Health Policy: The Latest From New America

Grand Junction, Colorado

Health Policy — Wed, 12 Aug 2009 23:00:00 -0400

The Hidden Drain

Economic Growth — Tue, 30 Jun 2009 03:02:00 -0400

Recently, discussions around health care reform have begun in earnest among politicians and policymakers in Washington, D.C. and beyond. President Obama has spent the month of June hitting the trail and the airwaves making the case for reform, and legislators are now aiming to pass a health care reform bill sometime this summer. With the possibility of comprehensive changes to health care on the horizon, it is important for leaders and policymakers—as well as citizens—to understand the full argument for reforming the health care system in the United States.

Realigning U.S. Health Care Incentives to Better Serve Patients and Taxpayers

Health Policy — Fri, 12 Jun 2009 02:00:00 -0400

Our Vision for Health System Reform:

The Hill Physicians Medical Group and the Baylor Health Care System

Health Policy — Wed, 25 Mar 2009 19:00:00 -0400

In these case studies for The Commonwealth Fund, Dr. Nichols and Tom Emswiler examine high-performing health care systems to see how they achieve better outcomes at lower cost. Both the Hill Physicians Medical Group, an association of physicians in individual practice, and the Baylor Health Care System, a highly integrated delivery system, have successfully standardized care, implemented electronic medical records, and improved clinical outcomes.

Making Medicare Sustainable

Health Policy — Thu, 19 Mar 2009 07:40:00 -0400

About the Collection:

The ever-growing cost of health care is the largest threat to our nation's long-term fiscal future. One way of tackling this problem is by using Medicare-the nation's largest purchaser of health care-as a catalyst for widespread efficiencies in the private sector. Medicare must become a more value-based purchaser to make the Program sustainable over time and incent the private sector toward change. It is imperative that we act decisively and soon. Yet, we believe embarking on a Medicare-only reform effort

A Modest Proposal for a Competing Public Health Plan

Health Policy — Wed, 11 Mar 2009 18:00:00 -0400

For the full text of the paper, please click here.

For a brief summary of the paper, please click here.

For Len Nichols' post on National Journal's Health Care Experts blog, please click here.

The Case for Health Reform

Health Policy — Fri, 20 Feb 2009 17:12:00 -0500

About this paper:

"The Case for Health Reform: The Moral, Economic, & Quality Motives for Action" compiles the facts and figures that explain why health reform is a moral imperative, an economic necessity, and a necessary step toward ensuring our health system delivers high-quality care to us all.

The Cost of Doing Nothing

Health Policy — Thu, 13 Nov 2008 17:07:00 -0500

Introduction
The U.S. health care system is in crisis. Health care costs too much; we often get too little in exchange for our health care dollar; and tens of millions of Americans are uninsured.

Guide to Health Care Policy: The 2008 Presidential Election

Fiscal Policy — Fri, 31 Oct 2008 07:56:00 -0400

One of the most pressing issues facing policymakers in the United State is rising health care costs. Cost growth is putting ongoing stress on the budgets of families, employers, and governments. The U.S. already spends $2.2 trillion a year - 16 percent of GDP - for health care. Nearly a third of this comes from the federal government.

Health expenditures are projected to nearly double to $4.3 trillion in a decade, at which point they will represent nearly one-fifth of the economy. According to the Congressional Budget Office, by 2030 they could consume a third, and by 2080 nearly half of GDP.

As health care costs grow, there will be considerable pressure on the federal government's budget. Medicare, which offers retired Americans hospital insurance (Part A), physicians' services insurance (Part B), and a prescription drug plan (Part D), is expected to grow faster than any other single part of the budget as health care costs rise and the population ages. Likewise, Medicaid, which offers insurance for poorer Americans jointly with the states, and the State Children's Health Insurance Program (SCHIP), which works with states to insure children in low-income families who aren't eligible for Medicaid, will see their costs go up. Together, these three programs are expected to rise from 4.2 percent of GDP today to 8.1 percent in 2030 and 18.5 percent in 2082. That would be above the historical average of tax revenue raised to finance all government spending.

The rising cost of private insurance also affects the government's finances because compensation paid in the form of health insurance is not subject to taxation. As health insurance grows as a share of compensation, this "employer exclusion" costs the government more in lost revenues. In 1993, the exclusion resulted in $46 billion in forgone revenue from the income tax. Last year, that number was $106 billion. By 2011 it will be $145 billion.

