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  • Reflecting on Health Reform—The Marketplace Experience: Month One - The Commonwealth Fund
    with the general demographics of the eligible population Twenty one percent of marketplace visitors were young adults ages 19 to 29 and about half were ages 30 to 49 Visitors were also generally healthy with nearly three quarters describing their health as good or excellent Older and sicker adults made up a smaller share of visitors The interest of younger healthier individuals in the exchanges is encouraging and is consistent with earlier Commonwealth Fund surveys indicating that young adults do in fact value health care coverage Fourth though only a small percentage of the eligible population reported enrolling the survey found that a significant majority of those eligible say they ll try out or return to marketplaces by the end of the enrollment period in March 2014 This is consistent with the Massachusetts coverage expansion experience in 2007 in which the vast majority of individuals signed up for insurance at the end of the enrollment period A similar deadline driven surge could take place in the first quarter of 2014 Notably a majority of young adults and those in excellent or very good health also say they ll shop for coverage before the March 31 deadline The new Commonwealth Fund survey also highlights issues that need to be monitored and addressed by policymakers if the insurance provisions of the reform law are to reach their full potential First our results show that many individuals who went to the marketplace had difficulty finding a plan they could afford While the law includes generous tax subsidies or Medicaid coverage for those earning up to 400 percent of the federal poverty level 45 960 for an individual and 94 200 for a family of four website problems could be preventing consumers from understanding how much coverage and care will cost them Respondents also reported problems comparing the benefits premium costs and out of pocket expenses under various plan options Choosing an insurance plan from even a limited number of choices can be a frustrating and confounding experience there are all those deductibles and copayments in network fees and out of network fees covered and uncovered services to consider Compared with the individual insurance market that existed before the ACA the law substantially simplifies consumer choice by requiring insurance companies to sell plans at four benefit levels bronze silver gold and platinum that vary only by premium and out of pocket cost exposure The health benefit package is comprehensive and largely the same across plans in the same metal tier Nevertheless plan choices can remain difficult especially in states that are consciously obstructing the work of navigators and others providing consumer assistance with sign up Finally consistent with many of the news reports regarding website failures a large majority of marketplace users are reporting fair or poor experiences The negative assessments are understandable given that many websites remain unusable Despite these difficulties just over half 52 who visited the marketplaces hold a favorable view of those options As a whole survey respondents are evenly

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/nov/the-marketplace-experience (2016-04-30)
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  • Reflecting on Health Reform: Buckeye Bellwether? - The Commonwealth Fund
    million potential Medicaid beneficiaries reside in holdout states which include the populous states of Texas and Florida As Ohio s action suggests however remaining state opposition to Medicaid expansion may not be carved in stone History illustrates this point After Medicaid was originally enacted in 1965 most states dribbled into the program gradually over a six year period Arizona the last to join didn t come aboard until 1982 Of the 24 current holdouts 10 failed to participate for at least two years after Medicaid became law Florida waited until 1970 The economic incentives to participate in the new Medicaid expansion are also compelling Ohio s decision means it will collect 53 billion in extra federal Medicaid monies over the next decade The 24 remaining holdouts are forgoing a total of 388 billion over the same period These funds benefit not only the physicians clinics and hospitals that directly receive them but also through what economists call the multiplier effect the general economy of the state Monies flowing into the health sector generate health care jobs Newly employed health workers buy more homes cars furniture and groceries thus generating economic activity in other sectors of local economies State and local tax revenues grow Studies of several states show that the full economic benefits far exceed any additional costs to states of paying for expanded Medicaid benefits From a political standpoint a recent Commonwealth Fund survey found that 68 percent of adults nationwide are strongly or somewhat in favor of making Medicaid available to more residents in their states The ongoing strong support of local hospitals for expanding Medicaid will also figure in the calculations of elected state officials going forward And finally there are the health consequences The health care literature has shown repeatedly that Medicaid saves lives and improves health The Commonwealth Fund State Scorecard for Low Income Populations has demonstrated that there are now two health care Americas One America experiences health and health care that equals or exceeds anything on earth But the other America has fallen far behind Many holdout states are in the latter category If they fail to expand Medicaid there is every reason to expect that they will fall further and further behind the rest of the United States and even some countries in the developing world For political leaders who take pride in their states national and international standing watching their states become second rate health care territories cannot be a pleasant prospect quite apart from its real human cost It may take some time for these economic political and human facts to sink in among leaders in many parts of America However history suggests that the attractions of Medicaid grow on initial opponents over time Ohio epitome of the American heartland and reliable predictor of the outcome of presidential elections may someday be seen as the bellwether of things to come Read other posts in David Blumenthal s Reflecting on Health Reform series The Presidential Health Care Curse Why Do They

