Category Archives: Health Care

The ROC Program: Accelerated Restoration of Competency in a Jail Setting

Source: Kevin Rice, Jerry L Jennings, Journal of Correctional Health Care, online before print November 13, 2013
(subscription required)

From the abstract:
In 29 months of operation, the restoration of competency (ROC) program provided treatment services to 192 incompetent to stand trial patients in a jail setting. The ROC restored competency for 55% of the patients in an average of 57 days compared to the state hospital average of 180 days. The average cost of treatment/restoration per admission was $15,568 compared to the state hospital average of $81,000. The ROC model accelerates needed treatment for mentally ill defendants, cuts demand for costly state hospital forensic beds, and assists jails in better managing inmates with severe psychiatric disorders—yielding major cost savings and improved care. In addition to preventing readmissions and negative behavioral episodes, the ROC improved the broader forensic system by eliminating the state hospital waiting list, accelerating access to psychiatric services, promoting local access for lawyers and family, and gaining stakeholder satisfaction.

7 Policy Changes America Needs So People Can Work and Have Kids

Source: Stew Friedman, Harvard Business Review, HBR Blog Network, November 11, 2013

We are in the midst of a revolution in gender roles, both at work and at home. And when it comes to having children, the outlook is very different for those embarking on adulthood’s journey now than it was for the men and women who graduated a generation ago. I recently published research from the Wharton Work/Life Integration Project, comparing Wharton’s Classes of 1992 and 2012. One of the more surprising findings is that the rate of Wharton graduates who plan to have children has dropped by about half over the past 20 years. …

…My research, and that of others, increasingly points to the fact that the thwarting of young people’s aspirations is the result of external pressures that make having both a successful career and a child seem impossible. Our current capacity to meet this challenge is cause for very serious concern. But there is no one solution; partial answers must come from various quarters. Here are seven ideas for action in social and educational policy, based on my own research — described in Baby Bust: New Choices for Men and Women in Work and Family — and what others have learned:

1. Provide World-Class Child Care….
2. Make Family Leave Universally Available….
3. Revise the Education Calendar….
4. Support Portable Health Care….
5. Relieve Students of Burdensome Debt….
6. Display a Variety of Role Models and Career Paths….
7. Require Public Service….

Fiscal Federalism: A Marriage of Money

Source: Anne Stauffer, Capitol Ideas, November/December 2013

The relationship between federal and state finances is complex, not well understood and vital to almost every aspect of Americans’ lives. Federal and state tax dollars jointly support schools, roads, health care, public safety and other key programs. This partnership, however, is under pressure from the enormous fiscal challenges of the past several years and the ongoing fiscal uncertainty at the federal level. An informed conversation using real data on the state impact of federal policies could help policymakers make the tough choices required to put all levels of government on a path to fiscal stability.

A dialogue is critical because federal and state finances are closely intertwined. Federal grants for health care, education, transportation and other programs make up roughly a third of state budgets, ranging from 24 percent in Alaska to 49 percent in Mississippi in 2011, the last year for which complete data are available.

Beyond that, total federal spending levels in states—on grants, contracts, salaries and direct payments to individuals for programs such as Social Security—are significant relative to the states’ overall economies, equivalent to between 12 percent of state gross domestic product in Delaware to 36 percent of state GDP in New Mexico, in 2010. In addition, many state-level fiscal policies piggyback on federal policies. …
Related:
Health Care and Federalism – Medicaid Expansion Decisions: Federalism, Politics or Both?
Source: Debra Miller, Capitol Ideas, November/December 2013

States More Reliant on Federal Dollars
Source: Capitol Ideas, November/December 2013

Special Investigation: How Insurers Are Hiding Obamacare Benefits From Customers

Source: Dylan Scott, Talking Points Memo, November 4, 2013

….Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

The insurance companies argue that it’s simply capitalism at work. But regulators don’t see it that way. By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces…..

Taking the leap

Source: Jennifer Grzeskowiak, American City & County, Vol. 128 no. 10, October 2013

Local governments move forward, despite debates over the Affordable Care Act. … Yet despite the uncertainty, many cities and counties have embraced their role as leaders in the community and are making sure they’re ready to help enroll and serve residents while determining what the ACA might mean for their own internal operations…

State-by-State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act

Source: Gary Claxton, Larry Levitt, Anthony Damico, Rachel Garfield, Nirmita Panchal, Cynthia Cox and Matthew Rae, Kaiser Family Foundation, Issue Brief, November 2013

Key provisions of the 2010 Affordable Care Act (ACA) create new Marketplaces for people who purchase insurance directly and provide new premium tax credits to help people with low or moderate incomes afford that coverage. We estimate that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014. This
issue brief provides national and state estimates for tax credit eligibility for people in these groups. We also estimate that about 29 million people nationally could look to new Marketplaces as a place to purchase coverage…

Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act’s Dependent-Coverage Mandate

Source: Yaa Akosa Antwi, Asako S. Moriya, and Kosali Simon, American Economic Journal: Economic Policy, Vol. 5 no. 4, November 2013
(subscription required)

From the abstract:
Using data from the Survey of Income and Program Participation (SIPP), we study the health insurance and labor market implications of the recent Affordable Care Act (ACA) provision that allows dependents to remain on parental policies until age 26. Our comparison of outcomes for young adults aged 19-25 with those who are older and younger, before and after the law, shows a high take-up of parental coverage, resulting in substantial reductions in uninsurance and other forms of coverage. We also find preliminary evidence of increased labor market flexibility in the form of reduced work hours.

Managing Prison Health Care Spending

Source: Pew Charitable Trusts, State Health Care Spending Project, October 2013

From the summary:
This report examines state spending on inmate health care and the factors driving costs higher. It also reviews strategies that some states have used to control these expenses while protecting public safety and maintaining or improving the quality of care that prisoners receive.

Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014

Source: Vernon K Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz and Laura Snyder, The Henry J. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, October 2013

From the summary:
The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state. At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program.

The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington.

Key findings from the survey include the following:
– Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013. In FY 2014, national enrollment and spending growth are expected to rise. States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds.
– The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
– Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
– Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.
– Looking ahead, FY 2014 will be a transformative year for Medicaid.