Health Affairs

Here’s another quick listing of recent foundation-related blog posts that you may want to check out.

Community Clinics

“Clinics Get Boost from Foundation,” Daniel Weintraub, in California Health Report, Mar. 16. In this blog, part of HealthyCal.org (a nonprofit journalism project funded by the California Endowment), Weintraub writes about the recent $7 million that the Blue Shield of California Foundation (BSCF) awarded to clinics in the state. This funding aims “to bolster their operating budgets and encourage innovation in the run-up to the new reality under health reform.” When the Affordable Care Act broadens eligibility for Medi-Cal (California Medicaid) in 2014, community clinics (also sometimes called community health centers) “will be the health care destination of choice for thousands of additional patients,” Weintraub says.

Up to $5 million of that BSCF funding goes for flexible operating support for not only licensed community clinics, but also licensed free clinics and tribal clinics. Read the foundation’s press release here.

Foundation News You Can Use

“Don’t Call Us, We’ll Call You,” Bradford K. Smith of the Foundation Center on its PhilanTopic blog, Mar. 4. Looking for a grant? Smith, who is the center’s president, notes, “Of the more than 86,000 independent, community, and corporate foundations in the United States, 60 percent state that they do not accept unsolicited proposals.” Smith offers two reasons why foundations are going this route and suggests a way that a grantseeker might still get a foot in the door.

“What I Learned at Grantmakers In Health’s Annual Meeting?” Ann Barnum of the Health Foundation of Greater Cincinnati on its blog called The Health Foundation, Mar. 17. Read Barnum’s insights on this conference held in Los Angeles in early March. On GrantWatch Blog, see a post by her colleague Janice Bogner and two posts that I wrote.

Health Care for the Elderly

“The Operation Is a Success but the Patient Has Died, Part I,” Chris Langston on the John A. Hartford Foundation’s health AGEnda blog, Mar. 22. Langston comments on a Geriatrics Workforce Policy Studies Center article in the Journal of the American Geriatrics Society, released in October 2010, which concluded, he says, “that geriatric medicine is not producing the number of new faculty needed to train future providers.” (Increasing the number of faculty members falls under the Hartford Foundation’s Academic Geriatrics and Training priority area. Read more here.) Work on this article was done under Hartford’s grant to the center, Langston told me. Foundations do not always admit when outcomes of their efforts have been disappointing, so Langston’s candor and outreach to blog readers for ideas on how to “collectively design a new program to draw new blood into academic geriatrics” is refreshing.

He mentions a few caveats: “No magic wand solutions and no appeals to grand powers,” such as the Bill and Melinda Gates Foundation—Langston concedes that he already tried that funder! Also, ideas from readers must be “affordable with the resources we can reasonably expect to control.” Langston told me he expects that those resources would be largely Hartford Foundation dollars, but possibly other funding could be solicited through a challenge grant or a matching grant.

In a subsequent post on Mar. 24, Langston suggests a new approach called “a competitive ‘debt service’ award targeting physicians in residency training who would commit early to go into academic geriatrics.” He asks readers if this idea is reasonable and notes that one Hartford Foundation grantee is already doing something similar to this. Remember, the objective here is to get people interested not just in geriatrics but in pursuing an academic career in this area of medicine! Langston’s observations are timely as the aging baby-boomers are becoming senior citizens.

Health Information Technology (IT)

“The Road Ahead for the New National Coordinator for Health IT,” Carol C. Diamond of the Markle Foundation on its Connected World Blog, Mar. 25. Diamond says that the successor to outgoing coordinator David Blumenthal “will have very big shoes to fill, but a different and equally important challenge—to preserve ‘meaningful use’ gains by finding ways to make them sustainable in broader health care reforms.” (The Centers for Medicare and Medicaid Services, through “meaningful use” programs, “is providing incentive payments to eligible health care professionals and hospitals [that] adopt certified [electronic health record] technology” and demonstrate that they meet certain criteria when using that technology, a government website explains. A 2009 federal law authorized these programs.) This post originally appeared on Health Affairs Blog (GrantWatch Blog’s sister blog).

