Category Archives: Health insurance

Aug 5 2014
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Staffing Mattered: Affordable Care Act Enrollment Got a Big Boost from Assister Programs

Healthy enrollment figures from state and federal marketplaces—topping 8 million sign-ups—during the Affordable Care Act’s (ACA) first open enrollment period got a significant helping hand from 28,000 full-time staff and volunteers in 4,400 assister programs, according to a Kaiser Family Foundation survey.

The survey, which is the first nationwide assessment of these programs and their impact, found that navigators and assisters provided in-person help to an estimated 10.6 million people.  Programs in states running their own marketplaces helped people at twice the rate of programs in states that relied on the federal marketplace.

Around one in eight assister programs reported that consumer demand exceeded capacity, and that share grew to one in four during a surge in March as open enrollment neared its deadline. Among the most difficult challenges programs faced were helping consumers with online technical problems, helping consumers understand plan choices, and helping consumers who had a limited understanding of the ACA.

The survey was designed to capture issues that came up with consumers, assisters’ experiences with the enrollment process, and suggestions for improvements during open enrollment next year.

Read the Kaiser Family Foundation’s Survey of Health Insurance Marketplace Assister Programs.

Apr 22 2014
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Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.

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Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage.  We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.

One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.

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Jan 3 2014
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RWJF Clinical Scholars Podcast: Health Insurance and Employment

As many as 900,000 people across the country may leave their jobs now that the Affordable Care Act provides health insurance alternatives, according to Craig Garthwaite, PhD. In an interview with Robert Wood Johnson Foundation Clinical Scholar Chileshe Nkonde-Price, MD, Garthwaite uses an analysis of the Tennessee Public Health Insurance Program to explain why a significant number of American workers may not feel the need to stay with their current employers as subsidized health insurance becomes available through health insurance exchanges.

Garthwaite is assistant professor of management and strategy at the Northwestern University, Kellogg School of Management. The interview is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.

The video is republished with permission from the Leonard Davis Institute.

Dec 9 2013
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Do Mergers with State Medicaid Programs Result in Cuts to State Public Health Department Funding?

Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW).  Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*

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It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.

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Nov 14 2013
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Human Capital News Roundup: Retail clinics, urban crime, diversity in medicine, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

As the demand for nurses continues to grow and more people go into the field, it is important to encourage a focus on community-based health and population health, Yvonne VanDyke, MSN, RN, told Austin, Texas, NBC affiliate KXAN. Van Dyke is an RWJF Executive Nurse Fellow and senior vice president of the Seton Clinical Education Center in Austin, which is seeking to increase the number of nurses earning Bachelor of Science in Nursing degrees.

A new program funded by the RWJF New Jersey Health Initiatives (NJHI) is enlisting ex-military members to help enroll people in insurance plans in the state. NJHI Director Robert Atkins, PhD, RN, an RWJF Nurse Faculty Scholar alumnus, told New Jersey Spotlight that veterans are well suited to the job of insurance-application counselors because “they know about service, they know about working in teams.” The New Jersey Hospital Association is hiring 25 veterans as certified applications counselors with the $1.8 million NJHI grant.

Diverse Education profiles RWJF Harold Amos Medical Faculty Development Scholar alumnus and National Advisory Committee member Levi Watkins Jr., MD, about his work to promote diversity at Johns Hopkins Hospital. “The best way to recruit minority students is by example … and the intervention of mentors,” Watkins said. “Students don’t look at recruitment and diversity offices when they are choosing schools, but they want to see if there are faculty and students in the place that look like them.”

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Oct 31 2013
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Human Capital News Roundup: The cost of disposable diapers, toxins in fish, fast food calories, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

WNYC in New York City broadcast an interview with RWJF Community Health Leader Joanne Goldblum about families reusing disposable diapers due to economic hardship. Goldblum, who is founder and executive director of the National Diaper Bank Network, conducted a study that shows how the practice leads to a range of problems for families living in poverty.

When it comes to digital health and new ways to deliver care, the focus should be on the consumer and improving outcomes, not on the technology, according to experts at a recent Connected Health Symposium in Boston, Massachusetts. Mobile Health News reports that Propeller Health (formerly Asthmapolis) CEO David Van Sickle, PhD, MA, an RWJF Health & Society Scholars alumnus, pressed for greater emphasis on outcomes.  Read more about Van Sickle’s work here and here.

