes, creating further constraints that influenced design choices. These special budgetary and ERISA constraints would not apply to federal health reform proposals. Even with these distinctive hurdles, the California experience provides important lessons for national policymakers about how to structure an employer responsibility requirement, as well as about the political forces that will shape its prospects.
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Three Essays on the Economics of Health Reform.

Three Essays on the Economics of Health Reform.

On March 23 rd , 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA), the first successful attempt at major health reform in nearly half a century. At the time of its passage, the need for health reform was particularly urgent. The rate of employer-sponsored insurance coverage had steadily declined since it was first measured in 1987, covering only 55 percent of Americans in an employer-based health insurance system (DeNavas-Walt, Proctor, and Smith 2011). At the same time, the private alternative to employer-sponsored coverage—insurance purchased directly from insurers in the non-employer market—was often difficult to obtain. Because these markets are characterized by adverse selection, insurance premiums were high relative to comparable employer-sponsored plans, and many individuals with high medical costs were excluded from the market altogether. As a result, nearly 55 million Americans, or 16 percent of the population, lacked health insurance coverage, putting them at risk of bad health outcomes and financial insecurity (DeNavas-Walt, Proctor, and Smith 2011; Council of Economic Advisers 2011).
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Health Reform Monitoring Survey -- Texas

Health Reform Monitoring Survey -- Texas

The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. It is designed to provide timely information on implementation issues under the ACA and to document changes in health insurance coverage and related health outcomes. HRMS provides quarterly data on health insurance coverage, access, use of health care, health care affordability, and self-reported health status. The HRMS was developed by the Urban Institute, conducted by GfK, and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation, and the Urban Institute. Rice University’s Baker Institute and The Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas). The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation. Information about the sample demographics of the cohort is available in Issue Brief #1. This Issue Brief is a summary of data extracted from the HRMS Surveys
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Health Reform. National Health Insurance A Brief History of Reform Efforts in the U.S.

Health Reform. National Health Insurance A Brief History of Reform Efforts in the U.S.

Rep. Mills, still chairing House Ways and Means, again took up the cause by cosponsoring Nixon’s CHIP. Realizing the potential for universal coverage, Kennedy then teamed with Mills to produce a middle-ground bill with an employer mandate and personal cost-sharing, using private insurers as intermediaries—but distinct from CHIP in requiring employees to participate and it was to be financed by a payroll tax. Sen. Long rejected the Kennedy- Mills bill, but agreed that he would not block the progress of health reform on its way to any future conference committee. Republican legislators were divided, feeling the need to support CHIP or a catastrophic coverage plan in order to block even broader NHI, while other Republicans wanted neither, but were muted by the President’s goals. By the spring of 1974 there was bipartisan support for health reform, with no members wanting to be seen
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Health Reform Medicaid and children s health insurance PrograM Provisions in health reform Bills:

Health Reform Medicaid and children s health insurance PrograM Provisions in health reform Bills:

This side-by-side compares the Medicaid and CHIP provisions in the Affordable Health Care for America Act, passed by the House on November 7, 2009 and the Patient Protection and Affordable Care Act, passed by the Senate on December 24, 2009 to current law. This analysis focuses on Medicaid coverage and financing changes; how Medicaid and CHIP interface with a new health insurance exchange, and other Medicaid benefits and access changes. A more comprehensive side- by-side of health reform proposals can be found at: www.kff.org/healthreform/sidebyside.cfm.

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Timeline: History of Health Reform in the U.S.

Timeline: History of Health Reform in the U.S.

In the face of stagflation and rapidly rising health care costs, President Carter prioritizes health care cost containment over expanding coverage. Sen. Kennedy, however, drafts another national health insurance proposal, which is then followed by Carter's own plan that would delay implementation until 1983. National health reform efforts were completely stalled in the face of an economic recession and uncontrollable health care costs.

