Health Affairs

Great struggles sometimes result in unexpected opportunities. In the waning moments of 2012, Congress remained in session to bridge partisan divides to solve the fiscal cliff impasse with the passage of the American Taxpayer Relief Act (ATRA). Signing the ATRA into law also achieved policy change on items far beyond the tax code.

For example, the new law repealed the Community Living Assistance Services and Support (CLASS) provision in the Affordable Care Act, which would have created a new, national, voluntary, long-term care insurance product. Yet the problem of how to best finance and deliver care for our vulnerable loved ones has been looming for years and endures. As a much-needed acknowledgment of this, the Congress created a new Commission to propose policy solutions to address the long-term care challenges that a growing number of Americans face.

Given the sheer magnitude of this issue, the current political climate, and the short time span for turning around a meaningful legislative proposal (six months), the Commission’s charge is nothing short of colossal. However, its creation in the wake of the CLASS repeal is an important step towards system transformation that will enable Americans to age with dignity, independence, and choice. The Commission will consist of 15 appointees, nine Democrats and six Republicans, to be named in the next month, who will report back to Congress by the summer. They must devise a plan on the financing and delivery of a comprehensive and coordinated system that ensures available long-term services and supports for people in need today, and options for Americans to plan for their future needs.

For the previous Health Wonk Review, Brad Wright chose a Baby New Year theme. However, there were some problems with the new beginning represented by the turnover from 2012 to 2103. For example, with the New Years fiscal cliff deal, one might have hoped that we would leave our budget crisis behind for a while and start with a fresh fiscal slate. But of course, that did not happen. Not only did we not escape our budget crisis, it multiplied into three crises: the debt ceiling, the still looming sequester, and the coming expiration of government funding –“The Trouble With Trillions,” one might say.

So I decided to give us a fresh chance at a new start by choosing an “Inauguration” theme for this Wonk Review, referring both to Monday’s celebration of a new presidential term but also to the word’s broader meaning of a formal beginning. And in the spirit of looking forward, we’ll lead with a post from Health Wonk Review cofounder Joe Paduda laying out his health policy predictions for the coming year. At Managed Care Matters, Joe offers five predictions, including these: most states will end up expanding Medicaid, and there will be a lot more mergers and acquisitions at the highest levels, among providers, health care systems, and payers.

One of the most vexing problems that has plagued the Medicaid and Medicare programs for decades is the siloed and inefficient system that Medicare-Medicaid eligible individuals must navigate to receive health care services and supports. Or perhaps it’s better to put it this way: we lack a rational, coordinated delivery system to improve health outcomes... Read the rest of this entry »

The constitutional waiting game is finally over. Nearly three months to the day after the historic hearings on the constitutionality of the Patient Protection and Affordable Care Act, the Supreme Court has upheld the vast majority of the law’s provisions. This includes the individual mandate, although the penalties for noncompliance were ruled constitutional under Congress’s... Read the rest of this entry »

One of the goals of the Affordable Care Act (ACA) is to reduce the fragmentation of services for patients. The problems of fragmentation are magnified for the six million Americans receiving long-term services. New analysis, released as a Web First by Health Affairs, examines the impact on this population of three provisions of the ACA—the... Read the rest of this entry »

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines efforts to better manage and coordinate care of more than nine million Americans covered by both Medicare and Medicaid, also known as dual eligibles. This heterogeneous group includes the sickest and most vulnerable adults, many with complex chronic medical or... Read the rest of this entry »

Research and analysis in the newly released June 2012 issue of Health Affairs, supported by a grant from The SCAN Foundation, emphasizes the need to develop new ways of paying for and providing care for the roughly 9 million Americans who are eligible for both Medicare and Medicaid benefits because of age, income, and/or disability.... Read the rest of this entry »

On Tuesday, June 5, Health Affairs will hold a briefing to discuss its June 2012 issue, “Focus On The Care Span For The Elderly And Disabled.” The volume explores a wide range of topics — from avoidable hospital admissions and readmissions, to coordination of care for dual eligibles, to reforming Medicare payment for skilled nursing... Read the rest of this entry »

On February 1, the American Medical Association’s Relative Value Scale Update Committee (RUC), Medicare’s primary advisor on physician payment, announced the addition of two seats: a permanent one for geriatrics and a rotating one for primary care. The American Geriatrics Society and the American College of Physicians praised the move as a step forward that... Read the rest of this entry »

Here are some blog posts that caught my eye this week, as I sifted through foundation blogs I follow. The descriptions are brief—just to give you a flavor of what the post is about.  This is a short week in the office for me, as I head over to nearby Baltimore for the Grantmakers In... Read the rest of this entry »

Flu vaccination rates among nursing home residents have improved slightly, particularly for blacks. Nonetheless, overall vaccination rates remain well below the 90 percent target for high-quality care, and black nursing home residents remain less likely to be vaccinated than whites, say Shubing Cai of Brown University and coauthors in the October issue of Health Affairs. The article... Read the rest of this entry »

A column by New York Times columnist David Brooks titled “Death and Budgets,” read in combination with a recent report from the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (“Medicare Hospices that Focus on Nursing Facility Residents”), makes painfully clear how urgently America must rethink the way... Read the rest of this entry »

A new Health Affairs Web First study finds that increased choice among Medicare Advantage plans leads to increased enrollment in the program among elderly Americans, but only when beneficiaries are choosing among 15 or fewer plans. When Medicare beneficiaries have a choice of 15 to 30 private plans, increased choice does not result in increased Medicare Advantage... Read the rest of this entry »

On July 7, 2011, Health Affairs will unveil its July 2011 issue, “New Directions In Systems Innovations.” The issue explores ongoing innovations in health care organization, delivery and financing across a broad front – from Vermont’s recent passage of single payer legislation, to new responsibilities for hospital boards of trustees as a consequence of the... Read the rest of this entry »

On July 7, 2011, Health Affairs will unveil its July 2011 issue, “New Directions In Systems Innovations.” The issue explores ongoing innovations in health care organization, delivery and financing across a broad front – from Vermont’s recent passage of single payer legislation, to new responsibilities for hospital boards of trustees as a consequence of the... Read the rest of this entry »

If you’re traveling over the long weekend, you’ll want to take along some reading material. While some might reach for a good novel by John Grisham or Dan Brown, the health policy blogs in this edition of the Health Wonk Review tackle equally compelling mysteries. Was the Medicare Trustees report really that gloomy? If Workers... Read the rest of this entry »

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the Community Living Assistance Services and Supports (CLASS) Plan, a voluntary, publicly administered insurance program enacted as part of the Affordable Care Act in 2010. It is designed to help people should they become disabled and need long-term services and... Read the rest of this entry »

Health Affairs today adds a new Medical Education recording to its free collection of Narrative Matters essays on iTunes U. The account was written by Fitzhugh Mullan, a physician and clinical professor of pediatrics and public health at the George Washington University and the original editor of the “Narrative Matters” section. The essay, “Me And... Read the rest of this entry »

President Obama has begun his campaign for re-election in 2012.  Several Republicans have declared their intention to consider the possibility of running.   Meanwhile, implementation of health care reform proceeds slowly, with threats of defunding and legal action scuttling alongside to keep up.  Policy debates about accountable care organizations, medical homes, and other attempts to bring... Read the rest of this entry »

The challenge of reining in the rising costs of the Medicare Program is particularly thorny because it confronts a recalcitrant societal tension between the necessity for cost control and the value of open-ended technology use for life extension in the later years. That tension is becoming more deeply entrenched because a growing number of older... Read the rest of this entry »