Posts Tagged ‘Urban Institute’

Websites like wine: healthcare.gov good now, getting better

Friday, July 2nd, 2010

HealthCare.gov: Take health care into your own hands Learn MoreThe web portal Healthcare.gov (@healthcaregov for all you twitterheads out there) went live, launching ahead of its July 1 deadline by hours Wednesday night. HHS deserves props for this site: not only was it delivered ahead of schedule, but it’s spiffy-looking, easy to use, and full of important info to help people get covered.

The website is what it says – a door through which consumers can check out what private insurance plans are available to them, depending on their age, state, current coverage, and health conditions.  There’s also information about public programs, like Medicaid, and how reforms in the new law affect people soon – such as the small business tax credit, high-risk pools for people with pre-existing conditions, and the ability of young people to join or stay on their parents’ plan till age 26.

If you haven’t checked it out yet, you should. We did a walk-through ourselves yesterday and were impressed by the clear, appealing design, the plain-language navigation to help consumers find out what their options are and, oh yeah, all that information.

In October, a more in-depth version will launch, and will include rates, coverage exclusions and other pricing information—a level of detail we think is critical for consumers looking for insurance options. To our mind, the more information, the better. And we’d like to see the portal move toward standard benefit descriptions that help people make “apples-to-apples” comparisons.

Other things we’d like to see on Healthcare.gov?  We think the website should include all private insurance products, such Medicare Advantage and Medigap plans. Right now, it doesn’t.

And it would be great instead of just describing and giving contact info or redirects to public programs, like state Medicaid agencies, if someone visiting the website could determine whether they were eligible and if so, enroll online.  Downloading an application, printing it out, finding out where to submit it, and getting there is often too many steps in a process that could be moved online. A report by the Urban Institute in January showed that there are 9.8 million uninsured individuals who are eligible for but not enrolled in Medicaid, and a one-stop online enrollment platform on the portal makes a lot of sense to help those people get health care coverage.

We’re glad to see that patient protections in the new law – what the administration’s calling the “patient bill of rights” – are prominent and spelled out clearly on the site.  In the future, we’d like healthcare.gov to point to consumer assistance programs, too, especially non-profit ones, which have a great track record of helping people navigate the system, determine eligibility, and enroll.

And for consumers with medical bills, we also want to make sure that the portal makes hospital financial assistance policies available, prominent, and easily searchable on healthcare.gov. We’re encouraged that there seems to be placeholder language about free and reduced care where more specific policy information will go in the future

Certainly there is room to refine and build. But this is day two. And improvements are already underway. In fact, a banner stretched across the top of every page says “Health care is getting better. So is HealthCare.gov. Help us improve by adding your comments”—this thing is a work in progress. But it’s also a work of progress, one we’ve proudly bookmarked.

–Kate Petersen, Health Policy Hub

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Posted in Hospital Accountability/Charity Care, national health reform, private insurance | No Comments »

The Insider: All this could be yours someday

Monday, June 14th, 2010

Fuzzy logic
As the “tax extenders” bill makes its way through the Senate, a provision to extend COBRA premium subsidies for the unemployed is in jeopardy. Opponents in the Senate and the Blue Dogs in the House who stripped the provision from legislation two weeks ago argue that it’s unfair to help people who are unemployed when other, equally needy people are getting no assistance.

Just stop and think about that for a minute: It’s not like they’re identifying an alternative beneficiary for assistance, or arguing to accelerate implementation of the Affordable Care Act. They are basically saying, “Because we can’t help everybody, we won’t help anybody.” If you apply that reasoning more broadly it leads you to advocate the repeal, or at least the suspension, of Medicare and Medicaid until 2014, when financial assistance to obtain coverage becomes more generally available–a move few Congressmembers would dare consider, even in a non-election year.

With unemployment remaining high, the COBRA premium subsidies in limbo are badly needed. They are good for the economy, the health care system, and mostly for the thousands of struggling families who will be able to retain their coverage. Find out more at Community Catalyst’s implementation headquarters.

Faulkner on health care
When William Faulkner wrote, “The past is never dead. It’s not even past,” he could have been talking about the politics of health care more than a half-century into the future. Congressional Republicans’ challenge of the White House public education campaign on Medicare changes as misuse of government funds for partisan advantage hearkens back to Democrats’ attacks on the Bush administration over the original Medicare Part D roll-out.

And Senators who opposed PPACA seem intent on re-debating the legislation at every opportunity: first, in the context of Don Berwick’s nomination to head CMS, and now in the debate over the Medicare physician payment fix. Republicans have offered an alternative that does more for the physicians but partially pays for it by eliminating desperately-needed financial assistance for state Medicaid programs—while slipping in a “poison pill” that would roll back the individual responsibility provisions in PPACA. Such a move could appeal to many on the left who are concerned that the affordability provisions don’t go far enough.

Someday, all this could be yours
As the “repeal and replace” drumbeat goes on, a third ‘r’ should be added to the sequence: Recycle. Congressional Republicans are recycling ideas from the debate that were shown to fail to reduce the number of uninsured or eliminate insurance discrimination.

