Health Policy Commons^™

How The Supreme Court's Medicaid Decision May Affect Health Centers: An Early Estimate, Katherine J. Hayes, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The nation's federally funded health centers are the principal source of primary health care for medically underserved populations. In CY 2011, more than 1,200 health centers, operating in more than 8,500 urban and rural locations, served 20.2 million patients, 36 percent of whom were uninsured and 93 percent of whom had family incomes below twice the federal poverty level. Federal grants provide core support to health centers, but Medicaid represents the largest single health center financing mechanism, accounting for 39 percent of revenues. Medicaid revenue growth allows health centers to preserve their core grant funding to reach uninsured patients while …

Coordinating And Integrating Care For Safety Net Patients: Lessons From Six Communities, Leighton C. Ku, Marsha Regenstein, Peter Shin, Holly Mead, Alice R. Levy, Kate Buchanan, Fraser Rothenberg Byrne

Health Policy and Management Faculty Publications

This report examines efforts to improve the coordination of health care among safety net providers in six communities (Austin, TX; Brooklyn, NY; Indianapolis, IN; Marshfield, WI; San Francisco, CA; and St. Louis, MO), based on case study site visits and a roundtable discussion. Across the communities, we identified three approaches to improving coordination: (1) collaboration of providers using a coordinating organization, (2) coordination facilitated by Medicaid managed care plans, and (3) development of highly integrated care systems. These represent models that could be used by different communities, based on their local circumstances. Successful development of coordination approaches involved shared commitment …

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 …

A New State Plan Option To Integrate Care And Financing For Persons Dually Eligible For Medicare And Medicaid, Jane H. Thorpe, Katherine J. Hayes

Health Policy and Management Faculty Publications

As health care costs continue to escalate, Congress, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, researchers, and policymakers are focusing on identifying new approaches to care delivery and reimbursement for individuals who are dually eligible for both Medicare and Medicaid. Although relatively few in number (9 million), dual eligible beneficiaries are more likely than others to experience poor health, including multiple chronic conditions, functional and cognitive impairments, and a need for continuous care. Sixty-six percent of dual eligibles have three or more chronic conditions; sixty-one percent are …

Promoting The Integration And Coordination Of Safety-Net Health Care Providers Under Health Reform: Key Issues, Leighton C. Ku, Peter Shin, Marsha Regenstein, Holly Mead

Health Policy and Management Faculty Publications

The Affordable Care Act includes several provisions designed to encourage greater coordination and integration among health care providers, including the promotion of accountable care organizations and health homes. While much discussion has focused on how these strategies might be adopted by Medicare and private insurers, little attention has focused on their application among safety-net health care providers. Such providers face particular challenges in coordinating care for their low-income and uninsured patients, and no single approach is likely to meet their diverse needs. Successful efforts will require federal, state, and local financial resources to sustain the safety net and make the …

Presentation Of The 2011-2012 Geiger Gibson Distinguished Visitor In Community Health Policy, Rachel A. Gonzales-Hanson

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Measuring Primary Care: Theory, Policy, And Practice, Barbara Starfield

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The Right Care At The Right Time By The Right Professional, Mary Jean Schumann

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Medicare's Accountable Care Organization Regulations: How Will Medicare Beneficiaries Who Reside In Medically Underserved Communities Fare?, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) released proposed regulations implementing the Medicare Shared Savings Program (MSSP). The thrust of the MSSP is to promote savings to Medicare as well as the greater clinical integration of health care through incentive payments to accountable care organizations (ACOs) that meet Medicare standards for structure, performance, and health care outcomes. The effort to spur greater clinical integration through the MSSP was part of a broader set of reforms contained in the Affordable Care Act (ACA) whose aim was to improve health care quality and efficiency. Among these reforms …

Medicaid And Access To The Courts, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California's appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court's ruling could fundamentally alter states' accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid's essential federal requirements.

