Digital Commons Network^™

No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky

National Health Policy Forum

This background paper describes important characteristics of the National School Lunch Program and the School Breakfast Program, reviews U.S. Department of Agriculture rules regarding the nutritional content of school meals, and examines compliance with current nutrition standards. It also considers the dietary status and obesity risk of meal program participants, discusses proposed improvements to nutritional standards and meal requirements, and highlights key legislative issues.

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.

Health Care Fraud, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

Adequate safeguards against health care fraud are essential to the proper functioning of any health care system. This analysis examines health care fraud in the U.S., and its findings underscore the importance to national health reform of comprehensive anti-fraud protections covering both public and private health insurance industry. This analysis, funded by the Robert Wood Johnson Foundation, examines health care fraud in a national policy context.

Using Primary Care To Bend The Curve: Estimating The Impact Of A Health Center Expansion On Health Care Costs, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Key findings include:

Increasing health center capacity by another 20 million patients by 2019 (to 39 million patients) under health reform can be expected to generate an additional $35.6 billion savings in 2019 and $212 billion in additional savings over the 2010-2019 ten-year time period.

Were the Medicaid prospective payment rate system to be applied to exchange …

The Economic Burden Of Health Inequalities In The United States, Thomas A. Laveist, Darrell J. Gaskin, Patrick Richard

Health Policy and Management Faculty Publications

This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides important insight into how much of a financial burden racial disparities are putting on our health care system and society at large. The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death.

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

Community Health Centers In Indiana: State Investments And Returns, Avi Dor, Patrick Richard, Ellen Tan, Sara J. Rosenbaum, Peter Shin, Lee Repasch

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state's most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state's …

Improving Medicaid's Continuity Of Coverage And Quality Of Care, Leighton C. Ku, Patricia Mactaggart, Fouad Pervez, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Medicaid provides health insurance coverage to tens of millions of low-income children, parents, seniors and people with disabilities. Unfortunately, Medicaid enrollment is like a leaky sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible, because of inefficient and cumbersome paperwork requirements. The interruptions in coverage affect the continuity and effectiveness of health care received. Interruptions also impair quality monitoring and improvement activities because many Medicaid enrollees were not enrolled long enough to assess the quality of their care. The presumption is that people who have been enrolled for less than a year …

Tri-Committee Draft Proposal For Health Care Reform, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

The Tri-Committee draft legislation takes a significant step towards establishing a health care workforce which will sustain a high-quality, cost-effective, fully accessible health care system. Moves to establish an Advisory Committee on Health Workforce Evaluation and Assessment, re-invest in the National Health Service Corps and Title VII of the Public Health Service Act, redistribute unused Medicare GME positions to primary care programs and establish teaching health centers, and address payment and practice challenges to primary care through the medical home and accountable care organization pilot programs are all positive moves towards a sustainable health care workforce. However, to fully achieve …

A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis

National Health Policy Forum

Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.

Financing Community Health Centers As Patient- And Community-Centered Medical Homes: A Primer, Peter Shin, Leighton C. Ku, Emily Jones, Brad Finnegan, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status …

Primary Health Care Access Reform: Community Health Centers And The National Health Service Corps, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

This testimony by Fitzhugh Mullan, M.D., addresses the following issues:

• Improving access to health care in the United States will require modifications in the U.S. health care workforce, the foremost of which will be the construction of a strong primary care base.
• Two-thirds of the U.S. physician workforce practice as specialists and the number of young physicians entering primary care is declining.
• The distribution of health care providers in the U.S. heavily favors urban areas. Metropolitan areas have 2-5 times as many physicians as non-metropolitan areas and economically disadvantaged areas have significant health care access problems.
• Today's physician-to-population ratio is …

The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan

National Health Policy Forum

This background paper provides a brief overview of the fundamental elements of the Children’s Health Insurance Program (CHIP). CHIP, which served more than 7 million children in federal fiscal year 2008, is a jointly funded federal-state partnership that was originally enacted in 1997 as a complement to the Medicaid program. CHIP is designed to provide health insurance coverage for children in families who earn too much to qualify for Medicaid but cannot afford to purchase private insurance coverage. The program was reauthorized in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, which included several changes and additions to …

Examining The Experiences Of Puerto Rico's Community Health Centers Under The Government Health Insurance Plan, A. Seiji Hayashi, Brad Finnegan, Peter Shin, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief examines the experiences of Puerto Rico's community health centers under the Commonwealth’s 1994 Government Health Insurance Plan (GHIP) – the Commonwealth's Medicaid program – also known as the Reforma. Of particular interest are the effects of Medicaid under-financing coupled with health centers' continuing obligations to furnish subsidized care for uninsured patients. To finance GHIP, the Commonwealth substantially curtailed its involvement with the direct provision of health care in both community and inpatient settings, transforming the former system of direct care provision into health insurance premium subsidies.

