The Commonwealth Fund | Issue Brief: The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions

Amy M. Lischko, Sara S. Bachman, and Alyssa Vangeli, The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions, The Commonwealth Fund, May 28, 2009. Full text of issue brief.

The Commonwealth Health Insurance Connector Authority is the centerpiece of Massachusetts’ ambitious health care reforms, which were implemented beginning in 2006. The Connector is an independent quasi-governmental agency created by the Massachusetts legislature to facilitate the purchase of affordable, high-quality health insurance by small businesses and individuals without access to employer-sponsored coverage. This issue brief describes the structure and functions of the Connector, providing a primer to policymakers interested in exploring similar reforms at the state and national level. The authors describe how the Connector works to promote administrative ease, eliminate paperwork, offer portability of coverage, and provide some standardization and choice of plans. National policymakers looking to achieve similar policy goals may find some of the structural components and functions of the Connector to be transferable to a national health reform model, say the authors. More at: The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions – The Commonwealth Fund.

CBO Brief: Budgetary Treatment of Health Reform Proposals

The Congress is currently considering various approaches for instituting major changes in the nation’s system of health insurance. Some of those proposals would significantly expand the federal government’s role in that system, thus raising the question of how such changes might be reflected in the federal budget. CBO has just released a brief describing the approach that CBO will take in judging the appropriate budgetary treatment.

Source: Director’s Blog » Blog Archive » Budgetary Treatment of Health Reform Proposals.

Study: Lower legal drinking age increases likelihood of poor birth outcomes

Amid renewed calls to consider reducing the legal drinking age, a new University of Georgia study finds that lower drinking ages increase unplanned pregnancies and pre-term births among young people. “Our findings suggest that a lower drinking age increases risky sexual behavior among young people, and that leads to more unplanned pregnancies that result in premature birth and low birth weight,” said study author Angela Fertig, assistant professor in the UGA College of Public Health. “The take-home message is that when it’s easier for young people to get alcohol, birth outcomes are worse.”

via College of Public Health: Health Policy and Management News.

The Commonwealth Fund | Policy Brief: Extra Payments to Medicare Advantage Plans to Total $11.4 Billion in 2009, or More Than $1,100 Per Enrollee –

B. Biles, J. Pozen, and S. Guterman, The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009, The Commonwealth Fund, May 2009.  [Full text]

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, MA plans have, for the past six years, been paid more for their enrollees than they would be expected to cost in traditional fee-for-service Medicare. Payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee, for a total of $11.4 billion. Although the extra payments are used to provide enrollees additional benefits, those benefits are not available to all beneficiaries—but they are financed by general program funds. If payments to MA plans were instead equal to the spending level under traditional Medicare, the more than $150 billion in savings over 10 years could be used to finance improved benefits for the low-income elderly and disabled, or for expanding health-insurance coverage. More at The Commonwealth Fund.

Urban Institute | Health Reform: The Cost of Failure

John Holahan, Bowen Garrett, Irene Headen, Aaron Lucas. Health Reform: The Cost of Failure. Washington, DC: Urban Institute, May 21, 2009.  Summary. Full Text.

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.

Senate Finance Committee | Policy Options for Financing Health Care Reform

Senate Finance Committee. Policy Options for Financing Health Care Reform. Description of Policy Options Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options. May 20, 2009.
The options for financing health reform report follows the release of policy options for reducing costs in the health care delivery system
and for expanding quality, affordable health care coverage to all Americans. Three areas of potential funding sources explored in the financing options are: savings achieved from within the health care
system from reductions in current levels of spending; reevaluating current health tax subsidies; and changing non‐health tax provisions.  Summary. Full Text.

The Commonwealth Fund | Issue Brief: The Long Wait: The Impact of Delaying Medicare Coverage for People with Disabilities

Stuart Guterman and Heather Drake, The Long Wait: The Impact of Delaying Medicare Coverage for People with Disabilities, The Commonwealth Fund, May 2009.  Full text.