Despite the amount the federal government spends on health care, there are nearly 46 million Americans without insurance and rising costs threaten to grow the rolls of the uninsured. Furthermore, there are many areas of our health care system where the quality lags behind other nations even as we pay a higher price.

The three inter-related issues - cost, coverage, and quality - dominate the health care debate. While there is little agreement about how it should be done, most Americans agree that something is needed to improve the current system.

Senators McCain and Obama have each proposed a set of reforms to the current health care system. But even accounting for the savings that could be achieved in Medicare, Medicaid, SCHIP, and the employer exclusion, both plans would come at a considerable cost to the U.S. Treasury.

Across State Lines Explained

Health Policy — Wed, 08 Oct 2008 03:36:00 -0400

As we enter the home stretch of a long presidential campaign, the good news is that both major candidates recognize that our health care system, especially the insurance marketplace, does not work well. The concept of selling health insurance across state lines has been included in health care proposals put forth by several Members of Congress and most recently in the campaign plan of Republican presidential nominee, Senator John McCain.

Allowing insurers to sell insurance across state lines would not work as advertised. While it may help the young and healthy, it will have a devastating impact on the insurance market for everyone else (and none of us will be young and healthy forever).

premiums would rise for many people,
benefits would be less-generous,
more Americans would likely become uninsured over time.

This policy approach fails to provide the incentives necessary to transition insurers to a 21st Century business model that values care coordination and high value care over underwriting and marketing. Without substantial additional reforms, the proposal to sell insurance across state lines will not work for most Americans.

For the complete policy paper, please click here. For a brief summary of the findings of the paper, please click here.

Ambulance Diversions

Health Policy — Wed, 03 Sep 2008 08:26:00 -0400

Every minute in the United States, an ambulance is turned away from a hospital because of a practice known as ambulance diversion. Diverting ambulances away from emergency departments (EDs) poses a serious threat to the health outcomes of both the insured and uninsured population. Ambulance diversions also indicate a struggling health system in need of comprehensive delivery system reforms.

What is an Ambulance Diversion?

An ambulance diversion occurs when a hospital ED cannot care for additional emergency patients. When a hospital is “on diversion” it redirects ambulances from their ED to another hospital or medical facility.

Why Do Diversions Matter?

Ambulance diversions pose a health risk to anyone who needs immediate medical attention. Furthermore, ambulance diversions are an indication that individuals are using EDs for their primary care, and that hospitals have inadequate bed capacities, and/or are being poorly managed.

What Can We Do to Fix This Problem?

There are two major possible policy solutions for ED diversion:

Standardizing Ambulance Diversion Criteria
Covering the Uninsured

For the full text of the issue brief, click here.

Promises, Promises: A Fiscal Voter Guide to the 2008 Election

Fiscal Policy — Wed, 20 Aug 2008 22:37:00 -0400

The United States faces serious fiscal challenges. Large budget deficits have returned, and shifting demographics along with growing health care costs are putting intense pressure on the long-term federal budget outlook. Over time, sustained deficits will weaken the economy and adversely affect the American standard of living.

Twelve Principles for Fiscal Responsibility

Fiscal Policy — Tue, 20 May 2008 10:45:00 -0400

The United States faces a number of serious fiscal challenges. Budget deficits are back, the economy has weakened, Social Security is unsound, growing health care spending is putting immense pressure on the budget, tax policy is at a major crossroads, and borrowing is projected to reach unsustainable levels. Politicians will have to take concrete steps to confront these challenges, and some level of sacrifice will be required. The sooner decisions are made, the better-both because it will give the public more time to adjust and because it will allow us to spread the sacrifices more broadly.

The presidential campaign can either be helpful in this process, by allowing politicians to develop a mandate for change, or damaging, if politicians merely use the election as an opportunity to promise new tax and spending initiatives that would make the situation worse instead of better. It is not surprising that politicians tend to prefer to propose costly new initiatives given that proposals to increase taxes or cut spending are rarely met with appreciation by voters and are almost always met with attacks from political opponents. But considering our current fiscal situation, it is critical that policymakers be willing to address the country's budgetary imbalances. It will require real leadership to do so.

To help move the political discussion forward, the Committee for a Responsible Federal Budget has put forth "Twelve Principles for Fiscal Responsibility." These principles will help voters ask the necessary questions and develop a better understanding of important fiscal issues, and they will help politicians speak directly to these looming problems in a manner that will prepare the country for the necessary changes ahead. Unless the next president and Congress take action to put our fiscal house in order, they will put the budget, the economy, and the well-being of future generations at risk.

