Health Policy Commons^™

Framing Inclusion: The Media Treatment Of Irregular Immigrants' Right To Health Care In Spain, Alisa Petroff, Anahí Viladrich, Sònia Parella

Publications and Research

With the passing of Royal Decree-Law 16/2012, Spain’s national health system switched from a model defined by universal and free health care principles, to a private insurance system that excluded large population groups. Based on a qualitative research design, this paper examines the media treatment of undocumented immigrants’ prerogatives to public health care in Spain (2012–2018). The analysis of 234 articles, drawn from three major Spanish newspapers, reveals three frames that underscore the media’s "rhetorics of inclusion," which argue for the extension of free medical services to irregular immigrants a topic traditionally underestimated by the literature. The moralist frame, supported …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum, Julia Paradise

Health Policy and Management Faculty Publications

Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as coverage …

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 …

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 …

Community Health Centers: The Challenge Of Growing To Meet The Need For Primary Care In Medically Underserved Communities, Tishra Beeson, Sara J. Rosenbaum, Jessica Sharac, Peter Shin, Julia Paradise

Health Policy and Management Faculty Publications

This policy brief profiles health centers and the patients they serve, discusses how health centers are funded, and traces the history of health center growth. It closely examines the recent reduction in both federal appropriations and state grants for health centers, state cutbacks in benefits for adult Medicaid beneficiaries, and the anticipated impact of President Obama's FY 2013 request for federal funding for health centers. Finally, it looks ahead to both the challenges and opportunities health centers face as the nation prepares for 2014, when the ACA will be fully implemented.

Medicaid And Community Health Centers: The Relationship Between Coverage For Adults And Primary Care Capacity In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Brian K. Bruen, Alice (Xiao-Xiao) Lu, Rachel Arguello, Jennifer Tolbert

Health Policy and Management Faculty Publications

Community health centers play an important role in providing care to uninsured and low-income individuals living in medically underserved communities. They rely on many different revenue sources and, over time, Medicaid has become a central source of funding for most health centers. To better understand how Medicaid influences health center practice, this paper compares the strength of health centers in states that have expanded Medicaid coverage for adults to health centers in states with more limited Medicaid coverage for adults. Differences between the two groups of health centers help shed light on the implications of broader Medicaid coverage for low-income …

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen P. Mays

Health Management and Policy Presentations

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

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.

Options For Cdc's Cancer Screening Programs: Implications Of The Affordable Care Act, Leighton C. Ku, Alice R. Levy, Paula M. Lantz, Rachelle Pierre-Mathieu

Health Policy and Management Faculty Publications

Screening to promote early detection of cancer is a fundamental tool in preventive medicine and public health that facilitates earlier treatment and reductions in cancer mortality. Systematic reviews of the research demonstrate that early detection and treatment for breast and cervical cancers can reduce cancer-related mortality. One of the most important barriers to women being screened is the lack of health insurance coverage. The Centers for Disease Control and Prevention (CDC) administers two programs designed to increase screening, particularly among low-income and vulnerable populations: the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer Control Program …

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 …

State Insurance Exchanges: An Overview, Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Community Health Centers And The Economy: Assessing Centers' Role In Immediate Job Creation Efforts, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federal investment in community health centers not only creates health care access but, based on previous studies, generates an estimated 8:1 return for medically underserved communities while creating thousands of jobs. Since our earlier 2008 economic impact study, Congress has made two major program investments: $2 billion under the American Reinvestment and Recovery Act (ARRA) of 2009; and $11 billion under the Affordable Care Act (ACA). This analysis measures the economic and jobs-creation benefits of this cumulative investment in health centers, as well as the impact of legislation enacted in April, 2011, which reduced the first year of new …

Medicaid And Access To Health Care--A Proposal For Continued Inaction?, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Post-Hmo Health Care: Are Acos The Answer?, Zachary F. Meisel, Jesse M. Pines

Health Policy and Management Informal Communications

"Remember the 1990s" retrospective lists always include Nirvana, Monica Lewinsky and Wayne's World, but leave out another major product that defined American life in the '90s: the health maintenance organization, or HMO — that nefarious health-insurance plan that seemed expressly designed to prevent you from seeing the doctor of your choice or receiving the treatments recommended by doctors, all under the guise of lowering costs and "improving" medical care. Of course HMOs are still around, but they are no longer central to the national discussion on health care. Why? For the most part, HMOs have eased limits on patient choice …

An Overview Of The Administration's Aco Policy: Opportunities And Challenges, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

For nearly a century, proponents of health reform have advocated for greater clinical integration to improve quality, promote efficiencies, and control costs. A seminal 1932 report issued by the Committee on the Costs of Medical Care called for the provision of care through group practice arrangements as part of a broader set of recommendations that included universal coverage, extension of public health services to the entire population, and a major investment in health professions education. Resistance to its findings was a key factor in convincing the Roosevelt Administration to abandon national health insurance in the original Social Security Act.