At a particularly difficult point in their lives, disabled individuals must wait two years before they are eligible to begin receiving Medicare benefits—a delay that can block access to needed care and relief from financial pressures. Although the cost to the federal government of eliminating the Medicare waiting period seems high, it would actually represent only a small percentage increase in Medicare spending.  More at: The Long Wait: The Impact of Delaying Medicare Coverage for People with Disabilities – The Commonwealth Fund.

White Paper: Beyond The Public Plan Debate: A Pathway To Transform The Delivery System

Editor’s Note: The post below by Harold Luft is an abridged version of a longer White Paper: Beyond the Public Plan Debate: A Pathway to Transform the Delivery System. The full White Paper and additional information about Dr. Luft’s work are also available.

There is substantial debate among Democrats about whether a public-plan option is a critical component of health reform; Republicans seem unified in opposing the idea. The “public plan” proposals are focused largely on expanding the population with coverage and on controlling federal costs. The proposal below focuses more on transforming the system to slow the growth in all health care costs. By doing so, it can facilitate the savings and political compromises necessary to allow coverage expansions.

Source:  Health Affairs Blog.

Senate Finance Committee: Policy Options for Expanding Health Care Coverage

Senate Finance Committee. Description of Policy Options. Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans. May 14, 2009.
The U.S. is the only developed country that does not guarantee health coverage for all its citizens, with 46 million uninsured and another 25 million underinsured. Today, the cost of caring for the uninsured is largely borne by those with insurance; providers charge higher prices to patients with private coverage to make up for uncompensated care, and these costs are passed on to consumers in the form of increased premiums. A high-performing health system would guarantee all Americans affordable, quality coverage regardless of age, health status, or medical history. This document outlines policy options for providing affordable health care coverage for all Americans.

Proposals included in this document would ensure that the insurance market functions effectively. Reforms proposed for the individual and small group markets would ensure a competitive insurance market in which plans compete on price and quality rather than on their ability to segment risk and discriminate against individuals with pre-existing health conditions. Proposals contemplated in this document would also make purchasing health insurance coverage easier and more understandable by establishing a gateway or marketplace where American consumers could easily compare and purchase the coverage that best fits their needs.

To ensure that coverage is affordable, this document outlines a proposal for targeted tax credits for low-income individuals and small businesses. And for the most vulnerable populations, policy options described here would improve public programs by covering those at the lowest end of the income scale who are least likely to have private coverage through an employer.

Once affordable, high-quality, and meaningful health insurance options are available to all Americans through their employer or the new gateway, individuals would have a personal responsibility to have health coverage. This step is necessary for insurance market reforms to function properly and to end the cost shifting that occurs within the system. It is expected that the vast majority of American employers would continue to provide coverage as a competitive
benefit to attract employees.

Finally, this document outlines proposals to promote prevention and wellness services in public programs. By encouraging healthy behaviors, these policy options make a first step in moving our health system away from a focus on treating disease toward one focused on preventing disease.

This document and the options described in it are intended to spur discussion regarding proposed options for policies that the committee is scheduled to act on in June. While these proposed
options are jointly offered for discussion, not all the options in this document have the support of Chairman Baucus or Ranking Member Grassley.  Full text.

Health Policy Brief: Medicare Advantage Plans

The first brief explores the current debate over cutting payments to “Medicare Advantage” plans – the privately run health plans that now serve almost a quarter of Medicare enrollees.

The brief not only explains how payments to private plans are calculated, but also delineates the arguments and points to research on both sides of the issue of cutting plan payments.

“Congress faces two sets of issues this year: a short-term issue related to the Medicare Advantage benchmarks, and a long-term issue over restructuring the payments to private plans.

The short-term issue is that payments to Medicare Advantage plans appear likely to fall an estimated 5 percent in 2010, according to an insurance industry analysis. The drop stems from several factors, all necessitated by law. But one of these factors — changes in physician payment — is actually a wild card that might or might not reduce the size of this expected cut.”  Full text.

Source: Health Affairs Blog