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Full-Text Articles in Health Policy
Multi-State Plans Under The Affordable Care Act, Trish Riley, Jane H. Thorpe
Multi-State Plans Under The Affordable Care Act, Trish Riley, Jane H. Thorpe
Health Policy and Management Faculty Publications
New state health insurance exchanges that are developing under The Patient Protection and Affordable Care Act (ACA) will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs. These plans will be administered by the federal Office of Personnel Management (OPM). The MSPs must meet the same requirements as other QHPs. As with other QHPs, people enrolled in the plans will be eligible for premium tax credits and cost sharing assistance if their income is less than 400 percent of poverty …
Examining The Evidentiary Basis Of Congress's Commerce Clause Power To Address Individuals' Health Insurance Status, Sara J. Rosenbaum, Leighton C. Ku, Paula M. Lantz, Holly Mead, Michal Mcdowell
Examining The Evidentiary Basis Of Congress's Commerce Clause Power To Address Individuals' Health Insurance Status, Sara J. Rosenbaum, Leighton C. Ku, Paula M. Lantz, Holly Mead, Michal Mcdowell
Health Policy and Management Faculty Publications
Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme …
Building A Relationship Between Medicaid, The Exchange And The Individual Insurance Market, Sara J. Rosenbaum, Trish Riley
Building A Relationship Between Medicaid, The Exchange And The Individual Insurance Market, Sara J. Rosenbaum, Trish Riley
Health Policy and Management Faculty Publications
The alignment of Medicaid and State Health Insurance Exchange (Exchange) policy and practice is a basic tenet of the Patient Protection and Affordable Care Act (ACA). Through both legislative provisions and implementing regulations, the ACA addresses this relationship. At the same time, the federal framework provides states with considerable discretion to flesh out the fuller dimensions of system interaction.
Analysis Of The Extent To Which State Insurance Laws Mandate Coverage And Payment Of Vaccines And Vaccine Administration Fees During Periods Of Declared Public Health Emergencies, Sara J. Rosenbaum, Nancy Lopez, Ross Margulies
Analysis Of The Extent To Which State Insurance Laws Mandate Coverage And Payment Of Vaccines And Vaccine Administration Fees During Periods Of Declared Public Health Emergencies, Sara J. Rosenbaum, Nancy Lopez, Ross Margulies
Health Policy and Management Faculty Publications
This analysis examines whether state insurance laws require health insurers, as a condition of doing business, to pay the costs associated with the administration of immunizations during declared public health emergencies. As is the case with the current H1N1 emergency, a public health emergency triggers nationwide distribution of free vaccine. But even when vaccine is distributed free of charge, its administration poses costs to private physicians and charges can be significant. As a result, the Institute of Medicine has identified vaccine administration as a potential financial barrier to care. Most communities have limited numbers of public health workers and professional …
Antitrust Aspects Of Health Information Sharing By Public And Private Health Insurers, Taylor Burke, Lara Cartwright-Smith, Erica Pereira, Sara J. Rosenbaum
Antitrust Aspects Of Health Information Sharing By Public And Private Health Insurers, Taylor Burke, Lara Cartwright-Smith, Erica Pereira, Sara J. Rosenbaum
Health Policy and Management Faculty Publications
This policy brief is the first of two to address antitrust considerations that arise in health system transformation aimed at producing greater clinical integration and greater levels of information about the quality and cost of care. The second policy brief will discuss the implications of several recent Federal Trade Commission rulings on physician joint contracting to achieve clinical integration and greater health information accountability. These rulings have significant implications for growing efforts, as part of health reform, to create entities known as accountable care organizations.
America's Public Hospitals And Health Systems, 2003: Results Of The Annual Naph Hospital Characteristics Survey, Jennifer Huang, Joshua Silbert, Marsha Regenstein
America's Public Hospitals And Health Systems, 2003: Results Of The Annual Naph Hospital Characteristics Survey, Jennifer Huang, Joshua Silbert, Marsha Regenstein
Health Policy and Management Faculty Publications
In 2003, members of the National Association of Public Hospitals and Health Systems continued to offer millions of uninsured and underserved individuals access to the medical services so critical for lifelong health and well-being. Delivering these services was difficult, however, given the economic downtown early in the decade and the resulting inadequacies associated with safety net financing. This report examines the operations and activities of NAPH members in 2003, presents the financial challenges they faced, describes the clinical and community services they provided, and profiles the patients they served.
