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Trading Up, Not Trading In: California Passes a Landmark Health Benefit Exchange Law

October 4, 2010
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Joe Mathews of NBC’s PropZero (and a New America Foundation Senior Fellow) wrote that “The Meg Whitman housekeeper story is the most interesting political story in California this week. It isn’t the most important.”

Instead, Joe tips Governor Schwarzenegger’s recent signing of two important pieces of legislation creating a health benefit exchange in California -- the first established in the US since the passage of the Affordable Care Act this past spring.

We agree. These bills are both symbolically and substantively important. As Schwarzenegger stressed in a ceremonial signing at the California Endowment headquarters in Los Angeles on Friday, the backing of a moderate Republican governor for the exchanges gives a leg up to the wider goal of implementation. Moreover, Schwarzenegger signed the bills in the face of spirited business opposition led by Anthem Blue Cross and the California Chamber of Commerce, which contended (wrongly, in our view) that the new exchanges would create an unaccountable new branch of government and gain undue authority over insurers.

Fiscal Reform and Poverty Reduction Are Mutually Reinforcing

  • By
  • Jason Peuquet,
  • Maya MacGuineas,
  • New America Foundation
September 30, 2010 |

There is no question that major changes will have to be made to the U.S. budget in coming years. Surpluses are never expected to return, the debt is projected to climb to unprecedented levels, and major programs are significantly underfunded, leaving participants uncertain about what benefits they will receive in the future.


COVERAGE: Recession Causes Drop in 2009 Health Coverage Continued

September 20, 2010
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According to the latest data from the U.S. Census Bureau's annual report on income, poverty and health insurance, the number of people without health insurance increased to 16.7 percent in 2009, up from 15.4 percent in 2008 -- the first time the number of people with health insurance dropped since record-keeping began in 1987.

“The numbers show us that one in six Americans don’t have health care, and that number is largely due to people losing their jobs,” explained the New America Foundation’s Health Policy Program Director, Kavita Patel, in an interview with WTOP. “What health reform will do, although it will take a couple of more years to see some of these changes, is give people some options to buy insurance that is affordable.”

“I know that talk of repeal is something that sounds very interesting as a campaign slogan or a sound bite,” Dr. Patel continued, “but that is not really going to solve the problem. The irony of all of this is that the same things that are distressing us with these numbers that came out today are the very things that we passed health reform to solve.”

Listen to the full interview here.

IN THE NEWS: Health Wonk Review -- Politics and Money

September 16, 2010
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The latest edition of the Health Wonk Review is up over at the Colorado Health Insurance Insider, hosted by Louise Norris. We've got a pretty straightforward theme this round -- health care costs, politics, and the economics of health care were the themes of the day. Be sure to check out all the great posts, including our own Shannon Brownlee's discussion of Don Berwick and the debate over alternative medicine.

The Great Recession Strains the American Social Contract

  • By
  • Lauren Damme,
  • New America Foundation
November 23, 2010

The Great Recession has exposed numerous flaws in our social contract – weaknesses that existed prior to the economic downturn – highlighting the need for changes in our system. This series of policy briefs explores the stresses on our social contract, and the policy changes that must be made to mend it. The six-part series includes:


Overview: The Great Recession exposes flaws in the American Social Contract.

The Next Priority for Health Care: Federalize Medicaid

  • By Greg Anrig, The Century Foundation
September 14, 2010

Medicaid has always been plagued by inequities and inefficiencies due to its dual federal-state character, which diffuses accountability, and because some state governments simply don’t care much about the poor.

COST: New Report, Same Old Story

September 9, 2010
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New numbers on United States health care spending came out today from the CMS Office of the Actuary. The new estimates are updated to reflect the new health care reform law and a couple other relevant pieces of legislation. The full report, National Health Spending Projections: The Estimated Impact Of Reform Through 2019, is available from Health Affairs (subscription required).

The report has critics of the PPACA on the offensive and proponents of the law on the defensive, but ultimately, the projections aren’t that shocking. The CMS Actuaries predict that national health spending will be 0.2 percent higher and the share of health spending as a percent of GDP will be 0.3 percent higher by 2019 than they predicted in their February report.

“In the aggregate,” Andrea M. Sisko, a CMS economist and the principal author of the report, told the New York Times, “it appears that the new law will have a moderate effect on health spending growth rates and the health care share of the economy.”

HEALTH REFORM: Within the Four Corners of the Constitution

September 3, 2010
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This continues our series of posts on the various constitutional challenges to the individual mandate, by Tony Cardona, an attorney who is doing some work with New America's health policy program. Read his post about federal authority and taxation here.

“The Congress shall have Power . . . To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution . . .” (U.S. Const., Art. 1, sec. 8, cl. 18)

In their required Contracts courses, first year law students learn “the four corners rule.” It simply means that the language inside the four corners of the contracted document will be the primary source for resolving a dispute. When our Founding Fathers drafted the Constitution, they created a contract with every generation of Americans. The Supreme Court, the interpreters of this contract, look within the four corners of the Constitution to decides whether a federal law -- such as the individual mandate to purchase health insurance -- exceeds the contract’s scope.  A federal action -- such as regulating the health insurance market -- doesn’t have to be mentioned specifically in the Constitution, but it does have to relate to a power enumerated in the Constitution.

COVERAGE: Everything You Need to Know About Dependents

August 20, 2010

Re-posted with clarification about employer-sponsored coverage.

Yes, it is that time of the year, Back To School. Along with the endless flyers announcing sales on packets of pens and pencils is a great deal of confusion around provisions in the health reform law that allow parents to keep their adult children on their health insurance plan, or dependent coverage as it is better known in the policy world.

Here is what I hope is a simple way to think about this for all of the parents and dependents out there, along with some unanswered questions that still need to be sorted out:

HEALTH REFORM: Right Care, Right Time, Right Place

August 16, 2010

Although it is August, there is a flurry of activity in Sacramento where the Schwarzenegger administration and state legislators are hard at work implementing federal health care reform. They are struggling -- yet again -- to come to a compromise to end a standoff over the state budget. Nevertheless, policymakers and advocates took the time to pack a hearing room in the Capitol to learn more about the role of scientific evidence in the delivery of health care.

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