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/oct/buckeye-bellwether (2016-04-30)
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  • Reflecting on Health Reform: Two Weeks in October - The Commonwealth Fund
    means that the law s implementation will likely continue at least until the next president takes the oath of office on the Capitol steps in January 2017 In the long term these political developments are far more important than any technical failures and that is precisely the reason that opponents were so desperate to stop the ACA during the first weeks of October They correctly perceive that by the time a new president takes office whether that person is a Republican or Democrat the law will be a fait accompli At a minimum the 15 states that are running their own marketplaces some with considerable success will probably have enrolled millions of previously uninsured Americans in Medicaid or private health insurance plans State run marketplaces account for half of the nearly 500 000 individuals who have already completed applications We learned last week that Oregon has already cut the number of its uninsured by 10 percent In the first five days California created over 43 000 accounts and recorded nearly 1 million website visits New York had received 80 000 applications by October 11 Kentucky had created 29 350 accounts by October 10 Beyond that even if it takes months the federal government will find a way to make its online marketplaces work The avalanche of interest in the exchanges 14 6 million visits to HealthCare gov by October 11 that helped take the federal system down in its first week suggests that currently discouraged consumers will migrate back to the federal website once it is up and running The insurance available in the exchanges will not be perfect for everyone But there will be opportunities to improve all levels of coverage Three years is plenty of time for the ACA to become a fact of American life like Medicare Medicaid and Social Security before it If Republicans regain the White House in 2017 they may then face the same difficult choice that President Richard M Nixon did in 1968 when he became the first Republican president after the enactment of Medicare and Medicaid in 1965 Republicans had strongly opposed these programs No one knew whether Nixon would try to dismantle them or make them work He did the latter In three short years the elderly had come to love Medicare and no national party could survive their alienation By 2016 Hispanic voters may have come to rival the elderly in the national political firmament and with their large rates of uninsurance 30 percent they will be major beneficiaries of the law Despite the ferocity of Republicans current opposition to the ACA cooler heads may prevail when faced with the choice of ripping coverage from the most rapidly growing voting bloc in the United States or trying to patch the law s flaws and make it work better for potential voters and the American people generally Technologically getting the exchanges to function is ultimately doable It s just a matter of time and effort trial and error Politically taking health

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/oct/two-weeks-in-october (2016-04-30)
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  • The Affordable Care Act: Keeping Our Eyes on the Ball - The Commonwealth Fund
    snags as well as direct consumers to alternative enrollment methods such as by phone or mail It is critical that everyone who is eligible and wants to enroll by Dec 23 is able to do so 2 Are people enrolling in health plans How many people enroll in health plans through the marketplaces will be a key indicator of how consumers view the desirability and affordability of new coverage options The Congressional Budget Office CBO projects that 7 million people may enroll in private health plans sold through the marketplaces for coverage during 2014 An additional 9 million people are expected to enroll in Medicaid To ensure that the marketplaces are successful and premiums are held in check young people between 18 and 35 will need to enroll in large numbers The Department of Health and Human Services HHS has said that it is important that more than 2 million of the new enrollees next year be young adults We think that if Americans enroll in numbers that come close to meeting CBO projections we would declare the first year of the marketplaces a success HHS has said that it will provide monthly updates on enrollment Some states that are running their own marketplaces are already reporting data on the number on applicants In most states as the Washington Post s Sarah Kliff points out the online application process is multistep People create accounts on the marketplace websites apply for coverage and then officially enroll by either paying their premium or requesting an invoice Other people are applying by paper application And others are applying directly through insurance companies As of October 11 a round up of press reports by the Advisory Board found that about 246 000 people created accounts on state marketplace websites 122 000 had applied for coverage and about 20 000 had enrolled In Connecticut there are signs of significant interest among young adults Of the 1 150 applications that were processed in the first week of enrollment 29 percent were from applicants under age 35 3 Is the number of people who are uninsured falling In 2012 48 million people were uninsured HHS estimates that about 41 million of them are eligible for one of the law s new coverage options Not everyone who is eligible for coverage is expected to enroll all at once The Congressional Budget Office is estimating that next year about 13 million fewer people will be uninsured as a result of the law s new coverage provisions with the number of uninsured falling over time The first national estimates of changes in the number of uninsured Americans won t appear until next September when the Centers for Disease Control and Prevention is scheduled to release its U S insurance coverage estimates for early 2014 in the National Health Interview Survey In December 2014 estimates from CDC will be available for the first half of 2014 These will tell us whether we are on track to meet CBO s projected decline