But as several states move forward with anti-Affordable Care Act ballot measures, new research from Massachusetts shows just how wrongheaded such opposition is. Until the coverage provisions of the Affordable Care Act kick in in 2014, Massachusetts provides the closest thing we have to a “beta site” for what the health care system of tomorrow will look like. While critics focus on the continuing cost challenges (problems that pre-dated health reform in Massachusetts  and were not really addressed in the landmark law in 2006) new reports published by the Urban Institute and the National Bureau of Economic Research underscore just what other states can gain as they move forward with implementing the law.

Urban’s latest report shows that the coverage gap between racial and ethnic minorities and non-Hispanic whites has been closed—the only place in the country where this is true. Additional findings show:

  • –high rates of coverage in Massachusetts persist despite continued high unemployment
  • –economic barriers to obtaining care remain low and have declined further for some populations since the inception of the law
  • –four years into implementation, there is still no evidence of ‘crowd-out’ of private coverage, and public support for the Massachusetts system remains high.

Get the details here (pdf).

The NBER paper found that since reform in Massachusetts, there have been fewer preventable hospitalizations and emergency room-generated admissions, and length of hospital stays has been reduced, most likely due to improvements in access to ambulatory care.

Sure makes implementation look like a lot better idea than repeal.

–Michael Miller, director of strategic policy

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Posted in affordability, Health disparities, Health Reform Insider, national health reform, Repeal Watch, state reform | No Comments »

UPDATE: You put the right bill in, you get the right vote out

Tuesday, March 2nd, 2010

(Please see corrected link below)

It’s not about the process
With the summit behind us, the press has returned to obsessing about (and misconstruing) the process by which health reform might move forward. So a few important clarifications are in order.

First, health reform will not pass via reconciliation.  Comprehensive health reform will pass as part of the normal Congressional order via a majority vote in the House of Representatives (more on that vote in a minute); having passed the Senate with a super-majority of 60 votes.  House Republicans will have one last chance to vote on this package and nearly everyone assumes that they will unanimously vote no.

What will also pass–by majority in both the House and Senate–are amendments to that bill.  Those amendments, as outlined by President Obama, would do a number of important things: They would increase and equalize federal Medicaid payments across states, provide low- and moderate-income families with better benefits and/or premium subsidies, close that Part D “doughnut hole,” make the excise tax on high-cost plans fairer, and provide tougher oversight of health insurance premiums.

The question that will come before Congress will be on these amendments.  And here’s what the media should be spending more time on: If Republicans vote no in a block, they will be voting for the “Cornhusker kickback” and against more Medicaid dollars for their states.  They will be voting against improving coverage for seniors with multiple chronic conditions  They will also have to cast a vote that makes it clear whether they stand with regular people or insurers on the issue of premium rate hikes. If we focus on substance over process, then voting for a package of fixes to the Senate bill should be a great vote for supporters of reform, and a tough vote for opponents.

About that vote
The President is expected to offer more specifics on the path forward later this week (probably Wednesday, so check in then for our update). But by now, it seems clear that the Republicans have no interest in tighter regulation of the insurance industry or a major effort to cover the uninsured—and Democrats have no interest in scrapping these elements of reform and starting over.  So we can expect a party-line vote going forward.

There has been a lot of media speculation about whether the votes are there for reform in the Democratic caucus in this scenario. Although it’s impossible to do a real vote count before a package of amendments is agreed on, both branches seem close to having the majorities they need.

Much of the recent speculation has centered on the House, where the challenge will be to find a sweet spot that will satisfy both Blue Dogs and Progressives, avoid too many defections on the abortion issue, and also attract 50 votes in the Senate.

Does that sweet spot exist?  Speaker Pelosi and Majority Leader Hoyer believe the answer is yes, and have reiterated their commitment to passing reform. And the House leadership team has so far shown an uncanny ability to move difficult legislation through the House, so betting against them would be unwise.

The final votes in both chambers may be close, and certainly an all-out effort from the grassroots will be needed, (so sign this petition to send a message in support of comprehensive reform and forward this link to your friends and networks too.)  But as we enter the homestretch of the health care reform debate this year, there is good reason for optimism.

About that status quo
Instead of focusing on the intricacies of Congressional procedure and speculating about the vote count, we need to focus on why reform is necessary.  To that end, the Urban Institute is out with a new issue brief that shows just who loses if health reform doesn’t pass.  The biggest losers (out) are older adults, people with pre-existing conditions (and many of you know firsthand just how big a group insurance companies have made that), small businesses and their employees, low-income households  and young adults. These are the groups for whom the current dysfunctional system works least well, and who will be most at risk of being priced out of coverage if reform doesn’t pass.  But ultimately, the Urban brief points out, improvements in security and stability of coverage, and in the quality of care people get, will benefit everyone.

And that’s what it’s all about.

–Michael Miller, director of strategic policy

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Posted in national health reform | 2 Comments »