Health Promotion and Disease Prevention/Global

“TB: When the Barriers to Care Are Too High,” Kathleen Kingsbury on the Open Society Foundations Blog, Mar. 24. The text of this post is very short. The focus here is on ten pictures by photojournalist Misha Friedman, who traveled to eastern Ukraine in January “to document the unique challenges that tuberculosis patients in the region face to access treatment.” Kingsbury notes that almost 50,000 people in this Eastern European country are diagnosed with TB each year. (Contrast that with the figure for the United States for 2010, recently released in the Centers for Disease Control and Prevention’s [CDC’s] Morbidity and Mortality Weekly Report. The figures are probably not exactly comparable, but the figure released by the CDC gives you an idea.)

Health Reform

“Health Reform: The Coverage, Cost, and Quality Reforms Ahead,” Karen Davis in the Commonwealth Fund Blog, Mar. 23. Davis, who is president of Commonwealth, notes that in year two under the Affordable Care Act, “the groundwork for further coverage expansions, as well as important quality improvement and cost-control measures, will ramp up.” Two interesting things Davis mentions are a new Physician Compare website for Medicare beneficiaries (part of the federal government’s Medicare.gov site) and the requirement that employers disclose the cost of health benefits on workers’ W-2 forms for tax year 2011. When I was trying to determine when Physician Compare started, I came across another blogger, at Forbes magazine, who called the site “deeply disappointing.” See what you think.

“Facts Are Stubborn Things,” James W. Squires in the Endowment for Health’s Insight blog, Mar. 21. Squires, who is president of this foundation in Concord, New Hampshire, says that a year after the Affordable Care Act was enacted, public discourse on reform “is dominated by words and phrases that include ‘Government takeover of health care’ and assertions that the law is unconstitutional.” He says that in his opinion, such assertions are not based on a body of facts; they instead reflect “wishes, inclinations and political dictates.” Instead, see what Squires thinks readers of this blog should know.

“Separating Exchange Facts from Fiction,” Joan Henneberry in the Colorado Health Foundation’s Health Relay blog, Mar. 23. Henneberry, who is the project director for the Colorado Health Insurance Exchange, works at the Colorado Health Institute. She reports that “Colorado is making big strides in planning for [its] state-based health insurance exchange.” The federal health reform law requires states to begin offering benefits to exchange customers on Jan. 1, 2014, she reminds us. She explains the basics of insurance exchanges and answers some FAQs, such as “Why are we planning for health reform? I thought the federal law was overturned already. Didn’t the courts rule it unconstitutional?” Uh, oh, that questioner is confused. . . .

Read about the California HealthCare Foundation’s effort to be a catalyst for change in this area.

While access to palliative care has been steadily increasing in hospital settings over the past decade, a survey published in 2007 on the availability of palliative care in California and funded by the California HealthCare Foundation (CHCF), found that only 33 percent of all California hospitals reported a palliative care consulting service. The situation for public hospitals was even worse, with only 20 percent of such hospitals in California offering a palliative care consulting service at that time.

Palliative care–as described by the Center to Advance Palliative Care–is the medical specialty focused on improving the overall quality of life for people facing serious and life-threatening illness. Palliative care emphasizes pain and symptom control, intensive communication (including family support and shared decision making), and coordination of care. Although palliative care is often associated with end-of-life care, its availability does not depend on a patient’s prognosis.

The substantial barriers to the expansion of palliative care in California public hospitals include a patient population that is poor and medically underserved; relentless change in hospitals’ fiscal and regulatory policy environments; and the linguistic diversity of patients in these hospitals, where English is sometimes a minority language among the dozens of languages spoken.

Recognizing the need to expand the availability of palliative care in public hospitals, despite these obstacles, in 2009 the CHCF awarded grants to start a palliative care consultation service at eight public hospitals and expansion grants to extend existing programs at four hospitals.