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/oct/keeping-our-eyes-on-the-ball (2016-04-30)
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  • Should "Value" Be the New Mantra in Health Care? - The Commonwealth Fund
    the term is that seemingly simple it is actually complex and subtle Under its umbrella a wide range of interested parties can find the things they hold most dear from improved patient outcomes to coordination of care to efficiency to patient centeredness And it is intuitively appealing As Thomas Lee noted in the New England Journal of Medicine no one can oppose this goal and expect long term success The question of course is whether the term will help spur the fundamental changes that our health care sector so desperately needs In this regard a closer examination of the value concept confirms its appeal but also exposes the daunting challenges facing health system reformers Read more from Dr Blumenthal and Kristof Stremikis guest post on the Leading Health Care Innovation blog part of the Harvard Business Review Blog Network Leading Health Care Innovation is an eight week online forum devoted to helping leaders managers and others in health care increase value by improving patient outcomes and reducing costs Tags Affordable Care Act Add to My Library Print Please enable JavaScript to view the comments powered by Disqus blog comments powered by Disqus e Alerts and Newsletter Sign up Publication Details Publication Date September 20 2013 Authors David Blumenthal M D Kristof Stremikis Citation D Blumenthal Should Value Be the New Mantra in Health Care The Commonwealth Fund September 2013 Related Publications May 3 2016 Envisioning a Digital Health Advisor April 21 2016 Implementing New York s DSRIP Program Implications for Medicaid Payment and Delivery System Reform Related Topics Health Care Delivery Health System Performance and Costs Mission The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access improved quality and greater efficiency particularly for society s most vulnerable including low income

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/sep/should-value-be-the-new-mantra-in-health-care (2016-04-30)
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  • New U.S. Census Data on the Uninsured Underscores Need for Expanded Coverage - The Commonwealth Fund
    of people with employer based coverage did not change last year About 55 percent of the population has health benefits through their own employer or that of a spouse partner or parent which is unchanged from 2011 Exhibit 3 There was also no change in the percentage of people who were uninsured who were employed full time 15 5 or less than full time 27 7 over 2011 2012 Public Insurance Public insurance coverage including Medicare Medicaid and the Children s Health Insurance Program CHIP continues to be a critical source of coverage for people of all ages without job based health insurance In fact the percentage of people with coverage through a government program including the military climbed from 32 2 to 32 6 percent This is likely a major reason why a smaller share of people were uninsured in 2012 overall More than 101 million people had health insurance through government programs in 2012 up from 99 5 million people in 2011 The percentage of people covered by Medicaid stood at 16 4 percent in 2012 or 50 9 million Exhibit 4 Medicaid coverage has helped people of all ages but children and older adults particularly benefit More than one third 36 of children under age 18 are now insured through Medicaid or CHIP And more than 40 million people age 65 and over the post World War II boomers are enrolled in Medicare The Affordable Care Act s Promise Families with incomes under 50 000 continue to be the income group most likely to lack health insurance A quarter 24 9 of people with incomes under 25 000 were without health insurance in 2012 and one of five 21 4 of those in families with incomes between 25 000 and 50 000 were uninsured Families in this income range will realize the greatest benefits from the full implementation of the Affordable Care Act in January 2014 through a substantial expansion in eligibility for Medicaid and premium tax credits to offset the cost of private health plans to be sold through the new state insurance marketplaces However so far only about half the states have decided to participate in the Medicaid expansion next year placing the health security of the nation s most financially vulnerable families in doubt Massachusetts which implemented a universal health insurance system in 2006 much like the Affordable Care Act led the nation in coverage with just 3 8 percent of its total population including those over age 65 without health insurance Exhibit 5 This stands in stark contrast to Texas where 24 2 percent of the total population is without health insurance the highest rate in the nation Seventeen states had uninsured rates that exceeded the national average of 15 6 percent of those 11 have not yet decided to expand their Medicaid programs under the Affordable Care Act next year potentially leaving millions of their residents without access to the law s coverage protections Looking Forward Today s Census report reflects the

