Category Archives: Health reform
Carole Pratt, DDS, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, where she worked in the office of Senator John D. Rockefeller (D-WV). Pratt was a practicing dentist in rural southwest Virginia for 32 years. This post is part of the "Health Care in 2013" series.
The Times Square ball has dropped, crisp new calendars have been affixed to office walls, and clean new agenda pages gape at us from computer screens, signaling prudent resolution makers that it is time to get serious about 2013. February 10 will mark another New Year, the beginning of the Chinese New Year festival ushering in the Year of the Snake. Parades will be held, people around the world will celebrate, and for a time at least, inherent fear of reptiles will be set aside.
In a century-long history that is somewhat convoluted, the American medical profession has come to be represented by the winged staff and serpent symbol, the Caduceus. So during 2013, the Year of the Snake, it may be no coincidence that things are looking up for the health care profession and the health of the nation in general. In its 2013 annual ranking, U.S. News & World Report announced the top ten most attractive jobs based on factors such as opportunity for employment, salary, work-life balance, and job security. Six of the top ten spots were claimed by jobs in health care.
Arthur Kellermann, MD, MPH, FACEP, holds the Paul O’Neill-Alcoa Chair in Policy Analysis at the nonprofit, nonpartisan RAND Corporation. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and the RWJF Health Policy Fellows program. This post is part of the "Health Care in 2013" series.
For the first month of my medicine internship at the University of Washington, I was assigned to Seattle’s VA Hospital. I was stunned to learn that my attending physician would be Paul Beeson, widely regarded at the time as one of the giants of American medicine. [i] At an age when most doctors are enjoying their retirement, Dr. Beeson was still doing what he loved best—caring for patients and teaching.
I have forgotten most of the clinical pearls Dr. Beeson taught that month. But one that still stands out is the way he questioned the need for every lab test, x-ray and treatment my team ordered. “Why do you want that?” he’d ask. “What will you do with the result?” Throughout the month, he urged us to forego interventions that offered little benefit to our patients, but exposed them to potential side effects or complications. His message was clear. Do only what’s needed, not more.
Today, we need Dr. Beeson’s message more than ever before. In the three decades since I trained under him, America’s health care system has grown so large, it claims a bigger share of the gross domestic product than American manufacturing or wholesale and retail trade. [ii] As a result, the federal government spends more on health care than national defense and international security assistance. In several states, health care is crowding out spending for education. In the past decade, health care cost growth has wiped out the hard-won earnings of middle-class families. [iii]
What the Election Means for Health and Health Care… The Country Needs More Providers, Better Mental Health and Elder Care, and an End to Poverty
Carolyn Montoya, RN, MSN, CPNP, is a fellow with the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico. A PhD Candidate, Montoya serves on the New Mexico Medicaid Advisory Committee, an advisory body to the Secretary of the state’s Human Services Department and the Director of the Medical Assistance Division Director. The RWJF Human Capital Blog asked scholars and fellows from a few of its programs to consider what the election results will mean for health and health care in the United States.
Human Capital Blog: Do you think there will be fewer challenges to the Affordable Care Act and more attention to how to implement it?
Montoya: Now that the election is over, the reality is that the Affordable Care Act (ACA) will not be repealed. As we go forward with the ACA in place, a strong emphasis should be placed on evaluation. Outcome measures, such low rates of diabetes complications or increased immunization rates, will be essential in terms of being able to establish what aspects of the ACA are working and which ones need to be revised.
What the Election Means for Health and Health Care… The Re-Election of President Obama Curtails the Likelihood of Major Medicaid Reductions
Frank J. Thompson, PhD, is a professor at the School of Public Affairs and Administrations and at the Center for State Health Policy at Rutgers, The State University of New Jersey. Thompson is a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, studying Medicaid: Political Durability, Democratic Process and Health Care Reform. The RWJF Human Capital Blog asked scholars and fellows from a few of its programs to consider what the election results will mean for health and health care in the United States.
Human Capital Blog: What do you think the election will mean for the country’s health care system?
