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Better Health, Better Care, and Lower Costs–One State at a Time

Nov 14, 2016, 12:00 PM, Posted by Bechara Choucair

While the Affordable Care Act is known for its national reforms, it has given states the opportunity to transform and improve their health systems.

Two doctors standing in a corridor consult together over some paperwork.

The Affordable Care Act (ACA) has drastically accelerated change within the nation’s health care system. While the law is known for ushering in national reforms—policies that aim to better health, improve care, and lower costs across the United States—it has also fostered new opportunities for states to serve as incubators for health care transformation. Valuable lessons can be drawn from these early-innovator states and their commitment to payment innovation, restructuring care delivery systems, and efforts to build healthy communities that extend beyond traditional medical providers. Multi-state health systems are uniquely positioned to facilitate this innovation.

The Centers for Medicare and Medicaid Innovation (CMMI), an office created by the Affordable Care Act to drive change in the health care system, has awarded about $960 million to 34 states, three territories, and the District of Columbia to test comprehensive transformation plans through its State Innovation Model (SIM) initiative. At Trinity Health, we're supporting and studying nine SIM awardees: Connecticut, Delaware, Idaho, Iowa, Massachusetts, Michigan, New York, Ohio, and Oregon. We're committed to sharing early lessons and best practices in addition to obstacles identified within our own health system. This information can help states, CMS, and other stakeholders expedite their own innovation.

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Honoring Andy Hyman: A Passionate Advocate for Health Equity

Aug 4, 2016, 9:37 AM, Posted by Brian C. Quinn

A new award celebrates and pays tribute to the life and work of Andy Hyman by recognizing a champion in the field of health advocacy.

The sunrise acts as a backdrop to the Capitol Building in D.C.

My boss and mentor Andy Hyman was the kind of visionary leader who instilled a deep sense of hope in everyone he came into contact with. He inspired in us a feeling that anything was possible. It’s this kind of unwavering hope that is needed when pursuing seemingly insurmountable goals—like the goal of ensuring that everyone in America has access to affordable, quality health care coverage.

Andy led the Robert Wood Johnson Foundation’s (RWJF) work on health insurance coverage from 2006 until shortly before his untimely death in 2015. One of the things I vividly remember was his deep conviction—even when progress seemed elusive—that we could make major strides toward improving coverage for those who needed it the most. 

Among his many wonderful qualities, Andy had keen political foresight that revealed itself when I started working with him back in 2006. He predicted a window to put the spotlight on health reform in 2008, regardless of who was elected president. In preparation, he led our team in building evidence to make the case for health reform and in bolstering the capacity of community of advocates nationwide who could work on state-level reform. Once the Affordable Care Act (ACA) was enacted, Andy worked tirelessly to help implement it in the states.

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How Health Insurers Can Help Kids Reach a Healthy Weight

Jun 1, 2016, 12:30 PM, Posted by Katherine Hempstead, Victoria Brown

Innovative approaches in health insurance can help support youth development and prevent chronic diseases.

Attendees visit tables at a health and enrollment fair.

While research shows that access to safe neighborhood spaces for physical activity along with affordable healthy foods help families and kids maintain a healthy weight, it’s often not enough.

Health care economist Mike Bertaut illustrated this reality through a deeply personal and passionate post last month. He opened up about his lifelong struggle with obesity and shared some important lessons about how the health care sector can help children maintain a healthy weight. It’s a moving piece worth reading.

As Mike shows us, health care providers—and health insurers—have a critical role to play, especially for children and families at highest risk for obesity and obesity-related disease.

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SHOP: Can it Boost Health Coverage for Small Business Employees?

Dec 14, 2015, 6:04 PM, Posted by Katherine Hempstead

A new report shows that small business owners care about the health insurance coverage they offer their employees, yet the Small Business Health Option Program (SHOP) remains an untapped resource with the potential to help employers find affordable plans.

In 1942, Ken Wilson’s grandfather started Bonnie Brae Conoco, a full-service gas station and neighborhood garage in Denver. Today, Ken is the third generation to manage the business. They’ve offered their employees health insurance since 1970, paying 100 percent of the costs for those who work full-time. Although it’s their largest expense, the Wilsons believe offering coverage is essential. They want to take care of their employees and attract and retain the best people.  