The Role Of Community Health Centers In Addressing The Needs Of Uninsured Low-Income Workers: Implications Of Proposed Federal Funding Reductions, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The severe economic downturn over the past few years has demonstrated the heightened importance of strengthening the health care safety net, particularly for working Americans who may have lost their health insurance coverage or do not have access to employer-sponsored benefits. Both historically and most recently during the current recession, health centers have played a critical role in providing services to the working poor, assuring that they continue to receive timely preventive care that obviates the need for, and minimizes use of, more costly services. We estimate that 1 in 4 low income, uninsured working adults depend on health centers …

The Health Care Access And Cost Consequences Of Reducing Health Center Funding, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

For over four decades, community health centers have served a critical role in providing affordable access to quality care to some of the nation's most vulnerable populations. Health centers have historically enjoyed broad bipartisan support, based on the evidence documenting their high quality care, crucial role in both urban and rural communities, and ability to "bend the cost curve."

On February 20, 2011, the U.S. House of Representatives voted to reduce discretionary health center funding by $1.3 billion in FY 2011 alone. Although the spending bill was rejected by the U.S. Senate on March 10, 2011, final spending measures for …

Who Are The Health Center Patients Who Risk Losing Care Under The House Of Representatives' Proposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On February 20, 2011, the United States House of Representatives approved more than $61 billion in discretionary spending reductions for the remainder of FY 2011. The legislation includes $1.3 billion in direct spending cuts for community health centers. Using the NACHC patient estimates, we present evidence on the characteristics of patients whose continuing access to health center services is at risk. We arrived at these estimates using data from the Uniform Data System (UDS), the federal reporting system in which all health centers must participate, as well as national estimates from the Medical Expenditure Panel Survey (MEPS), and published reports …

Changing Policy: The Elements For Improving Childhood Asthma Outcomes, Anne R. Markus, Meagan Lyon, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This report lays out the facts and offers specific policy recommendations for success that could change the face of childhood asthma in America. These recommendations aim to make better use of programs and policies already in place, such as Medicaid and the Children's Health Insurance Program (CHIP), as well as private sector insurance coverage and existing public health programs. The recommendations also underscore the importance of careful research -- scientific, practical, and community-based -- in order to continue to learn what works best and strengthen knowledge for future action. In a reformed health system, these initial efforts are not wasted …

Leveling The Field--Ensuring Equity Through National Health Care Reform, Bruce Siegel, Lea Nolan

Health Policy and Management Faculty Publications

Members of minority groups have higher rates of disease, poorer health, and more limited access to care than their white counterparts. They account for half of the uninsured population and 58% of the low-income uninsured population. Even when they have coverage, minority patients are at risk for receiving lower-quality medical and surgical care than white patients. The factors underlying these inequities are complex and go far beyond the health care system,but any meaningful reform must, at a minimum, confront disparities in care. Health care reform provides a unique opportunity to reversea legacy of inequality in health and health care. This …

An Analysis Of The Implications Of The Stupak/Pitts Amendment For Coverage Of Medically Indicated Abortions, Sara J. Rosenbaum, Lara Cartwright-Smith, Ross Margulies, Susan F. Wood, D. Richard Mauery

Health Policy and Management Faculty Publications

This analysis examines the implications for coverage of medically indicated abortions under the Stupak/Pitts Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health Care for America Act. In this analysis we focus on the Amendment's implications for the health benefit services industry as a whole. We also consider the Amendment's implications for the growth of a market for public or private supplemental coverage of medically indicated abortions. Finally, we examine the issues that may arise as insurers attempt to implement coverage determinations in which abortion may be a consequence of a condition, rather than the primary basis of treatment.

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

Talking With Patients: How Hospitals Use Bilingual Clinicians And Staff To Care For Patients With Language Needs, Jennifer Huang, Karen C. Jones, Marsha Regenstein, Christal Ramos

Health Policy and Management Issue Briefs

Improving access to language services in health care settings has become a focal point for health reform and disparities-focused legislation, in recognition of the increasing linguistic and cultural diversity of individuals across the nation. Bilingual staff and clinicians can serve as enormously valuable resources to hospitals and other health care organizations, offering a critical set of skills to interact with individuals who require care in a language other than English. Bilingual clinicians can serve a vital need for hospitals by providing high-quality health care, improving patient safety, and meeting organizational priorities to provide linguistically and culturally appropriate care for patients. …