When palliative care services are up and running, providers working with patients who have severe and life-threatening illnesses can call upon trained palliative care teams that will consult with them, and with patients and families, to reach consensus about how much and what kinds of medical interventions are desired. This process of developing an agreed-upon roadmap for treatment sounds natural–yet in hospitals where the default is often to treat all patients with every tool in the arsenal, regardless of the stage and degree of illness, reaching an informed decision about treatment through palliative care consultations is often a revolutionary process.

A recent interim evaluation report indicates that the CHCF has helped to serve as a catalyst to expand the number of high-quality palliative services in California public hospitals; through its funding, the hospitals have already served more than 3,400 patients. These services meet national standards and indicators of quality in palliative care. For example, they are integrated into the hospitals’ quality improvement measures and report both program and financial data. They also provide educational material in multiple languages and hold meetings with palliative care team members, patients, and families to discuss the goals of care and mutually determine best approaches to achieve comfort for patients.

The CHCF’s multifaceted approach to starting and advancing palliative care in public hospitals–which includes financial support, technical assistance, and a peer-learning community–appears to be successfully building palliative care capacity in such hospitals. The CHCF recipe for building that capacity has included the following ingredients:

(1) Build a knowledge base. First, using a series of CHCF surveys and reports, the foundation created a publicly available “library” of information and tools about palliative care, which is available on the CHCF website.

(2) Start with planning grants. An initial series of planning grants enabled hospitals to research and plan for what would be required to implement palliative care programs in their unique settings and to participate in the Palliative Care Leadership Center training at the University of California, San Francisco. It is one of eight leadership centers supported by a consortium of funders and affiliated with the Center to Advance Palliative Care.

(3) Provide substantial expansion and implementation grants. CHCF grants were awarded in 2009 and early 2010 to twelve hospitals so that they could either expand their existing palliative care services (four hospitals), or implement new services (eight hospitals). This round of funding reached twelve of the seventeen acute care hospital members (70 percent) of the California Association of Public Hospitals and Health Systems. The CHCF authorized another round of implementation grants in December 2010 for up to five hospitals. Hospitals are now in the process of responding to a request for proposals. If all are funded, then all acute care public hospitals in California would provide palliative care programs at the conclusion of the CHCF’s initiative.

(4) Support grantees with technical assistance. Implementation and expansion grants are supported by multiple types of technical assistance from the Palliative Care Leadership Center at UCSF. All grantee sites participate in multiple-day trainings at UCSF and have subsequent access to ongoing technical support from center staff.

(5) Mandate sites to develop a fiscal sustainability plan. An important aspect of UCSF’s technical assistance shows sites how to demonstrate financial savings from their palliative care services to help them make the financial case for sustaining these services. In addition, the California Health Care Safety Net Institute (the research and educational affiliate of the California Association of Public Hospitals and Health Systems), a key partner with the CHCF in working with the public hospitals, helps sites build their visibility through their relationships with public hospitals’ leadership.

(6) Gather data for collective learning. Sites collect common data to document their work, growth of palliative care services over time, and how the services fit within the larger hospital context. Data are shared across sites for benchmarking and mutual learning.

(7) Create a learning community. All sites participate in monthly calls and an annual meeting to discuss common topics of interest with experts— including pain management, integrating chaplaincy services into palliative care teams, and developing self-care programs to avoid provider burn-out—and to share case studies.

(8) Improve medical interpretation for palliative care. Interpreting palliative care consultations is very demanding, and many medical interpreters feel that specialized training would enhance these discussions. To address the needs of public hospitals, which see such a large percentage of non-English speakers, the CHCF is funding a national survey of medical interpreters to explore where additional training may be useful to interpreters. An educational program to prepare interpreters for the palliative care encounter is being developed; it will be available for face-to-face training in 2011, with plans to make the training available online as well.

(9) Fund an evaluation. The evaluation is documenting and summarizing the work of sites to tell the story of implementing palliative care in California’s public hospitals.