The twelve principles are:

1. Admit That We Face Serious Fiscal Problems
2. Elevate the Issue of Fiscal Responsibility
3. Commit to Reducing the Deficit
4. Suggest Solutions to Fix Social Security
5. Suggest Ways to Address Rising Health Care Spending
6. Suggest Solutions to Outstanding Tax Issues
7. Plan to Reform the Budget Process
8. Use Honest Numbers
9. Offset the Cost of New Policies
10. Do Not Perpetuate Budget Myths
11. Do Not Attack Someone Else's Plan (Unless You Put Forward an Alternative)
12. The Media Should Do Their Job

See the below PDF to read the entire report.

Employer Health Costs In a Global Economy

Health Policy — Tue, 06 May 2008 05:29:00 -0400

Increasing Employer Health Costs, Lowering U.S. Competitiveness

Although most Americans get health insurance through their employers, business leaders are increasingly united in their belief that rising health care costs threaten America’s competitiveness in the global economy. Business support for comprehensive health reform has been growing as a result.

Taking Back Our Fiscal Future

Fiscal Policy — Fri, 04 Apr 2008 01:57:00 -0400

The authors of this paper are longtime federal budget and policy experts who have been drawn together by a deep concern about the nation’s long-term fiscal outlook. Our group covers the ideological spectrum. We are affiliated with a diverse set of organizations. We have been meeting informally for over a year, under the auspices of The Brookings Institution and The Heritage Foundation, to define the dimensions and consequences of the looming federal budget problem, examine alternative solutions, and reach agreement on what should be done. Despite our diverse philosophies and political leanings, we have found solid common ground. We agree that:

Unsustainable deficits in the federal budget threaten the health and vigor of the American economy.
The first step toward establishing budget responsibility is to reform the budget decision process so that the major drivers of escalating deficits -- Social Security, Medicare, and Medicaid -- are no longer on autopilot.

More specifically, we recommend that:

Congress and the president enact explicit long-term budgets for Medicare, Medicaid, and Social Security that are sustainable, set limits on automatic spending growth, and reduce the relatively favorable budgetary treatment of these programs compared with other types of expenditures.
The programs be reviewed on a regular schedule by the Social Security and Medicare Trustees or the Congressional Budget Office to determine whether they will remain within budgeted amounts.
Significant long-term deviations from budgeted amounts trigger automatic adjustments in benefits, premiums, provider payments, or other revenues. These adjustments could only be over-ridden by an explicit vote of Congress and acceptance by the president.

We provide examples of specific policies that might be adopted to bring the programs in line with their long-term budgets but believe that the first action needed to restore long-term fiscal balance is a change in the way budget decisions are made...

For the full text of the paper, please see the PDF attached below.

This Paper was Jointly Authored by the Following Individuals:

Joseph Antos
American Enterprise Institute
Robert Bixby
The Concord Coalition
Stuart Butler
The Heritage Foundation
Paul Cullinan
The Brookings Institution
Allison Fraser
The Heritage Foundation
William Galston
The Brookings Institution
Ron Haskins
The Brookings Institution
Julia Isaacs
The Brookings Institution

Maya MacGuineas
The New America Foundation
Will Marshall
The Progressive Policy Institute
Pietro Nivola
The Brookings Institution
Rudolph Penner
The Urban Institute
Robert Reischauer
The Urban Institute
Alice Rivlin
The Brookings Institution
Isabel Sawhill
The Brookings Institution
C. Eugene Steuerle
The Urban Institute

Cost Of Failure

Health Policy — Tue, 25 Mar 2008 06:07:00 -0400

In 2000, the Institute of Medicine (IOM) estimated that the “annualized economic cost of the diminished health and shorter lifespan of Americans who lack health insurance is between $65 and $130 billion for each year of health insurance forgone.”

After updating the IOM’s numbers to reflect growth in the economy and increases in the number of uninsured, we estimate that the poor health and shorter lifespan of the uninsured cost the U.S. economy between $102 billion and $204 billion in 2006. This estimate does not include spillover costs. For example, when medical bills go unpaid, providers attempt to recoup lost revenues by raising the rates for their services. In response, insurers raise premiums. This vicious cycle of “cost shifting”
inextricably links the uninsured to rising health care costs and premium rates for the insured.