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MASSACHUSETTS HEALTH REFORM

MASSACHUSETTS HEALTH REFORM

As they consider these lessons, readers should note that Massachusetts started imple- mentation in a particularly favorable policy environment for expanding coverage. This included a relatively low rate of uninsured residents (about 10 percent) and high levels of employer-sponsored coverage. In addition, insurance market reforms were already in place; safety-net care was supported by a well-functioning Uncompensated Care Pool; and the state had been operating for almost a decade with a federal Section 1115 waiver that allowed for creativity and flexibility in expenditures for MassHealth, which encom- passes Medicaid and the Children’s Health Insurance Program (CHIP). Further, much of the impetus behind passage of the Massachusetts law had come from health care, busi- ness, and consumer groups that helped push through a bipartisan legislative solution. Five years later, health reform continues to garner broad support.
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Impacts of Health Reform in Tennessee

Impacts of Health Reform in Tennessee

Forecasting the impact of bold new health reform legislation is at best a proposition complicat- ed with risk and challenges. The political and regulatory uncertainties are enormous, and they are further complicated by the assumptions used in projecting future changes. For example, insurance take-up rates by individuals can change widely depending upon how aggressively new programs are promoted and the complexity of enrollment processes. Similarly, published estimates of how much public insurance programs crowd out private coverage range from near 0.0 percent to 60.0 percent. Recognizing the risk and uncertainty involved in model design and estimation, this report’s authors have consistently used middle-range estimates of key assumptions such as the take-up rates by individuals seeking insurance and the effects of the public and publicly-funded insurance crowd- ing out private insurance. The actual impacts may prove to be greater or smaller than those reported in this report, and much depends on both the outcomes of election-year politics nationally and how market competition and promotional practices in Tennessee will affect the actual enrollment of the previously uninsured through the various channels, such as the new insurance exchange and Medicaid expansion.
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What will be covered in the health insurance offered under health reform?

What will be covered in the health insurance offered under health reform?

insurers providing high-cost coverage to the individual market. This issue has been a major source of contention between organized labor and the Obama administration. The decision on implementing the fee was done through HHS. It is particularly troublesome since non- profit plans and their members are paying this tax to subsidize for-profit companies. The IAFF is working with other unions and our allies in Congress to address this issue. The assessment costs $63 per individual enrolled in 2014, and HHS will make a determination as to how much the fee will be in 2015 and 2016. The fee will be paid by health insurance issuers or “TPAs on behalf of self-insured group health plans.” 2
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Impact of Health Reform on Prescription Drugs

Impact of Health Reform on Prescription Drugs

– Opportunity for independent pharmacies to contract with Part D plans due to decreased competition with mail order and retail pharmacies that cannot supply daily or weekly dosing.. I[r]

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The Bell Is Tolling: Retiree Health Benefits Post-Health Reform

The Bell Is Tolling: Retiree Health Benefits Post-Health Reform

See generally INTERNAL REVENUE SERV., PUB- LICATION 969: HEALTH SAVINGS ACCOUNTS AND OTHER TAX-FAVORED HEALTH PLANS (2010), available at http://www.irs.gov/pub/irs-pdf/p969[r]

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Health Reform and Changes in Health Insurance Coverage in 2014

Health Reform and Changes in Health Insurance Coverage in 2014

In conclusion, we found that the number of Americans without health insurance declined significantly since the ACA open-enrollment period began in October 2013. The patterns of coverage changes were consistent with the eligi- bility criteria in the law regarding subsidized coverage and HHS statistics on state-level en- rollment in ACA programs. National estimates of coverage after the open-enrollment period will not be available from federal surveys until late 2014, and reliable state-level estimates will not be available until the fall of 2015. Future research with these government-conducted sur- veys will be valuable to corroborate these find-
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Health Reform SUMMARY OF KEY CHANGES TO MEDICARE IN 2010 HEALTH REFORM LAW

Health Reform SUMMARY OF KEY CHANGES TO MEDICARE IN 2010 HEALTH REFORM LAW

• Creates the Center for Medicare and Medicaid Innovations (CMI) to test, evaluate, and expand in Medicare, Medicaid, and CHIP different payment structures and methodologies to reduce program expenditures while maintaining or improving quality of care, to be established by January 1, 2011. Payment reform models that improve quality and reduce the rate of cost growth could be expanded nationally throughout the Medicare, Medicaid, and CHIP programs. Provides 20 possible models for testing, including allowing states to test and evaluate fully integrating care for dual eligible individuals in the state. Authorizes the Secretary to limit model testing to certain geographic areas. (Section 3021, as modified by Section 10306)
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An Economic Perspective on U.S. Health Reform