Still, many challenges remain. While the number of palliative care services continues to grow, they are still insufficient to meet the demand. Among the biggest concerns that sites have are their hospitals’ ongoing budget challenges and their palliative care teams being unable to manage the increased demand for their services once the word is out that they exist.

This initiative is still mid-course, and final results are not in. However, it appears that there is reason for optimism about the effectiveness of this approach to assuring that low-income, uninsured, and underinsured patients, many of whom have long-neglected medical and other needs, receive the best possible care while they face serious decisions about health care and the quality of their lives and deaths.

This is the second in a series of short posts on my trip to Los Angeles to cover the Grantmakers In Health (GIH) Annual Meeting earlier this month.

Humans need physical activity as much as they need food. Unfortunately, they have no internal prompt to be active, and they are programmed to be sedentary, said Antronette (“Toni”) Yancey, a professor at the University of California, Los Angeles, School of Public Health.

She holds both a master’s degree in public health and a medical degree. Also, she has been director of public health for the city of Richmond, Virginia, and director of chronic disease prevention and health promotion for the Los Angeles County Department of Public Health.

Yancey, the GIH meeting’s opening plenary speaker and a member of the Partnership for a Healthier America, the nonprofit founded to support First Lady Michelle Obama’s Let’s Move campaign to end childhood obesity, commented that efforts to get people to exercise more are not effective; we need “social prompts.” She advocates “push” interventions, such as “walking meetings” and auto-free zones. A meeting attendee asked how you conduct a walking meeting. Yancey responded: By having smaller meetings, weekly, where those attending don’t need to write down much as they walk and talk.

Yancey is the author of Instant Recess: Building a Fit Nation Ten Minutes at a Time (University of California Press), which was published in November. (An “Instant Recess” is a ten-minute or so break for exercise that can occur in schools, offices, or elsewhere in the community, the publisher explains.) Watch a September 2009 video on YouTube about the concept of Instant Recess in offices.

She talked about what GIH member foundations should do to encourage more physical activity in the United States. In the past, foundations required grantees to have smoke-free offices (until this was rendered unnecessary by federal regulatory and state/local legislative policy, Yancey pointed out to me later). Now, funders can “lead by example” by demonstrating a culture of healthy eating and active living within the foundation office(s). Foundations can also require that grantees practice healthy eating and an active lifestyle in their organizations.

Yancey later suggested that foundations fund grantees to modify sports rules to make practice sessions more continuously active for the children involved and support non-sports alternatives for kids, such as walking and running clubs. Actually, only a small subset of kids participate in team sports, she commented. She also highlighted the key role that foundations played in catalyzing the development of active, or physical, video games such as the Wii.

In fact, during her plenary speech, she directed the ballroom full of foundation staffers to get up out of their chairs and do a few minutes of exercise right there—that meant everyone, fat or thin, young or old! I felt a little self-conscious there in front of numerous foundation contacts I write about, but Yancey had a point: this is easy and low-cost and has to be better than being constantly sedentary all day at work.

The point is, Yancey said, Instant Recess-type physical activity is low-cost and can be done anywhere, anytime.

She noted that she coauthored a literature review that was published in the January 2011 issue of the American Journal of Preventive Medicine; it presented evidence that short periods of exercise are effective. Most of the articles reviewed involved schools. Read the abstract here.

Yancey mentioned the Robert Wood Johnson Foundation’s national program called Active Living Research (Building the Evidence to Prevent Childhood Obesity and Support Active Communities) in her speech. I see that she was co-principal investigator on a 2006–2009 grant awarded by this RWJF program.

She also mentioned that the California Endowment “walks the talk” of getting more physical activity at work. Staffers there take one or two physical activity breaks a day. (Yancey told me later that they also put “recess” breaks on meeting agendas in their outreach activities.)

In addition, Yancey referenced the San Diego Padres baseball team’s efforts to provide food that is more healthy (yet not too expensive) at the PETCO Park (ballpark). I looked it up, and the California Endowment and the team have a fitness initiative called FriarFit, announced in this 2008 press release, “to improve the health and fitness of San Diegans.” It involves the local ballpark, schools, and community. Yancey was also involved with this initiative: She produced a ten-minute Instant Recess exercise video for schoolchildren. It was set to music and included the participation of baseball Hall of Famer Dave Winfield, who played for the Padres (and other teams) and still works for the team, and other players, according to FriarFit’s website and Wikipedia.