Thompson: It means that the country can go forward with implementing the Affordable Care Act (ACA). My research focuses on Medicaid—the federal grant program to the states that insures some 65 million low-income people. Under the ACA, Medicaid is slated to cover most people with incomes up to 133 percent of the poverty line as of 2014. In the recent election, the differences between the two parties on the ACA and Medicaid were stark. The Romney-Ryan ticket pledged not only to repeal the ACA but to convert Medicaid to a block grant and to cut funding for the program by more than 30 percent over ten years. The degree to which a Romney administration would have achieved these objectives remains an open question. But the reelection of President Obama curtails the likelihood of major Medicaid reductions over the next four years.
The United States will need 52,000 additional primary care physicians by 2025 to meet demand that is growing due to three trends: population growth, population aging and insurance expansion. That is a key finding from a study published in the November/December issue of the Annals of Family Medicine. The researchers estimate that population growth will account for the majority of the needed increase in primary care doctors.
Given the current number of visits to primary care physicians and an expected population increase of 15.2 percent, the researchers predict that office visits to primary care physicians will increase from 462 million in 2008 to 565 million in 2025. This trend will be especially evident among people 65 and older, a segment of the population that is expected to grow by 60 percent. Population growth will require an additional 33,000 physicians, the study says, and aging another 10,000.
Insurance expansion under the Affordable Care Act will also require additional physicians, the researchers find. Eight thousand physicians will be needed to meet that growth.
The 52,000 additional primary care physicians would represent a 3 percent increase in the workforce.
Tiffany D. Joseph, PhD, is a Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research at Harvard University (2011-2013). This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.
It was incredibly exciting to attend the American Public Health Association (APHA) meeting for the first time! As a sociologist and current RWJF Health Policy Research Scholar, I am thrilled to be at a multidisciplinary conference with an explicit focus on all aspects of health: outcomes, disparities, coverage, service utilization. You name it, there is a session for it.
The opening was especially motivating and inspiring as Dr. Reed Tuckson and Gail Sheehy provided insightful talks on the relevance of preventive health throughout the life course and how public health professionals must continue to work to improve access to, and quality of, health care for a U.S. population that is increasingly racially, ethnically, and socioeconomically diverse.
U.S. Representative Nancy Pelosi also stopped by, unannounced, to welcome the APHA to San Francisco and thank its members for their steadfast commitment to, and support for, passage and implementation of the Patient Protection and Affordable Care Act (PPACA or ACA). Needless to say, everyone in attendance was thrilled and excited by her surprise visit and warm words.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Michelle Scott recently graduated from Rowan University and is an intern at RWJF, working with The Future of Nursing: Campaign for Action.
I’m 22 and uninsured. I’ve only had health insurance for the four years I went to college, and now that I’ve just graduated, I no longer have that luxury. I survived the first 18 years of my life without it, but thanks to the Affordable Care Act, I don’t have to live without it for the rest of my life.
The day I received my college health insurance card in the mail, that flimsy piece of laminated paper with my name on it, I vividly remember thinking, “Wow. I’m allowed to be sick.” During my time at college I never got sick, nor injured in a serious accident of any kind where I actually needed medical attention. There was a brief period where I thought I smashed my hip and orbital bone in a skateboard incident my senior year of college, but after sitting on the ground at the skate park for a minute, and contemplating whether my family could afford to patch me up, I decided to walk it off. From my very early childhood, that’s how I learned to treat any kind of issue: Walk it off, or rest up until you can walk it off.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico, assistant director of the RWJF Center for Health Policy at the University of New Mexico, and director of Research for Latino Decisions.
The Supreme Court decision regarding the constitutionally of the signature policy victory of the Obama administration has been the most anticipated and hotly debated decision of the Court in recent memory. In the spirit of a prior Human Capital blog post I wrote back in November, I wanted to take advantage of the opportunity to participate in this series by providing a perspective on how this decision will likely impact the Latino population. I have been analyzing public opinion toward health care reform for some time now, and draw on some of this data to provide a few examples. I focus my attention here on some of the more intriguing relationships to emphasize the complexity of Latino’s views of this historic policy.