Insurance Discrimination On The Basis Of Health Status: An Overview Of Discrimination Practices, Federal Law, And Federal Reform Options, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term "discrimination" in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws …

Health Care Workforce Issues And Access To Care: Assessing The Present And Preparing For The Future, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

Summary of Testimony Fitzhugh Mullan, M.D. Before the House Energy and Commerce Subcommittee on Health, March 24, 2009

• Improving access to health care in the United States will require modifications in the structure of the U.S. physician workforce, the foremost of which will be the construction of a strong primary care delivery base.
• There are over 800,000 practicing physicians today or 280 physicians per 100,000 people. This represents a greater physician density than Canada (210) and the United Kingdom (250) but a density less than France (340) and Germany (350).
• The distribution of physicians in the U.S. heavily favors urban …

Improving Medicaid: Assessment Of District Of Columbia Agencies' Claims Processes And Recommendations For Improvements In Efficiency And Customer Service, George Washington University, School Of Public Health And Health Services, Department Of Health Policy, Health Management Associates

Health Policy and Management Faculty Publications

The District of Columbia Department of Health Care Finance (DHCF), like other state Medicaid agencies, is constantly challenged to improve service delivery and reimbursement for Medicaid services. In the District, several governmental agencies ("Partner Agencies") play an instrumental role in Medicaid – either as a Medicaid provider or in operating a Medicaid program. Today, each Partner Agency may retain its own system and process for claims submission, provider enrollment, and administrative claiming as it relates to Medicaid. For these reasons, the DHCF initiated an assessment of the Medicaid claims processes for Partner Agencies. The purpose of the assessment is to …

Medicare Advantage's Private Fee-For-Service Plans: Paying For Coordinated Care Without The Coordination, Brian Biles, Emily Adrion, Stuart Guterman

Health Policy and Management Faculty Publications

Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans—a total of nearly $2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect …

Achieving Family Health Literacy: The Case For Insuring Children, Sara J. Rosenbaum, Peter Shin, Barbara Debuono

Health Policy and Management Faculty Publications

One aspect of the SCHIP reauthorization debate that has received more limited attention than it deserves is the relationship between children's health insurance coverage and family health literacy. That is, to what extent is children's health insurance associated with higher health literacy, and to what extent is reduced parental health literacy linked to lower rates of health insurance among children? This association is extremely important, since there is strong evidence of a link between health literacy and the appropriate use of health care. Evidence suggests that when previously uninsured children are covered by health insurance, parents at all income levels …

Walking A Tightrope: The State Of The Safety Net In Ten U.S. Communities, Marsha Regenstein, Lea Nolan, Marcia J. Wilson, Holly Mead, Bruce Siegel

Health Policy and Management Faculty Publications

This report presents the findings from the Urgent Matters safety net assessments and identifies common characteristics, opportunities and challenges for communities that wish to better serve the health care needs of uninsured and underserved individuals. It also illustrates differences across many of the communities, especially in terms of the structure and financing of their safety nets. It is a companion report to the individual safety net assessments and provides an overarching perspective of problems that affect safety nets across the country.

Health Coverage In Massachusetts: Far To Go, Farther To Fall, Sara J. Rosenbaum, Jeanne Lambrew, Peter Shin, Marsha Regenstein, Tanya Ehrmann, Dylan Roby

Health Policy and Management Faculty Publications

This analysis has been prepared to highlight the state's experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation's health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus …

An Evaluation Of Contracts Between Managed Care Organizations And Community Mental Health And Substance Abuse Treatment And Prevention Agencies, Sara J. Rosenbaum, Karen Silver, Elizabeth Wehr

Health Policy and Management Faculty Publications

This study represents a descriptive, point-in-time examination of the structure and content of provider network agreements between managed care organizations (MCOs) and community mental health and substance abuse (MH/SA) treatment and prevention agencies. This is not a study of the quality of managed care systems. Instead, this analysis is designed to assess provider contracts (one of the basic legal instruments on which the managed care system rests) and to identify the meaning of these instruments for MH/SA service providers, group purchasers, MCOs, individual consumers and their families, and public policy.