September 2008
Insurance Coverage: Is a Reported Decline in the Number of Uninsured Good News?
Newly released data from the Census Bureau show that uninsurance rates for health coverage have declined. However, people remain vulnerable to adverse health outcomes. This is due to access problems, underinsurance, and rapidly increasing rates of medical debt. These problems will continue to play out in the policy arena as rising costs of health care combine with a sluggish economy.

August 2008
Accessible Care
Across the United States, people are finding it increasingly difficult to access necessary health care. Some argue that this is evidence of a severe physician shortage, while others argue that the physician supply is adequate but poorly distributed across specialties and geographic regions. Along with the physician supply debate, the diversity of proposals for improving access to appropriate health care reveals the complexity of the problem.

July 2008
Health Insurance Benefits: A Moving Target
An enduring feature of the health care system is continual change. Whether in the clinical or the administrative setting, change is ubiquitous. For example, health insurance benefits continue to evolve by expanding, contracting, and transforming over time.

May 2008
Individual Health Insurance Market as a Mechanism for Increasing Access to Health Insurance
Recent proposals by Congress, President Bush, and the 2008 presidential candidates include provisions that would expand the individual health insurance market to increase access to health insurance. The individual and group markets are unique, and the impact of the proposed expansion on access, price, and quality of health care remains to be seen.

April 2008
Disparities in Health and in Health Care
While knowing how to shape and where to target interventions is challenging, much work is needed to develop solutions to eliminate disparate care at the individual/community level, provider level, and organization level.

March 2008
Health Care Costs-Challenges and Solutions
Per person spending on health care by individuals and the government is expected to increase from an average of $7,026 in 2006 to $13,101 in 2017, with the burden falling most heavily on public payers. And while the growth rate may not continue accelerating, the real level of health care costs is expected to account for an increasingly larger portion of the U.S. economy. Without restraint on future health care spending, the economic stability of the country is at risk. New HCFO-funded grants are looking at how to address cost growth and improve the value of care received.

February 2008
Challenges Facing the Health Care Safety Net
The U.S. safety net provides care to individuals regardless of their ability to pay. Because the safety net is dependent on a variety of sources of revenue-including local, state, and federal funds-state and federal policies may influence uncompensated care funding and the ability of the safety net to serve vulnerable populations.

January 2008
Preventing Disease in a Categorically Funded Public Health Care System
The American public health system is financed by a complex web of federal, state, and local resources. The contributing funding streams are mostly disease or purpose driven, with dollars specifically targeted toward prevention, treatment, and control of a specific disease or purpose (e.g. diabetes or bioterrorism preparedness). However, today's most deadly diseases, including diabetes, cancer, and heart disease, result from the same behavioral and environmental risk factors and may be targeted by similar early intervention and prevention programs. Thus, the public health system's inflexible financing mechanisms- which are often described as 'silos' or 'stove-pipes'- are sorely inefficient, leading to disconnected programs and redundant activities.

November 2007
Mental Health Parity: Take Two
As a result of increased research and awareness for mental health illnesses, treatments, and costs, the U.S. Congress is voting to expand the scope of current mental health parity laws to provide insured individuals with mental health benefits that are comparable to general medicine benefits.

October 2007
Medicare Advantage Under Scrutiny
As Medicare spending continues to increase, Medicare Advantage has become a subject of high interest because of its recent growth in plans and enrollees, and its impacts on Medicare spending.

September 2007
Cost-Effectiveness and Comparative Effectiveness: Strategies for Maximizing Value of Health Spending?
As health care spending increases and Americans experience little change in health status, health plan administrators and policymakers alike are exploring comparative- and cost-effectiveness research as strategies for maximizing the value of medical technology and spending.

August 2007
Medicare Part D: Strengths & Weaknesses
Medicare Part D: More than a year after its implementation, the debate continues on the successes and challenges of the most comprehensive prescription drug program offered to seniors.

July 2007
Rising Health Care Costs and the Challenge of Coverage
Rising health care costs affect individuals, employers, providers, and payers
both private and public. Unrestrained medical cost growth makes the search for new insurance products and benefit packages more pressing, yet it is difficult to accurately price these products or predict the impact on use and overall costs.  Moreover, developing accurate estimates and working to reduce costs is necessary for maintaining access to health insurance. Both challenges may detract from policymakers' efforts to expand access to health insurance.

May 2007
The Debate Over Employment-Based Health Benefits
Since World War II, employment-based health benefits have been the most common form of health insurance for non-poor and non-elderly individuals in the United States. In 2005, 62 percent of adults below the age of 65 and 57.5 percent of children were covered by an employment-based plan. As health reform takes on new prominence, the efficacy of this employer-based system is being debated. There is broad disagreement on across the political spectrum over whether employer-based coverage continues to make sense. This debate is not new. The conversation about fixing the employer-based system versus replacing it entirely has been ongoing since the late 1990s. Health care costs continue to outpace inflation; consequently, debate concerning reform of the employer-based system has again turned vigorous.