An American Thoracic Society panel of experts, including RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) grantee Richard Mularski, MD, is calling for better care for those who suffer severe shortness of breath due to advanced lung and heart disease. The Annals of the American Thoracic Society reports that the panel recommends patients and providers develop individualized actions plans to keep episodes from becoming emergencies, Medical Xpress reports.

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Oct 18 2013
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Who Will Benefit From Medicaid Expansion and What Will it Mean for These Patients?

Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.

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Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.

To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act.  The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).

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Oct 16 2013
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A Success Story: Health Insurance Enrollment in Colorado

Sue Birch, MBA, BSN, RN, is executive director of the Colorado Department of Health Care Policy and Financing, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2002).

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Now that I have caught my breath, I wanted to share the Colorado report on Obamacare’s October 1st Birthday!  Our state has decided to expand our Medicaid program and to form our own marketplace for Coloradans to shop and compare health insurance plans.  These changes will help us cover many uninsured Coloradans. 

In its first week, Connect for Health Colorado, our state’s health insurance marketplace, successfully attracted more than 162,941unique website visitors, had 9,658 calls and chats to the service center, and 18,174 accounts created.  We think this is a strong start and know that it will take time for Coloradans who have not had insurance before to learn about their options and apply for coverage.  We are working across state government to help make this happen.       

At my department, Health Care Policy and Financing, Coloradans can enroll through our new modularized interoperable cloud-based system, PEAK.  We had more than 9,000 applications come through this site in the first 10 days of October.  It is foundational to our desire to increase new consumerism and greater client responsibility by walking through a self-enrollment process.  Our website is Colorado.gov/PEAK and we have seen record traffic to the application site.

Overall, the marketplace opening went quite smoothly for Colorado—the exchange opened successfully, Medicaid began, and our technology functioned efficiently for being such a large, complex system. With the marketplace now up and running, individuals, families, and small employers can start making appointments with Health Coverage-Guides, learn about plan options, and apply for insurance when ready.

This is an exciting moment in health care history and we are proud to be working with partners across our state and our nation to provide affordable health insurance options to all residents of Colorado!

Sep 25 2013
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Pennsylvania Adopts Law Supporting Insurance-Less Health Care Offices

Zane Gates, MD, is a Robert Wood Johnson Foundation (RWJF) Community Health Leader and medical director of Altoona Regional Partnering for Health Services in Altoona, Pennsylvania. Gates and Patrick Reilly, president of Impact Health Solutions, founded the Empower3 Center for Health program, which is the model for a new health care law in Pennsylvania.

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The Commonwealth of Pennsylvania has recently adopted a law to fund community-based clinics that can demonstrate real impact to the community with regard to increased access, reduced costs, lower emergency room (ER) visits, and improved behavioral health outcomes for the low-income working uninsured.  It is modeled on community-based clinics featuring a unique structure that I created along with Patrick Reilly, an insurance consultant from western New York:— Empower3 Center for Health program.

The model we created features an “insurance-less” office concept that allows patients to come in as frequently as needed without worrying about being billed or having any balances to pay. The program has no co-pays, deductibles or balance billing when the patients use the participating community hospital that partners with the program.  Since there is no billing at the point of service, there is more face time with the medical professionals to spend creating a true relationship that focuses on care and provides dignity to the patients seeking quality medical care. The office is open five days a week to provide access to patients as needed. 

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Sep 3 2013
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The Real Cost of Hospital Care

Last spring, Time Magazine published a much-discussed article that looked at how hospitals set prices for the services they provide, and the wide variations in pricing from one hospital to another. But hardly anyone actually pays those seemingly outrageous prices, Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative co-director Mark V. Pauly, PhD, says, because public and private insurance companies negotiate them down for their customers.

In the third video in a series of RWJF Clinical Scholars Health Policy Podcasts, Clinical Scholar Chileshe Nkonde-Price, MD, interviews Pauly, an economist, about the price of hospital care and the difference between posted prices and what consumers pay.

The video is republished with permission from the Leonard Davis Institute.