The economic cost imposed on the nation by the uninsured is as much as and perhaps greater than the public cost of covering them...

For the full text of the issue brief, please see the PDF attached below.

Lessons From California's Health Reform Efforts For the National Debate

Health Policy — Fri, 07 Mar 2008 18:10:00 -0500

In January 2007, Governor Arnold Schwarzenegger unveiled a comprehensive health care plan that aimed to provide quality, affordable health insurance to all Californians. Based on individual responsibility, the plan focused on prevention and wellness and emphasized a shared responsibility approach to financing.

After almost a year of negotiations between Governor Schwarzenegger and Democratic legislative leaders, compromise legislation with a framework and goals similar to the governor’s original proposal passed the State Assembly with a large majority. This compromise legislation, however, was later rejected by the California Senate’s Health committee.

The effort to reform California’s health care system faced several obstacles unique to the state. Californians seeking reform had a very narrow margin of error within a complex set of legislative, political, and demographic challenges. Health reform proponents also encountered several systemic roadblocks regarding affordability and sustainability common to health care reform proposals generally.

Nonetheless, the bipartisan spirit displayed by Governor Schwarzenegger and Assembly Speaker Núñez showed that Republicans and Democrats can work together to solve our nation’s challenging health care crisis and proved that lawmakers can reach consensus without compromising core values. This bipartisan effort to cover all Californians united a broad coalition of advocates representing citizens, patients, workers, employers large and small, hospitals, insurers, and politicians.

While comprehensive health reform legislation was never signed into law, efforts to reform California’s health system produced a number of lessons for the national health care debate and other states seeking to institute reforms. Among the most important: leadership matters, broad coalitions can be built and maintained, and the issues of affordability for families and sustainability for taxpayers must be satisfactorily addressed.

For the full text of the policy paper, please see the PDF attached below.

Who Receives Uncompensated Care?

Health Policy — Tue, 04 Mar 2008 11:16:00 -0500

Uncompensated care (UC) is health care that is delivered, but not paid for by either a patient or a third party payer. Most UC is delivered to the very ill during or after a visit to an emergency room. In 2004, UC was estimated to total $41 billion dollars.

This issue brief finds that individuals with incomes above 200% of the Federal Poverty Level (FPL) or $41,300 for a family of four and people living at or below the poverty level account for two-thirds of all UC in the U.S.

Three policy solutions may be necessary to reduce UC costs:

More effective outreach initiatives to enroll low-income Americans who are eligible for subsidized coverage in order to minimize the number of people who are currently missed by the system.
Sliding scale subsidies to help make health insurance more affordable for all Americans.
When health insurance is affordable, a purchase requirement or “individual mandate” to address the “free rider” problem and ensure all Americans pay their share for health care.

For the full text of the issue brief, please see the PDF attached below.

Health Care Reporting Guide for Journalists

Health Policy — Tue, 04 Mar 2008 11:08:00 -0500

For reporters new to the health beat -- or for political or business reporters who need to delve into health policy now and then -- the topic can be daunting. Luckily, there are many, many resources on the web, useful whether you are in Washington or around the country... If you find yourself drowning in jargon and acronyms, it helps to take a breath and remember that health care is about people, and that it affects every one of us, and everyone we care about.

This issue brief discusses three common health care concepts:

What Hill Staff Should Know About Health Care

Health Policy — Tue, 04 Mar 2008 10:59:00 -0500

Our current health system is not sustainable. It leaves many Americans without access to quality, affordable health coverage, weakens the ability for U.S. businesses to compete internationally, and threatens the stability of our economy.

There are many ways that we could achieve a system of coverage for all Americans. However, in order to be economically and politically sustainable over time, any comprehensive reform plan must:

Cover all Americans

Lack of health insurance negatively affects the overall productivity of society, the stability of emergency care, and the health and financial well-being of individuals.
Control health care cost growth

No health reform proposal will be sustainable over time without serious efforts to control health care cost growth. Rising health care costs are the most pressing economic challenge facing our nation and have left many Americans simply unable to afford health insurance. In addition, the cost of health care threatens the competitiveness of U.S. businesses and the solvency of the Medicare program.
Improve quality

The Institute of Medicine estimates that almost 100,000 people die every year as a result of preventable medical errors. This is far higher than the OECD average...

For the full text of the the issue brief, please see the PDF attached below.