In 2007, the 47 operating sites of Puerto Rico's 19 federally …

An Overview Of Major Health Information Technology, Public Health, Medicaid, And Cobra Provisions Of The American Recovery And Reinvestment Act Of 2009, Sara J. Rosenbaum, Melissa M. Goldstein, Taylor Burke, Phyllis Borzi, Lara Cartwright-Smith

Health Policy and Management Faculty Publications

A detailed side-by-side analysis of the individual components of the American Recovery and Reinvestment Act of 2009 (ARRA), signed into law on February 17, 2009. One of the most sweeping pieces of economic legislation ever enacted, ARRA not only provides hundreds of billions of dollars in new health and health care spending but also makes comprehensive reforms in health law and policy, particularly in the area of health information law, including health information technology (HIT) adoption and health information privacy.

Workforce Issues In Health Care Reform: 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 Senate Finance Committee March 12, 2009

• Health Care Reform will require modifications in the structure of the U.S. physician workforce the foremost of which is 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 areas. Metropolitan areas have 2-5 times as many physicians as non-metropolitan …

Community Health Centers In An Era Of Health System Reform And Economic Downturn: Prospects And Challenges, Sara J. Rosenbaum, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines the role of health centers in the U.S. health care system, assessing their current and future roles in an era of both great promise and challenge. On one hand, government is poised perhaps more sharply than any time in nearly a generation to undertake a comprehensive effort at national health reform, addressing not only coverage but also access, quality, prevention, and the reinvigoration of primary health care, particularly for populations who face the highest health risks. On the other hand, the nation is facing the most severe economic recession in years, with lower income families and …

How Is The Primary Care Safety Net Faring In Massachusetts? Community Health Centers In The Midst Of Health Reform, Leighton C. Ku, Emily Jones, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Massachusetts' landmark 2006 health reform legislation sets an important precedent for national reform. Initial evaluations have demonstrated the law's success in dramatically expanding health insurance coverage and health care access, but less is known about its effects on community health centers, which serve one of every 13 residents and one in four low-income residents. This analysis evaluates the experiences of health centers with the Massachusetts reforms, using administrative data to examine finances and patient enrollment in addition to the qualitative results of in-depth interviews conducted during site visits in August 2008 and the results of a short survey of health …

Retiree Health Vebas: A New Twist On An Old Paradigm: Implications For Retirees, Unions And Employers, Phyllis Borzi

Health Policy and Management Faculty Publications

This issue brief provides an overview of stand-alone Voluntary Employees' Beneficiary Association trusts, through which employers have been able to rid themselves of future obligations to pay retiree health benefits in exchange for making a significant payment to designed to approximate the projected cost of these benefits. The paper include three case studies, including the VEBAs at the Big Three automakers.

Assessing The Need For On-Site Eye Care Professionals In Community Health Centers, Peter Shin, Brad Finnegan

Health Policy and Management Issue Briefs

Poor vision health severely impacts school and work performance, quality of life, and life expectancy, and results in billions of dollars in medical expenditures each year. While eye and vision problems are often associated with age, low income and racial and ethnic minorities also have elevated risk of eye problems. Federally-funded community health centers, which are mandated to provide comprehensive primary care in underserved communities, are often the only option to improve vision health for low-income residents.

With respect to certain chronic conditions, health centers are able to provide high quality care that meets or exceeds national benchmarks despite limited …

Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk

National Health Policy Forum

This document provides a brief overview of some of the policy and programmatic issues that were addressed in legislation to reau¬thorize the State Children’s Health Insurance Program (Title XXI of the Social Security Act) during the summer and fall of 2007. This overview provides a background for understanding the elements for a second round of reauthorization that will likely be debated in the early days of the 111th Congress. The paper reviews several of the key issues under discussion and summarizes some of the related provisions in the reauthorization bills that were considered in 2007.

Primary And Preventive Healthcare: A Critical Path To Healthcare Reform For Florida: The Role Of Florida's Fqhcs, Sara J. Rosenbaum, Peter Shin, Brad Finnegan, Ramona Whittington

Health Policy and Management Faculty Publications

Florida's health care system faces numerous challenges: a high proportion of residents without health insurance, a declining supply of primary care physicians at the same time that the state faces a growing need for high quality and cost efficient care for uninsured persons, and a growing emphasis on medical homes, especially for culturally diverse patients with complex chronic conditions. Nearly 3.8 million Florida residents lack health insurance, while more than 8 million lack access to a regular source of primary health care.

Assuring access to timely and high quality primary health care is a key dimension of any health reform …