Health Legislation

This commentary appeared on CNN on April 29, 2013.

Over the past several months, Governors Chris Christie of New Jersey, Rick Scott of Florida, and John Kasich of Ohio — all Republicans — have announced support for the Affordable Care Act's (ACA) Medicaid expansion. They join 22 other states and the District of Columbia in expanding the health insurance program for low-income Americans.

But more than a dozen of their counterparts in other states have decided against implementing the expansion, and the fight goes on in several states including Florida and Ohio where Scott and Kasich face hurdles in getting expansion through their state legislatures. Many have said these decisions are based on fears that expansion will cost states money in the longer-term. Yet, recent RAND research suggests that the economic arguments against state implementation may be questionable, especially for some lower-income states....

The remainder of this op-ed is available at cnn.com.

President Obama has said he intends to enroll, personally, in one of the health insurance exchanges created under the Affordable Care Act (ACA) when they become active later this year. So which one?

Speculation has focused on his home jurisdictions of Illinois or District of Columbia. But the President may want to consider a multistate plan (MSP). A recent RAND study analyzed MSPs and the population that may seek to enroll in them.

Amelia Haviland presents the results of several new RAND studies on cost and quality in consumer-directed health plans, and explores how switching plans affects the quality of care.

With additional elements of the Affordable Care Act (ACA) soon coming into effect, taxpayers and policymakers alike are scrutinizing the law to better understand exactly how much the law will cost — or save — them.

First the basics: The ACA increases insurance coverage by expanding Medicaid to everyone with an income below 138% of the federal poverty level and by providing subsidies for low- and middle-income people to purchase private insurance in the newly created health insurance exchanges. These pieces of the legislation will result in millions of people newly having insurance coverage. The Medicaid expansion and the subsidies will also push billions of dollars into state economies, but the law pays for this spending through reductions in Medicare spending, penalties for being uninsured, and other taxes that will take billions of dollars out of the states. According to the Congressional Budget Office, the net effect of the ACA will be about $109 billion dollars in income to the federal government over 10 years.

This commentary appeared in The Orange County Register on October 16, 2012.

Health care reform is a top issue in the presidential election, as demonstrated in the first debate between Gov. Mitt Romney and President Barack Obama. But regardless of which candidate wins in November, and regardless of whether ”Obamacare“ is repealed, amended or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year.

Arguments about who will (or won't) cut Medicare and whether or not Medicaid should be converted to block grants to the states don't change the underlying reality that America's health care system costs too much. Worse yet, it is growing more expensive every year. From 1999-2010, national spending on health care doubled, from $1.3 trillion to $2.6 trillion.

This commentary appeared on Ms. Magazine on October 8, 2012.

The debate in several states over women's reproductive rights and care has implications for the care women will receive under the Patient Protection and Affordable Care Act (ACA).

The ACA provides preventive care, including contraceptive and reproductive services, with no copays. However, several states are attempting to defund Planned Parenthood and otherwise reduce support for women's health centers, where many women receive both reproductive care and other health care services. While it has long been recognized that comprehensive care for men includes sexual and reproductive health, the same has not been true for women. For example, women's health insurance plans have typically allowed exclusions in this area for pregnancy and even when it is not a “preexisting condition”; indeed, there are no comparable accepted options for excluding entire aspects of health care for men while providing them for women.

In light of the current debate over women's reproductive rights and care, it is increasingly clear that the benefits of the Patient Protection and Affordable Care Act (ACA) for access to comprehensive health care will not accrue equally to women across the country. Simply put: There is more agreement on what must be included in comprehensive health care for men than on whether and to what extent contraceptive and reproductive services must be included in comprehensive health care for women.

While it has long been recognized that comprehensive care for men includes sexual and reproductive health, the same has not been true for women. For example, women's health insurance plans have typically allowed exclusions in this area even for pregnancy, and even when it is not a “preexisting condition”; indeed, there are no comparable accepted options for excluding entire aspects of health care for men while providing them for women.

According to a new study (PDF) by Deloitte consulting, around one in 10 U.S. employers with more than 50 workers plans to drop health coverage in the next few years as the main provisions of the Affordable Care Act kick in. The study also notes that more may do so over time.

This finding is reminiscent of another employer survey released by McKinsey in June 2011. That report, which garnered much media attention and controversy, examined more than 1,300 employers. McKinsey reported that when the ACA fully takes effect in 2014, it could prompt 30% of employers to drop coverage, pay the modest fine, and let their employees pursue coverage through one of the new state-based health insurance exchanges.

The wait is finally over. Today the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA), including the mandate that requires individuals to purchase health insurance, ending months of speculation about the fate of the law. Based on RAND COMPARE, we project that once the ACA is fully implemented, an additional 27 million Americans will have gained access to health insurance.

The Court's ruling is unquestionably historic, but there is a critical aspect of health care reform that still needs to be fixed. The nation needs to take decisive action to address the rising costs of health care.

The numbers tell the story. In just the last 10 years, U.S. spending on health care doubled, from $1.3 trillion to $2.6 trillion a year. National health care spending is expected to reach an eye-popping $4.6 trillion in 2020, at which point per-capita spending on health care will exceed $13,000 a year.

This commentary appeared on Health Affairs Blog on May 29, 2012.

Concern over prescription drug shortages has recently reached a fever pitch. The cause for concern includes the rise in the sheer number of shortages — from fewer than 80 shortages in 2005 to more than 250 in 2011 — and the types of drugs affected. Injectable drugs such as chemotherapy, which are often vital to patient health and have few close substitutes, account for an increasing number of shortages.

Numerous government reports and articles have explored the causes of shortages. A recent report by the HHS Assistant Secretary for Planning and Evaluation (ASPE) pointed to ongoing manufacturing problems, increases in drug volume, consolidation in manufacturing, regulatory burdens in approving new manufacturing sources, and unusually high rates of patent expirations.