Recently in Health Reform Category

Source: National Governors Association, 2010

States play a significant role in health reform implementation as part of the Patient Protection and Affordable Care Act. Some components of the law must be developed and implemented quickly, while other will involve a complex set of state decisions and long-term planning and implementation. Governors and other state officials need clear information, guidance and tools to determine the best course for their state.

This website is intended to be a central resource for state leaders about health reform implementation. In addition to NGA and Consortium publications, all relevant guidance from the U.S. Department of Health and Human Services, as well as priority publications from other organizations, is included on this site.
Related:
Health Reform Implementation
Source: National Conference of State Legislatures, 2010

Source: Commonwealth Fund, April 2010, Updated August 2010

Health care reform legislation--the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act--includes numerous provisions to expand access to health insurance, improve the quality and comprehensiveness of coverage, and make coverage more affordable for all Americans. This timeline outlines when the various health insurance provisions will go into effect.
See also:
- Coverage Timeline
- Graphic Timeline

Source: Amy Monahan, New York University Review of Employee Benefits & Executive Compensation, Forthcoming

From the abstract:
This symposium essay takes an initial look at the concept of "essential health benefits," a critical yet often-overlooked part of the Patient Protection and Affordable Care Act ("PPACA"). For the first time, through the requirement that all individual and small group health insurance policies cover "essential health benefits," the federal government will take an active role in regulating the substance of health insurance. PPACA does not define "essential health benefits" by statute, but instead grants authority to the Secretary of Health & Human Services to determine which benefits must be provided. Unfortunately, the statutory language provides very little guidance regarding how to meaningfully distinguish between services that ought to be considered essential and those that ought not. Most troubling is the fact that the statute gives the Secretary no concrete basis on which to exclude benefits from the definition of essential. To further complicate matters, the Secretary's decisions will come with significant fiscal implications for the federal government given the relationship between premiums and the cost of the newly-created premium tax credits. And while PPACA claims to retain a role for the states in regulating the substance of health insurance, this essay suggests that this power is largely illusory.

Source: Alliance for Health Reform and the Robert Wood Johnson Foundation, August 2, 2010

From the summary:
This session, sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation, looked into the key challenges facing states, including working within state legislative cycles against tight deadlines in the federal law, creating new roles at the state level as state budgets are being squeezed, and others. It looked at both near-term provisions, such as high-risk pools, as well as other provisions farther down the road, such as setting up exchanges and instituting changes to Medicaid eligibility.

What challenges need to be overcome by the states to implement various provisions in the law? What can we learn from implementation of previous federal reforms such as the Balanced Budget Act (BBA) and the Health Insurance Portability and Accountability Act (HIPAA)? How are states managing new tasks while making job cutbacks in tough economic times? What are some of the various policymaking tools states are using to affect change in the business of health care? What are leading states doing right? What are some of the federal legislative and policymaking challenges ahead?
See also:
- Webcast
- [video] Ed Howard, Alliance for Health Reform, Moderator
- [video] Sen. Jay Rockefeller, United States Senate, Moderator
- [video] Jay Angoff, HHS Office of Consumer Information and Insurance Oversight, Speaker
- [video] Len Nichols, George Mason University, Speaker
- [video] Brian Webb, National Association of Insurance Commissioners, Speaker
- [video] Lorez Meinhold, Office of the Governor of Colorado, Speaker
- Lorez Meinhold's Powerpoint Presentation
- Brian Webb's Powerpoint Presentation
- Len Nichols PowerPoint Presentation

Source: Amy Monahan, Daniel Schwarcz, Minnesota Legal Studies Research Paper No. 10-37, July 30, 2010

From the abstract:
This Essay argues that federal health care reform may induce employers to redesign their health plans to encourage employees who are likely to consume a greater-than-average amount of medical services to opt out of employer-provided coverage and instead acquire coverage on the individual market. Although largely overlooked in public policy debates, this prospect of employer dumping of high-risk employees raises serious concerns about the sustainability of health care reform more generally. In particular, it threatens the viability of individual markets and insurance exchanges by raising the prospect of adverse selection in these markets caused by the entrance of a disproportionately high-risk segment of the population. This risk, in turn, simultaneously threatens to increase the cost to the federal government of subsidizing coverage for qualified individuals and to exempt more individuals from complying with the so-called "individual mandate." The Essay offers several legislative solutions to the prospect of high-risk employee dumping that can substantially mitigate these risks.

