Coverage

Community health centers play a vital role in our health care safety net, but they are often overlooked in our national conversation. Luckily they weren't overlooked in the health reform legislation -- community health centers get $11 billion. What do they need to overcome barriers to care, give vulnerable and underserved populations the care they need, and plug in some of the gaps in the primary care system? A new report from the Commonwealth Fund, Enhancing the Capacity of Community Health Centers to Achieve High Performance, has some answers.

Starting in 2014, the new health reform law will expand Medicaid coverage to most of the population below 133 percent of federal poverty level, amounting to about 15.9 million newly eligible enrollees by 2019. In a new report from the Kaiser Family Foundation, John Holahan and Irene Headen of the Urban Institute crunch the numbers and provide a state-by-state breakdown of what the Medicaid expansion means to states -- and their budgets.

The expansion is great news for the millions of low-income Americans (including childless adults) in need of health care. By 2019, there will be a 45 percent reduction in the number of uninsured adults under 133 percent FPL. Cash-strapped states might have mixed feelings about the expansion, but there is some good news for them -- the federal government will pick up the tab for covering the newly eligibles. For the first three years, the federal government will pay 100 percent of the costs, and in subsequent years, the federal government’s share will phase down to 90 percent of the cost of extending coverage. All told, between 2014 and 2019, the federal government will pay out an average of $443.5 billion (about 95 percent of the total cost), while states will contribute $21.2 billion.

According to a new report by the Commonwealth Fund, young adults are going to win under the new health reform law. Nearly all of the 13.7 million uninsured young adults will get insurance coverage over the coming years, largely from significant Medicaid expansions, the provision that allows young adults to stay on their parents' insurance until the age of 26 and from the new exchanges and federal subsidies launching in 2014.

Starting in 2014, everyone earning a certain salary must carry health insurance. The Congressional Budget Office maintains that the "compliance of young adults will be particularly important in terms of creating broad and diverse risk pools in the exchanges and individual markets" and estimates that "the influx of young and health people into the exchanges and individual markets will lower premiums by 7 percent to 10 percent."

New America's California Health Program recently released the report of The California Task Force on Affordable Care. This group of leaders from the physician, hospital, insurance, business and consumer sectors worked together to develop a plan to save the state $305 billion in health spending during the next decade. This excerpt, the third of a series we will post on the blog, focuses on one strategy from the High Value Top Ten, a comprehensive set of proposals to improve value for the patient and bring down costs for Californians.

7. To promote value-based competition and enhance affordability, California should design its state-based insurance exchange for individuals and small businesses to promote maximum participation and to avoid risk selection.

Few subjects led to more lively conversations among Task Force members than that of the correct structure for the new health insurance exchanges envisioned in national reform. As anticipated by this dialogue, federal legislation created separate state-based exchanges for individuals (the American Health Benefit Exchanges) and small businesses (the Small Business Health Options Program [SHOP] Exchanges). These exchanges will open in 2014 and will be administered by a governmental agency or a non-profit organization.

How can health reform make us healthier as a nation? Who better to answer that than Dr. George C. Benjamin, MD, executive director of the American Public Health Association. We asked him to guest post for us and highlight some of the provisions in the legislation that promote public health.

The recent debate over health reform yielded legislation that signifies an important step to achieving access to heath care for Americans. The extension of health insurance coverage to more than 32 million people is indeed an historic step toward improving the health of the uninsured. However, it is clear that having health insurance does not guarantee health by itself. The new health reform law recognizes this fact. Several provisions which have received relatively scant attention were included to improve the delivery of health care services to underserved individuals, enhance the health and public health infrastructure and change broader conditions in communities to make it easier to be healthy.

Henry Stern hosts the latest edition of the Health Wonk Review over at InsureBlog this week. Stern's take on the Review brings us back to the basics -- he looks at the founding purpose statement of HWR and hits every major category: "Health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends re same are all fair game. We avoid things clinical in nature."

Stern makes special mention of the wonkiest post of all, submitted by Austin Frakt:

Making causal inferences in observational studies is more challenging than in randomized experiments. But econometric and statistical techniques have now improved to the point that a knowledgeable practitioner can draw causal conclusions from sound observational research. Though these techniques have already been employed in economics they have not been widely applied or appreciated in health services research. Given their utility and ease of application, that should end.

Stern ran the text through a Google translator to turn it from Wonkese into English. Click here to hear the result!

A typical family's health care costs increased 7.8 percent last year, or by $1,303 for a family of four, according to the Milliman Medical Index, which focuses on families covered by an employer-sponsored plan using a PPO (preferred provider organization). It's the biggest total dollar increase the actuarial firm has ever found.in its annual study (although not as a percentage).

Employers and employees alike shared the increase in cost this year, with employers total costs increasing 8.00 percent and employees total costs increasing 7.4 percent. The employee portion includes both out-of-pocket cost sharing at time of service and payroll contributions for medical coverage. Increasing health care costs remain a challenge for both employer and employee and are largely driven by increases in the underlying cost of care.

Total medical spending for the average American family reached $18,074 in 2010, compared with $16,771 in 2009, according to the study. The average employer paid $10,744, topping $10,000 for the first time.

How to get the best value out of health care? A recent New America Foundation in California event explored how to answer that question for the people of California (and beyond). Making Reform Affordable focused on actions that the citizens and leaders of California could take to ensure that health care reform promotes affordable high quality care. The event coincided with the release of the California Task Force on Affordable Care report, which includes input from the state's health care leaders to outline how Californians can save $300 billion on health care during the next decade.

Kim Belshè, Secretary of the California Department of Health and Human Services, emphasized that health reform means more than expanding coverage. It must also account for affordability and quality improvement. “This task force is well positioned and well suited to bring an important voice to many of the important implementation matters that will come before our state elected leaders and our policy administrators,” she said.

The New America Foundation's health policy program has a new director for a new era. Kavita Patel, MD, MS, is a primary care physician who has more than ten years of policy experience, working on national health care reform at the Senate's HELP Committee and in the White House Office of Intergovernmental Affairs and Public Engagement. She has a particular interest in developing national policies to support innovation in health care delivery including payment reform and quality improvement. She also still loves practicing medicine. In her first post, she writes about medical homes -- an area where her policy interests and her priorities as a physician overlap.

Since the passage of the historic law affectionately known as PPACA, we have seen a flurry of activity, including Health and Human Services Secretary Kathleen Sebelius's call to end insurance discrimination against women with breast cancer, encourage private plans to allow young adults to stay on their parents’ plans until age 26 and really push the envelope to narrow the administrative costs of health insurance plans so that more of each premium dollar is spent on patient care.

More than one in five Americans (under Medicare age) have a pre-existing condition, according to a Families USA report. Pre-existing conditions, which can be anything from cancer to diabetes to high blood pressure to a past sexual assault, are frequently used by insurers to deny coverage to people trying to purchase health insurance on the individual market. So according to the report, “Health Reform: Help for Americans with Pre-Existing Conditions,” approximately 57.2 million people under the age of 65 (22.4 percent) of Americans are at risk of being denied coverage. And that’s just counting diagnosed pre-existing conditions. The true number could be even higher. (Keep reading to learn how this will change under health reform!)