Category Archives: Health Reform

Trends in State-Level Opinions toward the Affordable Care Act

Source: Julianna Pacheco; Elizabeth Maltby, Journal of Health Politics, Policy and Law, Volume 44, Issue 5, October 2019
(subscription required)

From the abstract:
Context:
This article argues that the devolution of the Affordable Care Act (ACA) to the states contributed to the slow progression of national public support for health care reform.

Methods:
sing small-area estimation techniques, the authors measured quarterly state ACA attitudes on five topics from 2009 to the start of the 2016 presidential election.

Findings:
Public support for the ACA increased after gubernatorial announcement of state-based exchanges. However, the adoption of federal or partnership marketplaces had virtually no effect on public opinion of the ACA and, in some cases, even decreased positive perceptions.

Conclusions:
The authors’ analyses point to the complexities in mass preferences toward the ACA and policy feedback more generally. The slow movement of national ACA support was due partly to state-level variations in policy making. The findings suggest that, as time progresses, attitudes in Republican-leaning states with state-based marketplaces will become more positive toward the ACA, presumably as residents begin to experience the positive effects of the law. More broadly, this work highlights the importance of looking at state-level variations in opinions and policies.

State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA

Source: Linda J. Blumberg, Matthew Buettgens, John Holahan, Clare Wang Pan, Urban Institute, March 26, 2019

From the abstract:
This analysis provides information on some of the consequences should a case pending before the US Court of Appeals for the 5th Circuit be decided in favor of the plaintiffs. The plaintiffs argue that the entire Affordable Care Act be eliminated due to the fact that he individual mandate penalties were set to $0 beginning with plan year 2019. We estimate the state-by-state implications of full ACA repeal for insurance coverage and government funding of health care in 2019. Our estimates take into account 2019 marketplace enrollment and premiums as well as recent Medicaid data.

The Union That Roars

Source: Graham Vyse, Governing, February 2019

In an anti-union era, nurses are proving that organized labor can still be powerful. ….

…. NNU isn’t new to this fight. Breaking up the for-profit health-care system has been a defining mission of the union since its founding a decade ago. But now the group faces a new challenge. NNU is embarking on a revamped Medicare for All campaign not only at the federal level — where the prospects of success are bleak, at least in the short term — but in states across the country, especially those with Democratic governors, most notably California, Minnesota and New York. ….

How Democratic Candidates For The Presidency In 2020 Could Choose Among Public Health Insurance Plans

Source: Sherry A. Glied and Jeanne M. Lambrew, Health Affairs, Ahead of Print, November 16, 2018
(subscription required)

From the abstract:
Democratic candidates for president in 2020 will likely include some type of public plan in their health care reform platforms. Existing public plans take many forms and often incorporate private elements, as do most proposals to extend such plans. We review the types of public plans in the current system. We describe and assess the range of proposals to extend these plans or elements of them to additional populations. We suggest questions that candidates could use to guide their decisions about the scope and content of their health policy proposals. Developmental work during campaigns will contribute to success in turning candidates’ promises into accomplishments.

Getting Ready For Health Reform 2020: Republicans’ Options For Improving Upon The State Innovation Approach

Source: Lanhee J. Chen, Health Affairs, Ahead of Print, November 16, 2018
(subscription required)

From the abstract:
The 2020 presidential election will be consequential for the future of health reform, with the two major-party nominees taking very different views on the future of the Affordable Care Act (ACA), as well as the policies needed to lower health costs and continue to expand access to coverage. The Republican nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation–based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017. This article takes that legislation as a starting point, contextualizes it within the broader health reform discussion, and suggests ways to improve upon it to enhance the affordability of and access to coverage and to ensure that states have adequate flexibility to implement their policy goals.

Even Libertarians Admit Medicare for All Would Save Billions

Source: Matt Bruenig, Jacobin, July 30, 2018

A new study from a libertarian think tank admits that Medicare for All would save a whopping $300 billion. …. The report’s methods are pretty straightforward. Blahous starts with current projections about how much the country will spend on health care between 2022 and 2031. From there, he adds the costs associated with higher utilization of medical services and then subtracts the savings from lower administrative costs, lower reimbursements for medical services, and lower drug prices. After this bit of arithmetic, Blahous finds that health expenditures would be lower for every year during the first decade of implementation. The net change across the whole ten-year period is a savings of $303 billion. ….

Related:
The Costs of a National Single-Payer Healthcare System
Source: Charles Blahous, George Mason University, Mercatus Working Paper, 2018

The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A), would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022, rising to early 12.7 percent of GDP in 2031 and further thereafter. Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.

The Case for Single-Price Health Care

Source: Paul S. Hewitt and Phillip Longman, Washington Monthly, Vol. 50 no. 4/5/6, April/May/June 2018

We could largely solve the cost crisis simply by making Medicare prices universal.

Related:

Their Own Medicine
Source: Fran Quigley, Washington Monthly, Vol. 50 no. 4/5/6, April/May/June 2018

Patient activists were once at the forefront of lowering the cost of life-saving medication. To solve today’s prescription drug crisis, they’ll have to find their voice again.