Source: Sara R. Collins, Sheila D. Rustgi, and Michelle M. Doty, Commonwealth Fund, Volume 93, July 30, 2010

From the summary:
This issue brief analyzes how, over the next decade, the Affordable Care Act (ACA) is likely to stabilize and reverse women's growing exposure to health care costs. Up to 15 million women who now are uninsured could gain subsidized coverage under the law. In addition, 14.5 million insured women will benefit from provisions that improve coverage or reduce premiums. Women who have coverage through the individual insurance market and are charged higher premiums than men, who have been unable to secure coverage for the cost of pregnancy, or who have a preexisting health condition excluded from their benefits will ultimately find themselves on a level playing field with men, enjoying a full range of comprehensive benefits.

Source: David Raths, Governing, Vol. 23 no. 10, July 2010

The huge challenges of implementing a $30 billion program are just beginning to hit the states.

Source: Robert Wood Johnson Foundation, State Coverage Initiatives, July 2010

Two reports released today analyze how the Patient Protection and Affordable Care Act (PPACA) provide states with a variety of tools and resources to implement reform. The reports were funded through the Robert Wood Johnson Foundation's State Coverage Initiatives national program.

State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals organizes PPACA into understandable policy directions to help state policy leaders understand and prepare for the implementation process. The report classifies state-related decisions and actions into several broad themes--each with highlights and directions on how states may best use the many new tools and resources PPACA provides to accomplish long-standing health policy goals.

Health Benefit Exchanges: An Implementation Timeline for State Policymakers maps out a timeline for states to use as a resource for identifying major implementation decisions. The timeline provides policymakers with materials needed to effectively and strategically plan for the development of Health Benefit Exchanges under PPACA.

Source: John Holahan, Stan Dorn, Urban Institute, June 21, 2010

From the abstract:
The Patient Protection and Affordable Care Act (PPACA) will have substantial effects on state governments. There will be a dramatic expansion of Medicaid enrollment; however, in most cases the federal government will pay a very high share of the costs associated with the expansion. States who offer more limited coverage today will see the greatest benefits. The legislation should also reduce many costs that states now bear for caring for the uninsured. They could also save by no longer covering Medicaid beneficiaries with incomes above 133 percent of the federal poverty line (FPL); states are also likely to save on current coverage of children, and could see lower expenditures for elderly and disabled. States will also benefit from income-related subsidies that provide federal support to individuals with low and moderate incomes

Source: Health Affairs, Vol. 29 no. 6, June 2010

From the Editor-in-Chief:
President Obama has understandably made light of Republican House leader John Boehner's prediction that enactment of health reform legislation would lead to Armageddon. As Obama has noted several times since, no asteroids have fallen, cracks haven't opened up in the earth, and nobody has been "dragged away to be forced into some government-run health care plan." Yet while the proverbial End of Days isn't upon us, some version of "implemegeddon" may be. This issue of Health Affairs begins to tackle the hundreds of implementation issues inherent in health reform and offers prescriptions for averting trouble.
Articles include:
- Presidents and Health Reform
- From Massachusetts to 1600 PA Ave.
- Why Reform Finally Passed
- Costs: Reform Must Bend Curve
- Costs: Likely to Widen Deficit
- Implementing Insurance Market Reforms
- How Will Insurers Respond?
- Insurance Exchanges: 6 Design Issues
- New Roles for States
- Expanding Medicaid
- Delivery, Payment Reform Foundation
- View from Large Employers
- Interview: Geisinger's Steele on Reform
- Update on Massachusetts