Category Archives: Affordable Care Act
Linda Wright Moore, MS, is a senior communications officer at the Robert Wood Johnson Foundation (RWJF).
The swirl of controversy and nonstop debate around the Patient Protection and Affordable Care Act (ACA) is like a play that never ends: Every time you think you’re coming to the finale, another character or plot twist crops up—and the production drags on … and on.
So it goes with the ACA: Last year, the U.S. Supreme Court ruled the new law to be mostly sound, but fudged on the state mandate to expand Medicaid just enough to keep the drama twisting and turning—and to make many poor and uninsured people ineligible for government subsidies.
Meanwhile, repeated attempts to repeal the law—at least 38 to date—have contributed to a jarring statistic: 42 percent of Americans are unaware that the ACA is the law of the land. In light of the lack of knowledge that the health reform law is the law—it’s no surprise that half of the public admits to not having enough information to understand the likely impact of the ACA on themselves and their families.
The U.S. Department of Health & Human Services (HSS) last week announced that it will support twice as many primary care residencies during the 2013-2014 academic year as it supported last year, thanks to $12 million in funding from the Affordable Care Act. The new funds will support more than 300 residents at community-based Teaching Health Center programs across the country.
“Teaching Health Centers help attract students who are committed to serving communities of need and prepare them to practice in these communities,” HHS Secretary Kathleen Sebelius said in a news release. “Students exposed to training opportunities in health center settings are more likely to stay in these communities and continue to contribute to the care of their residents.”
Residents will be trained in family and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry.
This week, the U.S. Department of Health and Human Services is rolling out a new website that provides educational tools designed to help people understand their insurance choices and select coverage that best suits their needs when open enrollment begins on October 1st. With 99 days to go until then, the new effort includes a consumer call center that will offer help to consumers in more than 100 languages. It will eventually employ 9,000 people, who will answer questions from the public 24 hours a day.
HealthCare.gov is designed to be the destination for the new Health Insurance Marketplace, also called exchanges. The new website will add functionality over the next few months so that, by October, a consumer will be able to create an account, complete an online application, and actually shop for an insurance plan.
For Spanish speakers, CuidadoDeSalud.gov offers the same information and functionality in Spanish.
Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.
In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.
Facing What May Be the Affordable Care Act’s Ultimate Challenge: The Gap Separating Evidence from the Policy-Makers Who Need It
David Grande, MD, MPA, is an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine, a senior fellow at the Leonard Davis Institute of Health Economics, associate director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and an alumnus of the RWJF Health & Society Scholars program. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
It’s a time of unprecedented upheaval in U.S. health care. Big changes are bursting through on virtually every front. Legislators and administrators in Washington and 50 state capitals struggle daily to reinvent their health care systems even as they lack an exact blueprint for the new things they’re supposed to be building.
This was nowhere more evident than at the recent AcademyHealth National Health Policy Conference, where state and federal officials and interest groups lined up to present long lists of policy questions that confront them as they grapple with implementation of the Affordable Care Act and mounting public budgetary pressures.
For instance, in the “Opportunities & Challenges for State Officials” session, New Mexico’s Medicaid Director Julie Weinberg described the unknowns surrounding how “churn” between private and public coverage will change and how new Medicaid eligibility standards will impact enrollment processes.
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is the first in a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
Like Goldilocks wandering through the house of the Three Bears, policy-makers in search of a health care payment model have found it difficult to settle on an option that is "just right."
Fee-for-service—paying doctors separately for each service they provide—leads to too much unnecessary and duplicative care (too hot!). Capitation—paying doctors a fixed fee for caring for patients—leads doctors to skimp on care and avoid costly populations (too cold!). A "just right" payment model should give providers incentives to provide all the clinically necessary care to patients while keeping costs low.
Shared savings models—allowing providers to keep a portion of the money they save caring for patients—have been touted as one method for aligning the incentives of providers and payers. Most prominently, shared savings is a central element of the Affordable Care Act's Accountable Care Organizations (ACOs).
An ACO is a network of providers that have agreed to accept a bundled payment for treating patient populations, and in return stand to gain incentive payments for meeting performance targets (or to lose money for missing targets). In the "happily ever after" version of ACOs, groups of providers will finally have a business case for coordinating patient medical records, reducing costly visits to the emergency room, and improving patient compliance with chronic disease therapies without leading to excessive procedures or gaps in care. Healthy patients, healthy profits.
But will it work?
This is part of the March 2013 issue of Sharing Nursing's Knowledge.