There’s an idea that foundations in other cities with baseball teams can try!

Numerous funders supported GIH’s Annual Meeting. They include the Aetna, Ahmanson, Archstone, California HealthCare, California Wellness, Colorado Health, Consumer Health, DentaQuest, Robert Wood Johnson, W.K. Kellogg, Marisla, Gordon and Betty Moore, David and Lucile Packard, Fannie E. Rippel, Samueli, Staunton Farm, and Sunflower Foundations; as well as the California Endowment, Kaiser Permanente, the Missouri Foundation for Health, and the federal government.

Drew Altman is the 2011 recipient of Grantmakers In Health’s (GIH) Terrance Keenan Leadership Award in Health Philanthropy. Here, I focus on his remarks at a Mar. 3 luncheon at the GIH Annual Meeting, in Los Angeles, which I attended.

P.S. GrantWatch Blog just marked its one-year anniversary. We hope that you enjoy the posts, and we encourage you to write a guest post or comment on one that you read.

Drew Altman, president and chief executive officer (CEO) of the Henry J. Kaiser Family Foundation (KFF), cautioned the audience of foundation staffers from around the country that some foundations’ “preoccupation with corporate-style governance” is a concern. He said that at the KFF, “we care about management,” but “our job is to make a difference” in the lives of people. As a matter of fact, Altman said later in the speech, that the question that Terry Keenan of the Robert Wood Johnson Foundation often asked was, How will this grant matter to people?

Altman, who has been at the KFF since 1990, said in his award acceptance speech that he had actually worked with Terry Keenan, for whom the award is named, back in the 1980s when they were both at the RWJF. Altman has also worked for the Health Care Financing Administration (now called the Centers for Medicare and Medicaid Services), the Pew Charitable Trusts, and the state of New Jersey (where he directed the Department of Human Services).

An entertaining speaker, Altman told a hilarious story about his “ignominious beginning in philanthropy,” which involved his family cat’s accident on a suit he wore while taking the feline to the veterinarian, leaving his suit smelling like a litter-box. He had the suit dry-cleaned once or twice (I missed that point). Later, he had a meeting to make, his first at the Commonwealth Fund, and wore the suit. His attempt to sidle near a window to disguise the persistent odor only puzzled former Commonwealth president Margaret (“Maggie”) Mahoney, a distinguished health foundation leader, who could not understand his bizarre behavior during the visit. She asked someone else at the meeting what was wrong with Altman, he said with a chuckle.

 What an icebreaker for his speech!

However, Altman focused his remarks on health philanthropy—he believes “strongly in an activist orientation for philanthropy.” There needs to be an independent force that is neither commercial nor political, he added.

He cautioned the audience about something else: he is worried that the “metrics movement [measuring grantees’ work] can go too far” and can rob philanthropy of its “essential difference” from corporations. The KFF’s biggest impact, he noted, has been “invisible, behind-the scenes” work that the foundation staff admittedly “does not know how to quantify,” he said. The KFF views itself as an independent voice and a source of information and analysis—this operating foundation (see the Foundation Center’s glossary for a definition) releases studies, fact-sheets, news, and polls. Its product is information.

Read more here about the KFF. It works on many policy-related topics, including health reform, Medicaid/Children’s Health Insurance Program (CHIP), Medicare, costs of health care/insurance, the uninsured/insurance coverage, state health policy, prescription drugs, HIV/AIDS, U.S. global health policy, minority health, and women’s health policy.

As noted earlier, Altman came to the KFF in 1990; he was charged with remaking the foundation, with a new staff. (The overhaul occurred in 1991, according to GIH materials.) The lesson here is that change is possible at a foundation, as is continuing adaptation. He mentioned that the KFF currently has some “strong-minded” board members, including journalist Cokie Roberts and former U.S. Senate Majority Leader Bill Frist (R-TN).