Analysis Of Carefirst's Performance As A Charitable Not-For-Profit Health Insurance Company In The National Capital Area, Sara J. Rosenbaum, Brian Kamoie, Charlotte Collins, Ann Zuvekas, Judy Feder, Gary Claxton
Analysis Of Carefirst's Performance As A Charitable Not-For-Profit Health Insurance Company In The National Capital Area, Sara J. Rosenbaum, Brian Kamoie, Charlotte Collins, Ann Zuvekas, Judy Feder, Gary Claxton
Health Policy and Management Faculty Publications
The George Washington University School of Public Health and Health Services ("GWU") and the Georgetown University Institute for Health Care Research and Policy ("GU")conducted this analysis on behalf of the DC Appleseed Center for Law and Justice in order to examine whether, in its operations and business practices, CareFirst BlueCross BlueShield ("CareFirst") appears to be fulfilling its chartered mission for the National Capital Area. The study began as an analysis of the coverage and access implications for the region of a proposal made by CareFirst and WellPoint Health Networks, Inc. ("WellPoint") to convert CareFirst to for-profit status and permit its …
How Care Is Managed: A Descriptive Study Of Current And Future Trends In Care And Cost Management Practices Under Private Sector Employee Benefit Plans, Phyllis Borzi, Marsha Regenstein, Lee Repasch, Soeurette Cyprien, Sara J. Rosenbaum
How Care Is Managed: A Descriptive Study Of Current And Future Trends In Care And Cost Management Practices Under Private Sector Employee Benefit Plans, Phyllis Borzi, Marsha Regenstein, Lee Repasch, Soeurette Cyprien, Sara J. Rosenbaum
Health Policy and Management Faculty Publications
In the fall of 2001, the United States Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation (ASPE) asked the Center for Health Services Research and Policy in the School of Public Health and Health Services, The George Washington University Medical Center, to undertake a descriptive study of the current and future trends in cost and care management techniques used in the employment-based health insurance marketplace. The purpose of this study was to identify and report on (1) the cost and care management techniques currently in use in the private sector by health plans …
Child Development Programs In Community Health Centers, Sara J. Rosenbaum, Michelle Proser, Peter Shin, Sara E. Wilensky, Colleen Sonosky
Child Development Programs In Community Health Centers, Sara J. Rosenbaum, Michelle Proser, Peter Shin, Sara E. Wilensky, Colleen Sonosky
Health Policy and Management Faculty Publications
This report, the third in a series that reviews federal health policy related to child development, examines the role of community health centers in providing child development programs for children age 3 and younger. It also presents an analysis of health centers using the Uniform Data System, a database maintained by the federal Bureau of Primary Health Care (BPHC) that contains user, utilization, and financial information on each reporting center. In addition, the report presents findings from a 2000 survey of four categories of child development programs at 79 health centers; examines the new prospective payment system for health centers …
Mental Illness And Addiction Disorder Treatment And Prevention, Sara J. Rosenbaum, Peter Shin, Marcie Zakheim, Karen Shaw, Joel B. Teitelbaum, Kay Johnson
Mental Illness And Addiction Disorder Treatment And Prevention, Sara J. Rosenbaum, Peter Shin, Marcie Zakheim, Karen Shaw, Joel B. Teitelbaum, Kay Johnson
Health Policy and Management Faculty Publications
This Special Report of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts (2d Ed.) analyzes Medicaid managed care contract provisions related to mental illness and addiction disorders (MI/AD). The analysis is based on 54 contracts and related documents (including 12 managed behavioral health care contracts) which were in effect as of the beginning of 1997. While this Special Report considers Medicaid contracts, its findings have implications for other public purchasers of managed care services for persons with MI/AD because, like Medicaid, other sources of third-party financing have traditionally supported services and activities that may not …