For three years, Congress has failed to fund a federal panel that was created to address a dire shortage of health care professionals—and now the news media is beginning to take note.
The unfunded panel broke through the media silence in January when Politico, an inside-the-Beltway publication that covers Congress and the White House, ran a story about it. In February, the New York Times followed up with its own piece.
Officially called the National Health Care Workforce Commission, the panel was created in 2010 under the health reform law to address concerns over a short supply of health care providers at a time when demand is growing, thanks to the aging population and an influx of newly insured people expected to enter the health care system next year.
A leading nurse researcher, Peter Buerhaus, PhD, RN, FAAN, a professor of nursing at Vanderbilt University, was tapped to chair the commission and 15 members were appointed. But Congress never appropriated funds for it—a phenomenon that was noted at a recent hearing before a U.S. Senate subcommittee.
“It’s a disappointing situation,” Buerhaus told the New York Times. “The nation’s health care work force has many problems that are not being attended to. These problems were apparent before health care reform, and they will be even more pressing after health care reform.”
When insurance coverage expands under health reform next year, dramatically increasing demand for primary care services, approximately 51 million Americans will be living in primary care shortage areas, according to a study published online in Health Affairs. Seven million people will be in hard hit areas, where the expected increase in demand for providers is nearly twice that of other regions (10% greater than their current supply, as compared to 5%).
The researchers predict the states most likely to have dire physician shortages because of increased demand are (in order) Texas, Mississippi, Nevada, Idaho and Oklahoma. They estimate the nation will need an additional 7,200 primary care providers, or 2.5 percent of the current supply.
The researchers “also found that small areas with a greater need for primary care services and providers, although concentrated in certain states, can be found in forty-seven states,” the study says. “The results of this study suggest that promoting and refining policies related to the distribution of primary care providers and community health centers may be as important as policies aimed at increasing the overall supply of primary care providers.”
The study was conducted by Elbert S. Huang (School of Medicine, University of Chicago) and Kenneth Finegold (Division of Health Care Financing Policy, Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services).
A report completed this month by the Congressional Research Service (CRS), which conducts analysis for members and committees of Congress, examines how the Affordable Care Act (ACA) will affect the nation’s supply of physicians. In particular, the report focuses on the workforce’s size, composition and geographic distribution.
The health care system cannot work effectively or efficiently without a physician workforce of appropriate size. Too few physicians means delayed care, and too many physicians can mean unnecessary or duplicate care. But measuring the size of the physician workforce—and the future physician population—is challenging, and estimates vary. The CRS report notes that “predicting the timing, content, and effect of policy change is difficult, which adds to the uncertainty of the projections.”
The ACA authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. It requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents. It also includes provisions designed to increase physician productivity and the volume of physician services available. The law encourages care coordination—in medical homes and accountable care organizations, for example—and expands the non-physician workforce that can augment or substitute for physician services.
Human Capital News Roundup: Electronic health records, advance care planning, myths about 'death panels,' 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 and grantees. Some recent examples:
As part of its 25th anniversary celebration, Nurse.com recognized RWJF Senior Adviser for Nursing Susan B. Hassmiller, RN, PhD, FAAN, as a “pillar” of the New York/New Jersey nursing community. Hassmiller serves as director of the Future of Nursing: Campaign for Action. Nurse.com also honored Beverly L. Malone, RN, PhD, FAAN, a member of the RWJF Nurse Faculty Scholars National Advisory Committee and CEO of the National League for Nursing––one of the organizations leading RWJF’s Academic Progression in Nursing (APIN) program.
The New York Times reports on a new analysis by the RAND Corporation, co-authored by Arthur Kellermann, MD, MPH, FACEP, an alumnus of the RWJF Clinical Scholars program and the RWJF Health Policy Fellows program. The analysis finds that “the conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care.” The article also quotes RWJF Investigator Award in Health Policy Research recipient David Blumenthal, MD, MPP. Read a post Kellermann wrote for the RWJF Human Capital Blog about health care spending.
Investigator Award recipient and RWJF Generalist Physician Faculty Scholar program alumnus Peter Ubel, MD, wrote an article for Forbes about a study he co-authored with RWJF Scholars in Health Policy Research alumnus Brendan Nyhan, PhD, and Jason Reifler, PhD, that finds the “death panel” myth––that the government would decide who was “worthy of health care” under the Affordable Care Act––has persisted, and may even grow with time. The Washington Post Wonk Blog also reported on the study. Read a post Ubel wrote for the RWJF Human Capital Blog.