Altman pointed out that the Pew Charitable Trusts is another example of a funder that has changed. Several years ago Pew became a public charity and “morphed” into a funder that is “taking on huge issues.” It has remained under the same leadership before and after the change—president and CEO Rebecca (“Becky”) Rimel, as well as Pew family members. Pew shows that a grantmaker can adapt to change. Altman commented that he does not like all that Pew does, but he admires the grantmaker.

The federal health reform law (the Affordable Care Act) will survive, Altman commented—at least, that is his hope, if not his conviction.

Altman donated the prize money he received from Grantmakers In Health to the International Medical Corps.

Read more about the KFF here in Altman’s President’s Message, last updated in June 2009.

Read the abstract of a June 2010 Health Affairs article, “Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform,” which Altman coauthored. (Journal subscribers have free access to the full text of the article.)

Numerous funders supported GIH’s Annual Meeting. They include the Aetna, Ahmanson, Archstone, California HealthCare, California Wellness, Colorado Health, Consumer Health, DentaQuest, Robert Wood Johnson, W.K. Kellogg, Marisla, Gordon and Betty Moore, David and Lucile Packard, Fannie E. Rippel, Samueli, Staunton Farm, and Sunflower Foundations; as well as the California Endowment, Kaiser Permanente, the Missouri Foundation for Health, and the federal government.

The Grantmakers in Health (GIH) Behavioral Health Funders Network caught the Hollywood bug at the annual meeting of GIH, held in Los Angeles in early March. At a breakfast meeting with John O’Brien, senior advisor on health care financing at the Substance Abuse and Mental Health Services Administration (SAMHSA), the network presented its Top-Ten Things Foundations Can Bring to Partnerships with Government list.

At the meeting, O’Brien shared SAMHSA’s strategic plan for 2011-2014 with the network, which is a special interest group within GIH that has almost seventy members. SAMHSA’s message includes the following: behavioral health is essential for health; prevention works; treatment is effective; and people recover from mental and substance use disorders. SAMHSA also promotes integrated care (behavioral health and primary care), parity in insurance coverage, and participant-directed care (in which individuals determine what mix of services and supports works best for them). The network supports these principles.

Most governments—local, state, and national—often do not realize what terrific partners foundations can be. And, honestly, sometimes foundations forget what great partners governments can be. Public-private partnerships can greatly enhance the work of both sectors by aligning, supporting, and enriching each other’s work. To that end, here’s the list we presented to O’Brien:

1. Knowledge and experience to help inform efforts. Foundations have been supporting projects that integrate behavioral health and primary care for some time. We can share what we’ve learned with government to inform public efforts.

2. Nonpartisan analysis and study. Foundations can provide an independent, objective view and bring in perspectives from health care providers, businesses, community leaders, and the person on the street.

3. Financial resources to leverage greater impact. Foundations and government entities can coordinate their giving to fund new projects, which would enhance the chances of those projects succeeding. This could occur by co-funding projects or by offering matching grants.

4. Common strategies to reduce duplication and conflict. Foundations have their goals and objectives, and so do government entities. Sometimes, trying to meet those divergent missions pulls grantees in different directions or leads to duplication of efforts. When possible, foundations and government entities should work together on common strategies; this would produce better results.

5. Neutral conveners. Foundations are usually seen as unbiased and can convene disparate stakeholders to discuss hot issues on neutral ground.

6. Technical assistance. Foundations can provide advice and training to enhance government initiatives. For example, foundations can fund training to develop skills in current and future public-sector leaders, fund planning grants to assist health providers in obtaining government grants, or fund consultants to lend expertise to local, state, or federal projects.

7. Program evaluation. Foundations have developed ways to evaluate the effectiveness of programs they’ve funded. We can support nonprofits as they evaluate their government-funded projects and share with government what we’ve learned about evaluation.