Healthcare for All

Source: Dissent, Spring 2018
(subscription required)

Articles include:
Crisis and Opportunity
Adam Gaffney
The left will not live forever on the sidelines of political power. When we have an opportunity to remake our healthcare system, we must be sure to seize it.
Introducing the special section of our Spring issue.

How to Win Medicare for All
Josh Mound
For a progressive program of government-provided healthcare to make it into law, survive, and thrive, it must be popular.

Undocumented, Uninsured, Unafraid
Beatrix Hoffman
In the fight for healthcare for all, single-payer and immigrant rights activists face serious obstacles, but also the opportunity to demonstrate the benefits of true universalism.

Cashing in on Despair
George Karandinos
Profiteering is distorting the response to the opioid epidemic as much as it shaped its origin.

The Class Politics of Teeth
Mary Otto
Inequalities in oral health and dental access reflect our deepest social and economic divides.

Single-Payer or Bust
Adam Gaffney
By providing a single tier of coverage to all, with automatic enrollment, comprehensive benefits, and no cost-sharing, single-payer provides a distinct—and more egalitarian—vision of universality.

Health Insurance Reform In The USA—What, How, And Why?

Source: Theodore Joyce, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The U.S. Congress failed to repeal and replace the Affordable Care Act (ACA). Will the country limp along with a politically unsupported ACA or is this an opportunity for a serious discussion about health insurance reform in the United States? In this Point/Counterpoint, Adam Gaffney, a physician and instructor in Medicine at the Harvard Medical School and a member of the Cambridge Health Alliance, argues for a national insurance program that provides first-dollar coverage to all Americans. Dana Goldman, the Leonard D. Schaeffer Chair and distinguished Professor at the University of Southern California, and Kip Hagopian, co-founder of Brentwood Associates and Managing Partner at Apple Oaks Partners LLC, also argue for universal coverage, but one consistent with standard principles characteristic of automobile or home insurance. These widely differing approaches to health insurance reform could not be more timely or more cogently argued.

Related:

It Is Time For Universal Coverage Without Breaking The Bank
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

….So what can be done now that “repeal and replace” has failed? There is a call for bipartisan solutions, but proposals are often short on details. What specifics we do get involve modest reforms to reduce cost-sharing and stabilize the existing markets. This is not enough; we need fundamental reform, and five goals should undergird a bipartisan plan:
• make coverage universal and progressive;
• build on, but do not replace, the private insurance system;
• keep it affordable and sustainable; reduce incentives for adverse selection (avoidance of bad health risks); and
• create incentives for prevention and long-term investment…..

Health Insurance Reform In The United States—What, How, And Why?
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

Last summer, Republican efforts to repeal the Affordable Care Act (ACA)—seven-years in the making—dramatically collapsed. Yet, if the failed Senate vote in July marked a pause in conservative reform efforts, it only further animated the health care reform debate on the left side of the political spectrum.

In this article, I argue that one of the reform models under discussion—single-payer national health insurance (NHI)—is the most potent and realistic policy solution. First, I make the case that universal coverage is economically feasible. Second, I examine why achieving universal coverage remains paramount. Third, I describe how universal coverage can be quickly and effectively achieved via NHI enrollment. Fourth, I discuss benefit design, emphasizing the importance of comprehensive benefits, and first-dollar coverage. And finally, I explore the role of the public and private sectors, arguing that health care coverage must remain entirely within the public sphere if the goal of universal health care is to be, at long last, attained…..

Medicare-For-All: Not Our Only Option For Universal Coverage
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The failure to meet ambitious but attainable goals—cover everyone, control costs—has created opportunity for radical reform. Dr. Gaffney advocates for universal health coverage via the burgeoning “Medicare-for-All” approach that has dominated the progressive health reform landscape for decades. As appealing as it may be from the outside, the strategy ignores several key health policy realities, namely the proper amount of insurance, the historic limitations of Medicare, the pitfalls of cutting costs by reducing administration, and the rising pressure of private markets in international health insurance…..

Universal Underinsurance Is Not The Same As Universal Health Care
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

I begin my response to Dana Goldman and Kip Hagopian’s admirably clear reform proposal on a point of agreement. Today, 28 million Americans remain uninsured according to the United States Census Bureau. The three of us clearly agree that this status quo is unacceptable, and that universal coverage is attainable, affordable, and right.

Beyond that, however, it becomes clear that we have very different visions for the future of American health care……

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans

Source: Lina Walker, Jane Sung, Claire Noel-Miller, and Olivia Dean, AARP Public Policy Institute, Fact Sheet, September 2017

The Graham-Cassidy (GC) bill, as proposed on September 13, 2017, threatens to make health care unaffordable and inaccessible for millions of older Americans. The bill eliminates two sources of financial assistance—premium tax credits and cost-sharing reductions—critical to ensuring that low- to moderate-income older adults are able to afford the coverage they need. For a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year if they wanted to keep their current coverage. The bill may also allow states to charge older adults age 50–64 significantly higher premiums than under current law on the basis of their age by waiving federal protections that limit the practice known as age rating…..