Latinos had a lot at stake in this decision, as the Affordable Care Act (ACA) is projected to expand insurance to 9 million Latinos. It is therefore not surprising that support for health care reform, and the ACA in particular, has been higher among Latinos when compared to non-Latinos. In fact, since Latino Decisions started collecting data in October 2011, on average 51 percent of Latinos have supported the ACA. Conversely, as reflected in the figure below, the percentage of Latino voters who want to repeal the law has been lower than what other polls have shown for the non-Latino population over this time period.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, is an assistant professor of nursing at the Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, and an RWJF Nurse Faculty Scholar.
By upholding the Affordable Care Act, the Supreme Court’s landmark ruling has allowed health reform to continue to move forward. But the promise and potential of health reform depends on having a robust, well-trained workforce that can meet the demands of a changing health care system, an aging population, and newly insured Americans with increasingly complex health care needs.
More than ever, the recommendations from the Institute of Medicine’s (IOM’s) report The Future of Nursing: Leading Change, Advancing Health will be critical to achieving the goals of health reform. For example, this defining moment provides an opportunity to redefine roles to take advantage of the fullest extent of all providers’ capabilities to improve health system efficiency and meet the health care needs of the population.
The first recommendation from the IOM report is that nurses should practice to the full extent of their education and training. Many of the Affordable Care Act’s provisions rely on the health care workforce, particularly the primary care workforce, working in new and expanded roles. Whether it is implementing new models of integrated care, providing much needed care to previously uninsured Americans, or delivering guaranteed preventive services and essential benefits, meeting the coming demand for primary care will require “all hands on deck”—every provider working at their fullest capacity. Although advanced practice nurses are one way to grow the primary care workforce, their ability to fully participate has been limited by legal barriers that restrict them from practicing up to the level they have been trained and often requiring physician oversight.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Sara Rosenbaum, JD, is the Harold and Jane Hirsh Professor at George Washington University, School of Public Health and Health Services, Department of Health Policy. Rosenbaum received an RWJF Investigator Award in Health Policy Research in 2000, and is on the board of the RWJF Health Policy Fellows program.
In affirming the constitutionality of the Affordable Care Act, the United States Supreme Court assured the legal survival, not just of thousands of discrete legislative provisions, but also the big ideas embedded in the Act. One of the biggest is its emphasis on strengthening the juncture between health care and health, an opportunity whose potential is only beginning to be explored. The most publicly visible aspect of this emphasis is the Act’s expansion of coverage for clinical preventive services without cost-sharing across the principal health insurance markets recognized under the Act: Medicare; employer-sponsored health plans, state regulated individual and small group markets (including the new Exchange market) and the Medicaid “benchmark plan” market that will serve newly eligible beneficiaries. (Ironically, the Act leaves out of this expanded clinical preventive coverage design the health plan market serving traditional Medicaid beneficiaries; other than a state option to expand coverage at slightly favorable federal financing rates, the law does not require expanded clinical preventive benefits for the very poorest beneficiaries. Although family planning services are a required benefit for all beneficiaries of childbearing age, services such as screening colonoscopies and adult immunizations remain optional for the traditional coverage group).
But the opportunities to bridge the health/health care divide go well beyond the important, threshold question of coverage design. The biggest opportunities are those that are intended to change the way that two of the principal players in the health care system—physicians and hospitals—envision their role in society and position themselves in communities. In the case of physicians, the Act incentivizes formation of accountable care organizations (ACOs), entities that assume responsibility not simply for health care of a defined group of patients (like any practice network) but for the health of the population they serve. ACOs are expected to move beyond improvements in the quality of clinical services they furnish and to reach into their communities through greater involvement in community health improvement activities. Similarly, the Act expands and strengthens the community benefit obligations of the nation’s nonprofit hospitals seeking federal tax-exempt status, upping their responsibilities related to community health improvement planning, and incentivizing investment in community health improvements and community building.