8. Support of local work to complement new government initiatives. Not every worthy program will receive state or federal grants to get started. Foundations can provide start-up funding for local programs that parallel government initiatives to broaden the impact on the community.

9. Jump-start government priorities. Some practices are encouraged by the government but not funded. For example, the federal government encourages using evidence-based treatments in health care but doesn’t always provide money to bring these treatments into nonprofit provider agencies. Foundations can provide start-up funding to jump-start these kinds of efforts.

10. Being a testing ground for innovative programs. Foundations can play a role in funding cutting-edge ideas and determining what it would take to scale up the successful practices.

At the end of the meeting, O’Brien said he would serve as the contact person for the developing relationship between the network and SAMHSA. He also promised to make sure that foundations are at the table for upcoming discussions at SAMSHA. He kept to his word: Thomas Adams from the Missouri Foundation for Health, a member of the network, participated in SAMHSA’s national dialogue regarding the role of behavioral health in public life; the event was held on Mar. 15, only eleven days after the breakfast meeting.

The Behavioral Health Funders Network hopes to keep this momentum going. If you’re interested in learning more about the network, please contact Emily Art, program associate at GIH. She can be reached at eart@gih.org or 202-452-8331.

Later this month the Accountable Care Act will mark its one-year anniversary. I have been wanting to mention three items on federal health reform that I was alerted to in late February. Here they are! 

Projected Effects of Health Reform in Colorado

A new issue brief provides strong financial justification for the Affordable Care Act—at least in the state of Colorado. The brief projects what the budgetary effects of federal reform may be on families, businesses, and the state of Colorado. “The Economic Impact of Health Reform in Colorado,” an issue brief prepared for the Colorado Trust, was released Feb. 23. (The seven-pager contains highlights from a more in-depth study conducted by a team at the New America Foundation, a research organization, and funded by the trust and the Colorado Health Foundation.)

In the brief, New America researcher Michah Weinberg summarizes the report’s projections. Under reform, he notes, health care cost increases in Colorado will slow down; premiums for employer-sponsored health insurance will be lower; and “increasing health insurance coverage in Colorado will spur increased economic activity and create more jobs, even after accounting for the costs of financing reform,” according to a press release. One reason for this projected good news is that the Accountable Care Act is expected to make the medical system more efficient. Another reason is that with more people in the state having insurance and seeking medical care, demand for health care workers will increase—and with more opportunities to work, more people with disposable income will “buy other consumer goods from Colorado businesses,” the release says.

Two methodological points: New America researchers began the study before federal reform had been enacted, so they had to update certain findings to reflect provisions of the Affordable Care Act. The Center for Colorado’s Economic Future at the University of Denver validated the full study’s findings.

Opinions of Kentuckians on Reform

Recently released poll results show that the most popular elements of the Affordable Care Act for Kentuckians were tax credits for small businesses (82 percent of Kentucky adults responding favored this provision); access to basic preventive services without a copayment (78 percent); prohibiting insurance companies from denying coverage for children with pre-existing conditions (76 percent); and closing the Medicare prescription drug benefit’s “doughnut hole” over time (76 percent). Those specific provisions had majority support whether respondents were Democrats or Republicans, according to a February 2011 report from the 2010 Kentucky Health Issues Poll; however, as might be expected, higher percentages of Democrats felt “more favorable” toward each of those four elements.

Forty-seven percent of adults in the Bluegrass State “had a generally unfavorable opinion” of the federal health reform law as a whole. Twenty-six percent of respondents had a generally favorable opinion of the law, and, interestingly, 26 percent of respondents “expressed no opinion about the law.”

The poll, funded by the Foundation for a Healthy Kentucky and the Health Foundation of Greater Cincinnati, also found that only 27 percent of Kentucky adults felt that they had enough information about the Affordable Care Act “to understand how it would affect them personally,” said a Feb. 24 e-alert.

The Institute for Policy Research at the University of Cincinnati conducted the telephone survey, which covered a variety of health topics, in December 2010. The institute surveyed 1,677 adults from throughout Kentucky.

