March 7, 2014
State Medicaid programs and other state health agencies need to monitor and evaluate changes in health insurance coverage, access to care, financing, and the quality of health care delivery. The availability of new financial resources through the Patient Protection and Affordable Care Act is accompanied by raised expectations for such accountability. While state agencies often contract with universities on an ad hoc basis for specific policy projects, fourteen states have established formal state-university partnerships so that their analytic and technical needs can be addressed more readily. After a brief overview of these partnerships, this article provides examples of their projects, which most often affect Medicaid policy, including work on program eligibility, provider payments, and optional benefits. State-university partnerships are working on policy-relevant projects that influence decision making. Like the variation in Medicaid programs across the country, no two partnerships are alike. They thrive in a mix of structures, using different means of contracting, and with varied degrees of data access. All partnerships are interested in building a national network to share innovative practices and projects, spawn comparative policy studies across states, and support the development of new state-university partnerships.
Freely available online through the Journal of Health Politics, Policy and Law open access option.
via Supporting the Needs of State Health Policy Makers through University Partnerships.
February 24, 2014
The Patient Protection and Affordable Care Act has fostered intense debate on the delivery of health care over the past five years. We are now five months into the six-month roll out of Obamacare, and fewer than one-quarter of Americans believe the President’s health care law will actually improve their family’s health care. Americans know there are problems in health care delivery, but they do not want Washington, D.C. to manage their personal health choices. Long wait times, inefficient systems, dysfunctional web sites, fewer choices and higher costs are all symptoms of the problem. But state legislatures have found a solution.
They are increasingly adopting the Health Care Compact, a way for states to take control of health care regulations locally. Eight states currently belong to the HCC, because local control would improve the delivery of health care while improving medical innovation, reducing fraud and providing more health care options for people within their states. Additional states are also considering the HCC and for good reason; local control works better. For example, during the disastrous healthcare.gov website roll out we were told that the problems were mostly with the federal website and that state web sites were working much better. This fact reflects the larger point of the HCC; that states can manage problems better on behalf of their citizens.
via The Health Care Compact: Fixing American Health Care, One State At A Time.
February 18, 2014
Legislation to continue Arkansas’ compromise Medicaid expansion has failed in the state House.
The plan would have reauthorized funding for the “private option” that was approved last year as an alternative to expanding Medicaid’s enrollment under the federal health law. The measure fell five votes shy of the 75 needed for passage in the 100-member House.
Under the private option, Arkansas is using federal Medicaid funds to purchase private insurance for thousands of low-income residents.
Supporters of the measure are expected to try again. House Speaker Davy Carter has said he would try multiple times if the funding measure failed.
via Arkansas House Votes Down Compromise Medicaid Plan – ABC News.
February 16, 2014
That Oregon ended up with the most disastrous of all the Obamacare exchanges—an impressive achievement, considering how bad the law’s rollout has been—has stunned America’s growing herd of health care wonks. Twenty-five years ago—long before Massachusetts created the template for Obamacare—Oregon began trying to implement universal health care coverage. The state should know more about its uninsured population and how to reach them than any other. But no one who’s watched developments over that quarter-century should be surprised that, once again, Oregon’s attempt to provide health care coverage to everyone in the state has culminated in a nationally embarrassing failure.
via The Guinea Pig State | The Weekly Standard.
February 9, 2014
Vermont’s CGI Federal-built website didn’t work on October 1, and today, the state still does not have a fully functioning marketplace. There is no way for small businesses, the heart of Vermont’s economy, to purchase coverage online; instead, they have to buy insurance directly from one of two state-approved insurers. Payments for premiums still cannot be processed online – people have to snail-mail checks to a CGI processor in Nebraska. And individuals who registered online but then got divorced, changed jobs or had either pay cuts or increases cannot alter their information online.
A review of the state’s race to build a health insurance website is more than a fresh look at how CGI Federal, the Fairfax, Va.-based arm of Montreal-based CGI Group, bungled its attempt to cobble together a highly complex piece of technology on a very tight deadline. It is also a tale of how many Republican and Democrat state officials, the latter ardent supporters of Obamacare and in control of the state, glossed over ominous warning signs and Keystone Cops-like planning to chase a bigger prize: bragging rights to an exchange that Vermont hopes will underpin the nation’s first system in which the state foots health-care bills for all residents – what conservatives call “socialized medicine,” some call “single-payer” and liberals, including Peter Shumlin, Vermont’s Democratic governor, call “universal financing.”
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“It was all just way too ambitious,” says Amy Lischko, associate professor of public health and community medicine at Tufts University medical school and a member of an advisory board to Vermont exchange officials. “Did CGI overpromise? Yes, but everybody had a can-do attitude, and there was a lot of money floating around.”
via Doubling Down on Obamacare – Newsweek.
February 7, 2014
Under the scheme, a provision of Obamacare requires that staff members of every hospital in Massachusetts be paid at least as much as the members of the staff of the state’s rural hospitals, with the federal government paying for the extra cost of compliance.
As it conveniently happens, the only “rural hospital” in Massachusetts serves the rich and famous on the fashionable island of Nantucket, summer enclave of the rich and beautiful people, mostly Democrats.
The hospitals in bucolic Western Massachusetts must pay the same wages as the well-appointed medical “cottage” that caters to Nantucket’s 1 percenters, including Mr. Kerry. It’s a $257 million Medicare reimbursement bonus for Massachusetts.
It’s beyond outrageous. According to the Centers for Medicare and Medicaid Services, this scam will cost Arkansas hospitals $5.2 million, Louisiana will lose $6.7 million and North Carolina $12.6 million. The 2014ers are desperate to correct this imbalance before the autumn campaigns.
via EDITORIAL: The Massachusetts Obamacare Boondoggle – Washington Times.
February 5, 2014
On Monday, the Congressional Budget Office (CBO) issued a report which shows that Obamacare will cost the economy the equivalent of 2.5 million jobs by 2024. That’s a lot of lost hours and paychecks, but we thought it would be interesting to extrapolate this number by state. The Bureau of Labor Statistics tells us what percentage of all jobs each state has, so it’s a simple matter to figure out how many jobs Obamacare might cost each state.
via Americans for Tax Reform : How Many Jobs Might Obamacare Cost Your State?.
January 29, 2014
North Carolina is enrolling uninsured people at a rate at least twice that of any other state that has refused to set up its own health exchange and refused to expand Medicaid. In short, among states that are dragging their feet on the Affordable Care Act – no advertising campaigns, no speeches by the governor on how important it is for everyone to have access to health care, no Medicaid expansion that guarantees the lowest income workers coverage – North Carolina is by far leading the pack in private plan enrollment.
via How NC surprisingly became a leader in ACA enrollment | Other Views | NewsObserver.com.
January 9, 2014
More than a third of health-care spending may be wasteful in Massachusetts, where costs are among the highest in the nation, a state report released on Wednesday said.
Main drivers of excess spending included patients returning to hospitals for preventable reasons and emergency-room visits that better primary care could have warded off, the state\’s Health Policy Commission concluded, citing 2012 data. The commission estimated between $14.7 billion and $26.9 billion in wasteful spending that year, representing between 21% and 39% of total health expenditures
via Massachusetts Wastes Third of Health Spending, Report Says – WSJ.com.
January 3, 2014
Could North Carolina became the first State to achieve universal health insurance coverage? A student asked me recently what it would take financially to do so, and how it could most simply and quickly be done. Here is a quick estimate.
via How North Carolina could (sorta) have universal coverage by 2016 | freeforall.