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Exchange politics : opposing Obamacare in battleground states
\"The Affordable Care Act (ACA) contained a threat that any state refusing to set up a health insurance exchange would lose control to the federal government. Republicans had supported the concept before it became part of Obamacare, and so virtually every state was expected to cooperate and implement this core part of the law through which millions would receive financial assistance to buy health insurance. However, 34 states refused to participate, using their flexibility as an opportunity to try to bring down the entire law. This is a stunning miscalculation by the Obama administration. This book tells the story of what happened in the final two states to choose state control (Idaho and New Mexico) and the two that came the closest but did not (Michigan and Mississippi). Contrary to how it is typically described in the media, the most intense split was not between Republicans and Democrats, but within the Republican Party. Governors were the most important people in the fight over exchanges, but did not always get their way. The Tea Party was amazingly successful at defeating the most powerful interest groups. State-level and national conservative think tanks were important allies to the Tea Party. The relative power of these groups was shaped by differences in institutional design and procedures, such as whether a state has term limits and the length of legislative sessions. Opposition was more easily overcome in states whose conditions facilitated the development of legislative \"pockets of expertise.\" This is a dramatic example of opponents using federalism to block national reform and serves as a warning of the challenge of inducing state cooperation in other policy domains such as the environment and education.\"-- Provided by publisher.
Book
Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children
Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or \"welcome mat\" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.
Journal Article
Inequality and the health-care system in the USA
Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10–15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.
Journal Article
Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care
New targets have been set for value-based payment: 85% of Medicare fee-for-service payments should be tied to quality or value by 2016, and 30% of Medicare payments should be tied to quality or value through alternative payment models by 2016 (50% by 2018).
Now that the Affordable Care Act (ACA) has expanded health care coverage and made it affordable to many more Americans, we have the opportunity to shape the way care is delivered and improve the quality of care systemwide, while helping to reduce the growth of health care costs. Many efforts have already been initiated on these fronts, leveraging the ACA's new tools. The Department of Health and Human Services (HHS) now intends to focus its energies on augmenting reform in three important and interdependent ways: using incentives to motivate higher-value care, by increasingly tying payment to value through alternative payment . . .
Journal Article
Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout
These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.
Journal Article
Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions
By September 2015, a total of 29 states and Washington, D.C., were participating in the ACA Medicaid expansion. During year 2 after implementation, the expansion was associated with substantial reductions in rates of uninsurance and in reports of inability to afford health care.
The Affordable Care Act (ACA) expanded Medicaid eligibility to persons earning up to 138% of the federal poverty level, as part of the largest expansion of coverage to nonelderly adults since the 1960s. Although the expansion was originally intended to be enacted nationally, a 2012 U.S. Supreme Court decision made it optional for states. A total of 24 states decided not to expand in 2014, which affected 6.7 million uninsured low-income adults who otherwise would have gained eligibility.
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Since 2014, an additional 5 states have implemented expansions, although 19 states still have not adopted the expansion as of January 2017. . . .
Journal Article
Health Insurance Coverage and Health — What the Recent Evidence Tells Us
The authors report their analysis of the highest quality research over the past decade examining the effects of health insurance on health and conclude that insurance coverage increases access to care and improves health outcomes.
Journal Article
The Effects Of Medicaid Expansion Under The ACA: A Systematic Review
Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.
Journal Article
The ACA's Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care
Large disparities in health insurance coverage and access to health services have long persisted in the US health care system. We considered how the insurance coverage expansions of the Affordable care Act have affected disparities related to race and ethnicity. In the years since the law went into effect, insurance coverage has increased significantly for all racial/ethnic groups. Because coverage increased more for non-Hispanic blacks and Hispanics than for non-Hispanic whites, disparities in coverage have decreased. Despite these improvements, a large number of adults remain uninsured, and the uninsurance rate among blacks and Hispanics is substantially higher than the rate among whites.
Journal Article
Pragmatic Vision
On March 23, 2010, President Barack Obama signed the Patient
Protection and Affordable Care Act into law, providing every
American with the opportunity to have guaranteed health care
coverage. The Affordable Care Act-frequently referred to as
Obamacare-is almost synonymous with Obama's presidential legacy and
reflects a series of key decisions that he made beginning before he
took office. As Meena Bose shows, it was Obama's particular brand
of pragmatic politics that ultimately shaped the passage of the
Affordable Care Act and made a lasting mark on health care reform
in the United States.
Pragmatic Vision examines eight of Obama's decisions
that resulted in the landmark enactment of health care reform,
starting with his commitment to health care reform in the 2008
presidential campaign and concluding with his decision to allow for
flexibility with its implementation, following technical hurdles
and Supreme Court rulings. Bose shows that Obama's steadfast
commitment to the issue was crucial to its passing, especially
after the Democrats lost their filibuster-proof majority in the
Senate. Obama's direct engagement built key political support for
the legislation and was aided by the senior White House staff and
Democratic leaders in Congress who skillfully navigated the bill to
passage just fourteen months after Obama took office.
The story of Obama's leadership in enacting the Affordable Care
Act is a tale of today's partisan divide and the polarization of
Congress. The legislation passed on a party-line vote and continued
to divide politicians long after its passage. Nevertheless, despite
repeated efforts by Republicans to repeal the law, it is more
popular today than ever and seems destined to remain in force until
the next stage of reform. Pragmatic Vision is an
authoritative guide to this singular achievement of the Obama
administration.
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