An Economic Perspective on U.S. Health Reform

Commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among QHBP offering entities offering Exchange-participating health benefits plans of premiums collected for such plans that takes into account (in a manner specified by the

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The interface between health sector reform and human resources in health

The interface between health sector reform and human resources in health

Although each country's reform process has its own spe- cificity, there are common trends, such as the pursuit of better outcomes in terms of quantity and quality of serv- ices using the same or fewer resources, which has become known as "getting more value for money." In the health sector, these objectives are commonly expressed in terms of improving equity of access to services, effectiveness of care, efficient utilization of resources, satisfaction of users, and sustainability. The emphasis varies, however, depend- ing of the economic conditions and the political environ- ment of the country. Here we will focus on the equity, efficiency and quality objectives, as they tend to be com- mon to all health reform processes. We refer to these objectives as "declared objectives," recognizing that, in practice, reform processes can be driven by other motives and objectives, while still using the language of equity, efficiency and quality.
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Colombian Health System Reform *

Colombian Health System Reform *

In 1993, in the middle of a delicate economic, political and social scene, the Colombian government, led by the current President Alvaro Uribe, proposed a reform of the health system, supported by what is called ¨structured pluralism¨. The Colombian health reform was considered an absolute success and became symbolic in Latin America. It was claimed to be so successful that it was catalogued as the fairest in the world in according to the WHO (WHO, 2002). In the following paragraphs we will show how this was not the case.

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Human Resources and the Success of Health Sector Reform

Human Resources and the Success of Health Sector Reform

Some of the health occupations in the UK, particularly the doctors and nurses, have well established and effective political lobbying and policy influencing capacity. Without their support (or tacit compliance) it is very difficult for a government to fully implement substantial change in the HR elements of health reform. At an operational level, management of medical staff has been a particular challenge to HR since the NHS was established in 1948, as doctors retain various employment freedoms. The current NHS Plan led reforms have been based on a “partnership approach” with the main trade unions and professional organisations “bound into” the process of developing the plan. The leaders of most of the main unions were signatories to the Plan document. The price of this support was target setting to increase the number of doctors, nurses and other professionals employed in the NHS, and a pledge of new pay structures and career structures. Major indicators in the new HR performance framework include indicators of staff well-being and access to training. The Plan is only in its early stages of implementation and the biggest challenge will be to “sell” it to staff at the operational level. There are already signs that some medical professionals are unhappy about proposals to curtail their private practice and to implement mandatory performance appraisal.
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UNDERSTANDING HEALTH CARE REFORM

UNDERSTANDING HEALTH CARE REFORM

FACT: AARP, the AMA, the American Hospital Association, and nursing homes across the country support the health reform law because it strengthens the Medicare program for seniors and taxpayers. Health reform improves Medicare by closing the Part D “donut hole,” improving coverage of preventive benefits, and extending the life of the Medicare trust fund by a decade. A Republican-led filibuster blocked a permanent fix to the Medicare physician payment issue in October but Democrats remain committed to enacting a long-term doctor’s fix .

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Disability Insurance and Health Insurance Reform

Disability Insurance and Health Insurance Reform

Because most non-elderly adults in the United States obtain health insurance coverage through their employer, individuals who experience a work-limiting health condition face a difficult dilemma: attempt to keep working in spite of an uncomfortable impairment in order to maintain employer-sponsored health insurance (ESHI) or stop working in order to apply for SSDI or SSI and risk an extended period of uninsurance. Some of these individuals may be able to obtain subsidized coverage through a spouse’s employer. Others may be able to retain their employer coverage temporarily under COBRA provisions, but at full cost during a period without labor earnings. 2 If the disincentive arising from loss of health insurance coverage presently discourages labor force withdrawal and disability benefit application, then the ACA’s introduction of affordable health insurance coverage outside of employment could free workers from “employment lock,” and consequently increase both disability-related labor force
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Electronic Health Record (EHR) Reform

Electronic Health Record (EHR) Reform

Large scale implementation of EHR systems need to be part of a clearly defined vision and strategy agreed within the healthcare sector. All EHR projects should be the subject of a clearly defined business case based on a benefits and outcomes (clinical, financial, on the public health system and others) assessment across the health organizations to which all stakeholders subscribe. User engagement is vital throughout the whole EHR selection, decision and

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