The View From New Hampshire: The Imperative Of Linking Health Care Reform To Economic And Job Growth, Maggie Wood Hassan

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Health Reform: Back To The Future, Christopher Jennings

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Health Care Outlook For 2011 And Beyond: The Legal, Policy And Political Landscape, Mark L. Hayes

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The Essential Health Benefits Provisions Of The Affordable Care Act: Implications For People With Disabilities, Sara J. Rosenbaum, Joel B. Teitelbaum, Katherine J. Hayes

Health Policy and Management Faculty Publications

In establishing minimum coverage standards for health insurance plans, the Affordable Care Act includes an "essential health benefits" statute that directs the U.S. Secretary of Health and Human Services not to make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. This issue brief examines how this statute will help Americans with disabilities, who currently are subject to discrimination by insurers based on health status and health care need. The authors also discuss the complex issues involved in implementing the essential benefits …

The States' Next Challenge--Securing Primary Care For Expanded Medicaid Populations, Leighton C. Ku, Karen Jones, Peter Shin, Brian K. Bruen, Katherine J. Hayes

Health Policy and Management Faculty Publications

In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated …

Statement On Essential Benefits, Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

The essential health benefits statute is unique. Because its legislative history is quite limited, the text itself takes on particular importance. The provisions of the statute differ significantly from the highly detailed coverage terms of Medicare Parts A and B. Similarly, its provisions differ from the coverage provisions of the Employee Retirement Income Security Act, which governs virtually all private employer-sponsored health benefit plans and which (with the important exception of the insured small group market) remains unaffected by the essential health benefits provision. In referencing broad benefit categories, the essential health benefits statute bears some resemblance to the structure …

Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges, Benjamin D. Sommers, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level …

Hospice, Palliative Care And Health Care Reform: Beyond "End Of Life" To Quality Of Life, Dale Lupu

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Health Care Reform Implementation: One State's Perspective, John M. Colmers

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

A "Broader Regulatory Scheme"-- The Constitutionality Of Health Care Reform, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The fundamental goal of the ACA is no less than the preservation of the U.S. health care system. In a country that depends on health insurance to finance care, preservation cannot happen without a comprehensive regulatory scheme that reaches from coast to coast and sets the minimum rules of market entry and operation for health insurers. The glide path to this new system is long and complex, but the law's end point is clear and visionary, and its constitutionality--at least in this first round--is incontrovertible.

The Affordable Care Act: U.S. Vaccine Policy And Practice, Alexandra M. Stewart, Orriel L. Richardson, Marisa A. Cox, Katherine J. Hayes, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

When fully implemented, the Patient Protection and Affordable Care Act, amended by the Health and Education Reconciliation Act will extend health insurance coverage to 94 percent of Americans while establishing a comprehensive set of strategies to improve care and contain costs. The central provisions of the Act – guaranteed affordable and accessible coverage – take effect January 1, 2014. Important insurance reforms aimed at improving coverage become effective before that date, as do a series of investments aimed at improving the accessibility and quality of health care.

This report has several aims: 1) to examine how the laws address vaccine …

Buying Health Care, The Individual Mandate, And The Constitution, Sara J. Rosenbaum, Jonathan Gruber

Health Policy and Management Faculty Publications

Three separate cases raising constitutional challenges to the Affordable Care Act (ACA) are now under way, and together they present issues of great legal complexity. Yet although difficult legal questions must be resolved, a pivotal issue is whose version of events will serve as the judicial analytic filter. For reasons related to the very basis of Congress's constitutional power to enact health care reform, the fight is over whether the individual mandate to purchase health insurance (or pay a tax) is about regulating individuals' economic conduct or regulating their noneconomic status. Depending on which characterization of the facts prevails, the …

Strengthening Primary Care To Bend The Cost Curve: The Expansion Of Community Health Centers Through Health Reform, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The recent enactment of health reform sets into motion important changes that will expand health insurance coverage, increase funding for community health centers and alter the way that health centers are paid. These reforms will have a major impact on two major challenges of health reform: bolstering the capacity of the nation's primary care system and reducing the long term growth in health care costs.

Our analyses examine the impact of the new health reform law on the number of patients who will receive primary care services at community health centers and the effect of the service expansions on overall …

Medical-Legal Partnerships: Addressing The Unmet Legal Needs Of Health Center Patients, Peter Shin, Fraser Rothenberg Byrne, Emily Jones, Joel B. Teitelbaum, Lee Repasch, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Medical-legal partnerships (MLPs), now available at over 180 hospitals and health centers across 38 states, are an important option for addressing the legal needs affecting low-income and vulnerable patients, and thereby improving their overall health. We estimate that each year, anywhere between 50 and 85 percent of health centers users - or between ten and 17 million people - experience unmet legal needs, many of which negatively impact their health. In a medical-legal partnership, health care staff at hospitals, clinics, and other sites are trained to screen for health-related legal issues, refer the patient to an affiliated lawyer or legal …

Public Health And Health Reform: A Chance For Transformation, Jeffrey Levi

Health Policy and Management Faculty Posters and Presentations

What's in the new health reform law with a special focus on public health provisions; How public health became a part of health reform; Challenges associated with implementation: can public health meet the expectation of transformation?