Misinformed People

Twenty-two percent of respondents to the national February 2011 Kaiser Health Tracking Poll were under the impression that the Affordable Care Act “has been repealed and is no longer law” and 26 percent of respondents said they did not know the status of the law or refused to answer the question, according to the survey. Oh, dear! Drew Altman, president and chief executive officer of the Henry J. Kaiser Family Foundation (KFF), called these results “a doozy” in his Pulling It Together monthly column.

Altman titles his Feb. 24 column “Forget Math and Science, Teach Civics (Or Why We Need to Bring Back ‘Schoolhouse Rock’”). He inquires, “How could a repeal ‘vote’ in the [U.S. House of Representatives]—however dramatic but still, only symbolic—be misunderstood as an actual repeal by so many Americans?” He suggests that people have busy lives and may have just seen the word “repeal” and jumped to the conclusion that the entire law was repealed. Also, Republican respondents may have been doing some “wishful thinking” about repeal, Altman commented. He calls for Schoolhouse Rock!, a television series of short films that used to air on Saturday mornings, to return and teach some civics. (A couple of films, under the category “America Rock,” apparently were on civics.) This show was after my time, so I defer here to Wikipedia!

Another finding from the Kaiser Health Tracking Poll was that 48 percent of Americans had an unfavorable view of the Affordable Care Act, and 43 percent had a favorable view. Princeton Survey Research Associates conducted the telephone survey, in English and in Spanish, in February 2011.

Related resources:

Cato Institute Conference, Monday, Mar. 21: “The New Health Care Law: What a Difference a Year Makes.” Speakers include Michael Cannon of Cato; Ron Pollack of Families USA; Douglas Holtz-Eakin of American Action Forum (he is a former director of the Congressional Budget Office in the George W. Bush administration); and Kavita Patel of the Engelberg Center for Health Reform at the Brookings Institution (she was formerly with the Obama administration). Click on the above link to register for this free conference by noon, Friday, Mar. 18.

Sarah Dine, a colleague here at the journal, forwarded to fellow staffers this column, “Dumbing Deficits Down,” by Paul Krugman of the New York Times. In this Mar. 10 column, Krugman writes about a panel discussion at the Academy Health National Health Policy Conference, Sarah pointed out. (Health Affairs was cosponsor of this Feb. 2011 conference.) Krugman comments that he was amazed at the reasoning of some congressional staffers during that dialogue. Check out his op-ed.

Below, we list the three most-read posts of the month. Take a look in case you missed one of these when the original tweet or e-alert was sent out.

1. “Update on What Foundations Have Been Doing in Oral Health Care” (Jan. 27, 2011). Read about the efforts of a number of foundations all over the United States. We mention recent funding awarded, results of a foundation initiative, publications, and a website—all on oral health. You may read about one or two funders you are not familiar with. As an aside, foundations are interested in oral health: I was just at the Grantmakers In Health meeting in Los Angeles and understand from Ralph Fuccillo of the DentaQuest Foundation that the Funders Group on Oral Health Policy breakfast there had a very good turnout—thirty-eight participants. In his view, interest in the topic has increased.

2. “The Robert Wood Johnson Foundation and Its Mastery of Social Media,” by Hope Leman of Samaritan Health Services (Jan. 25, 2011). This guest blogger is a research information technologist and Web administrator in Corvallis, Oregon, and a GrantWatch reader. She is online much of her workday and writes in this post about the innovative work that the Robert Wood Johnson Foundation (RWJF) is doing. The RWJF is funding health technology projects, and its staff is using social media in their daily work. We believe that Leman’s is the most popular post since GrantWatch Blog was launched almost a year ago!

3. “RWJF Poll: Two Health Affairs Articles among Top-Five ‘Most Influential Research Articles of 2010’ by RWJF Grantees” (Feb. 10, 2011). Health Affairs is pleased to appear twice on this list of articles by Robert Wood Johnson Foundation grantees. The list resulted from an informal, online poll that the foundation conducted. Enjoy reading about all five of the top vote-getters.