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/sep/new-us-census-data-on-the-uninsured (2016-04-30)
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  • New Agenda for a Changing Health System - The Commonwealth Fund
    the ongoing implementation of the health reform law the spread of information technology and it offers a next step on the path toward high performance Though much will change much will also be retained For starters The Commonwealth Fund s primary mission of promoting a high performing health system will remain the foundation s touchstone My decision to come and lead the Fund was due in large part to how strongly that mission resonated with my values and experience I had no desire to change it nor did our Board of Directors or the rest of the Fund s staff Another thing that will not change is how the Fund goes about promoting improvement in the nation s health care system These methods have consisted first and foremost of developing trusted relevant information and communicating that information effectively to private managers and public decision makers when and where they are ready to receive it To be more explicit our work going forward will focus on four programmatic areas some familiar and some new Health Care Coverage and Access Health Care Delivery System Reform International Health Policy and Practice Innovations and Breakthrough Health Care Opportunities And those programs will be supported and complemented by a set of special initiatives Advancing Medicare Controlling Health Costs Tracking Health System Performance and Engaging Federal and State Health Policymakers You can read more about our new direction here but in this post I wanted to share some personal reflections I brought to this planning process my own perspective and experience as a frontline physician and teacher of young doctors as well as my tenure as national coordinator for health information technology My work as a primary care physician and teacher has sensitized me to the fact that decisions at the sharp end of health care in the daily interactions and behaviors of providers and consumers of care profoundly influence the overall performance of our nearly 3 trillion system How could it be otherwise These decisions obligate resources match resources to need and determine the effect of medical services on individual and population well being My intense recent exposure to the world of health information technology has convinced me that valid timely information is foundational to providing high quality efficient care and to effective policy and management The decisions made by clinicians patients consumers managers and policymakers are only as good as the information they have at the time they make their choices These interactions between patient consumer and provider sit at the center of all the influences we sometimes call them levers that The Commonwealth Fund or others might employ to improve the performance of our health care system Those influences or levers create opportunities for constructive change And so many of our programs will look for ways to engage consumers and health care providers in improving care but they will also endeavor to draw in all the other types of stakeholders that can affect leverage points for change policymakers employers entrepreneurs software developers insurers

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/sep/a-new-agenda (2016-04-30)
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  • Two Americas - The Commonwealth Fund
    scored in the top half of regions in The Commonwealth Fund s local scorecard an outlier in a state that ranked 46th in our last state scorecard Similarly the Greensboro and Hickory areas of North Carolina ranked among the top half of regions of the U S much better than the state as a whole which placed in the bottom fifth of states But these oases of high performance in otherwise poor performing regions are not sufficient to change the overall patterns And while we can take some comfort in positive outliers the sheer variation in cost quality and overall health system performance across the country is reason for significant concern Our recent local scorecard documented consistent 10 to 20 percentage point differences between high and low performing regions on a host of measures related to health care access quality and costs Gaps between the best and lowest performing areas are staggering For example the proportion of adults with health insurance in the leading regions is more than 50 percent higher than in the lagging areas while the rate of potentially preventable mortality in the best region is one third of that in the worst The reasons for regional disparities in health and health care are not yet fully understood and we must understand them before we can address them Poor performing regions tend to have much higher proportions of uninsured citizens This could get somewhat better because of the Affordable Care Act though not if states in those areas don t take advantage of the law Other explanations undoubtedly lie outside the realm of health care in education poverty levels diet and lifestyle Unfortunately many of the states that lag in health care performance are choosing not to expand eligibility for Medicaid under the Affordable Care Act We know that insurance coverage including Medicaid improves access to care and results in improved health for previously uninsured people States skipping expansion will also miss an opportunity to lower the costs of uncompensated care for their hospitals and forgo an infusion of federal dollars for traditionally underserved and rural areas Uneven implementation of the ACA therefore could increase preexisting disparities in the health and health care available in high and low performing areas of the U S Persistent differences in health care across the country matter for all of us In the end we are one nation and one people When some of our citizens suffer we all suffer If some regions lag economically because of health care deficits we will all feel the downward tug on employment tax revenues GDP and our international competitiveness We are stronger as a country when all of us are strong The U S health care divide deserves much more attention than it has received The Commonwealth Fund remains committed to tracking the two health care Americas an undertaking that will continue next month with the release of our new scorecard on health system performance for low income populations Bringing the troubling variation in health

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/aug/two-americas (2016-04-30)
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