Small businesses, like all businesses, have struggled to keep up with the rising cost of health insurance. But unlike larger companies that can leverage their purchasing power to negotiate lower premiums and more comprehensive benefits, small businesses often have a choice of costlier plans with skimpier benefits. A recent study found small firms are far less likely than larger firms to offer health coverage. In 2012 and 2013, the percentage of small employers offering health insurance was 35 percent, while the percentage of large employers offering insurance was 95.8 percent.  

The Affordable Care Act (ACA) has several implications for small businesses. Under the ACA, small business health plans are subject to the marketplace regulations similar to those in the individual market. Depending on the state in which the business is located and the characteristics of the work force, these changes could make premiums change a lot or a little. Many small businesses are still offering pre-ACA plans, and many of them will need to transition to ACA-compliant coverage in 2017.

One new opportunity is the Small Business Health Options Program or SHOP, which is an online marketplace where small business owners with 50 or fewer full-time employees can purchase health insurance for their workers. Features of SHOP attempt to provide flexibility for both employers and employees. Business owners can set their contribution and their employees can choose the plan and benefits they want. Small business owners with 25 or fewer full-time employees can also qualify for a tax credit to put toward the cost of coverage.

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Open Enrollment: One Step Closer to Coverage for All

Nov 2, 2015, 9:00 AM, Posted by John Lumpkin

Let’s build upon the success of the Affordable Care Act with this year’s open enrollment.

A pediatrician makes a home visit to check on an infant patient.

Open enrollment is here again—the annual opportunity for Americans to find and enroll in a health plan through HealthCare.gov or their state-based health insurance marketplace. In three short years, millions of Americans have gained access to health plans that cover important services like doctor’s visits, prescriptions, hospital stays, preventive care, and more. As a doctor, I’ve seen the difference health coverage can make in the lives of families. Quality, affordable health insurance means new access to care—care that can have a huge impact on health, equity, financial security, and a better quality of life. It moves us closer to a Culture of Health, where people can access care when they’re sick and when they’re well, making prevention the priority.

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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

Two children play in a toy tractor on a farm.

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by Tara Oakman

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

A CVS Retail Clinic at the corner of a street.

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

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A Portrait of Women with Health Insurance

Feb 19, 2015, 2:21 PM, Posted by Susan Dentzer

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male—a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men—and in fact, some evidence indicates that they were less likely to be uninsured than males.

What is clear that many women were highly motivated to obtain coverage under the health reform law—most likely because they want it, and need it.

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Entering the Final Stretch

Feb 3, 2015, 6:15 PM, Posted by David Adler

As we head into the final weeks of this year’s open enrollment season, we can all be proud of the progress that’s been made. New numbers released last week show 9.5 million Americans signed up for health coverage through marketplaces across the country. Behind each number is someone who now has quality, affordable health coverage with access to health care when they need it and protection from financial ruin if they get sick.

But there are still millions more who are eligible for coverage this open enrollment period. RWJF and our partners are doing all we can to get as many people enrolled as possible before the February 15 deadline. These collective efforts focus on breaking down the biggest enrollment barriers for people to get covered. Our research shows that consumers are more motivated to enroll when they understand the benefits of coverage, believe they can afford the cost, and know they can find enrollment support to complete the process.

Enroll America, an RWJF grantee, is addressing the need for in-person help head on—operating grassroots efforts in 11 states and connecting consumers to enrollment tools and help nationwide. Their connector tool, allows consumers to schedule appointments for in-person help right away. Drawing from lessons learned from the first open enrollment period we know this one-on-one support will be critical for many consumers during these final weeks.

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Field Notes: What Cuba Can Teach Us about Building a Culture of Health

Jan 29, 2015, 9:54 AM, Posted by Maryjoan Ladden, Susan Mende

Ever since President Obama announced the restoration of diplomatic ties between the United States and Cuba, there’s been growing excitement over the potential for new opportunities for tourism, as well as technology and business exchanges. Most people assume that the flow will be one-sided, with the United States providing expertise and investment to help Cuba’s struggling economy and decaying infrastructure.

That assumption would be wrong. America can—and already has—learned a lot from Cuba. At RWJF, we support MEDICC, an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States—South Los Angeles; Oakland, Calif.; Albuquerque, N.M.; and the Bronx, N.Y. Even with very limited resources, Cuba has universal medical and dental care and provides preventive strategies and primary care at the neighborhood level, resulting in enviable health outcomes. Cuba has a low infant mortality rate and the lowest HIV rate in the Americas, for example—with a fraction of the budget spent in the United States.

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