April 2007
SCHIP Reauthorization - Expand, Reduce, or Maintain?
The 110th Congress marks the beginning of the first reauthorization for the State Children's Health Insurance Plan (SCHIP). As the debate begins, primary issues involve appropriate funding levels and program design for the purpose of expanding, maintaining, or restricting the program.

March 2007
Individual Insurance Market and Tax Credits
In his January 23, 2007, State of the Union Address, President Bush proposed an aggressive initiative to increase access to health insurance. It includes a standard deduction for individuals and families who purchase private health insurance, as well as federal subsidies to states that provide private health insurance options to low-income individuals and individuals whose prior health histories make them difficult to insure.

February 2007
Universal Coverage- One State at a Time
Over the last several months, increasing numbers of governors have announced plans to provide health insurance for every resident of their respective states. The plans offer promise, but also significant challenges.

January 2007
The Evolution and Treatment of Disease over Time
Over the last century, treatment and understanding of disease, has evolved and reconfigured in response to advances in medical technology as well as social and environmental changes. The interplay among these factors has resulted in the development of different approaches to the organization of care at different points in time.

December 2006
State Flexibility: The Answer to Medicaid's Woes?
The Deficit Reduction Act of 2006 (DRA) charged Department of Health and Human Services Secretary Michael Leavitt with creating a bi-partisan commission to recommend short- and long-term reforms to the Medicaid program.

November 2006
Non-Profit Hospital Community Benefits Under Review
In exchange for tens of billions of dollars a year in tax breaks, non-profit hospitals are required to provide charity care and other benefits to their surrounding community.

October 2006
Rationing Health Care: Is the United States Willing?
Many Americans have a negative visceral reaction to the term "rationing." But as health care costs continue to climb and as new threats challenge limited resources, rationing may become a reality.

September 2006
Finding a More Rational System:Medicare Physician Payment Reform
Most discussions on physician payment inevitably lead to an examination of the Medicare physician payment formula and the recurring debate on annual updates. Given its stature in the market, as Medicare payments go, so go the private insurer payments to physicians.

August 2006
The Informed Patient: Do Consumers Have the Tools To Make Healthcare Decisions?
The Institute of Medicine highlighted a trend toward increased responsibility for consumers in health care in a 2004 report stating, "[i]ndividuals are asked to assume new roles in seeking information, advocating for their rights and privacy, understanding responsibilities, measuring and monitoring their own health and that of their community, and making decisions about insurance and options for care."

July 2006
Public Health Preparedness: Are Public Health Systems Ready for a Disaster?
A glance at the newspapers reminds us of the many reasons to examine the preparedness of our health care system: the arrival of a new hurricane season, the fear of bioterrorism, and the potential for an avian flu pandemic, just to name a few.

June 2006
The Current Malpractice Crisis Cycle?
Malpractice crises are not new to the healthcare system and in fact appear to resurface about every ten years. The most recent focus on the issue has prompted legislation designed to cap damages as a way to keep health care costs under control and malpractice insurance affordable. Unfortunately, the legislative effort has stalled and policymakers remain mired in the complex issues surrounding liability insurance and the attendant impact on cost, quality and access in the healthcare system.

May 2006
Health Insurance and Small Businesses: Ways to Make Coverage More Affordable
As policymakers continue to struggle with how best to meet the health care coverage needs of employees of small businesses, legislation has once again stalled in Congress. On May 11, 2006, a bill that would have allowed small businesses to join together and create association health plans (S. 1955) failed to pass in the Senate.

April 2006
State High Risk Pools
On February 10, 2006, President Bush signed into law the State High Risk Pool Funding Extension Act of 2006 authorizing appropriations to states for the establishment and operation of high-risk health insurance pools. Currently, approximately 30 states operate this type of high-risk health insurance pools. Yet enrollment is limited and challenges are plentiful.

March 2006
Challenges of the Public Health System
In the aftermath of 9-11 and Katrina, and as we continue to watch the spread of avian flu and worry about the potential for bioterrorism, it is clear that this country’s public health system will take on increasing importance and increasing burden. Yet core public health functions such as tuberculosis control and childhood immunizations remain critical.

February 2006
HSAs Form Cornerstone of President’s Health Agenda
The State of the Union, on January 31, provided the first glimpse into the President’s plans for addressing America’s health care needs. Health Savings Accounts (HSAs), the cornerstone of the Bush administration’s efforts to improve access and control costs, continue to be the primary focus.

January 2006
Dual Eligibles Face Significant Prescription Drug Changes
For the approximately six million dual-eligibles enrolled in both Medicare and Medicaid, the Medicare Modernization Act (MMA) represents a change in insurance, not an added benefit. Transitioning dual-eligibles from comprehensive prescription coverage under Medicaid to Medicare’s private prescription drug plans (PDPs) will be a significant experiential shift.

December 2005
End-of-Life Care: The Struggle to Provide Quality Care while Containing Costs
As baby boomers approach Medicare eligibility, end-of-life care has become an all too familiar topic. A recent report that medical students do not receive proper training in end-of-life care affirms the continued interest in improving proper care at the end of life. HCFO research has explored factors that influence end-of-life care, including efforts to provide quality care while controlling costs.

November 2005
HSAs Growing in Popularity
It's open enrollment season and more people than ever are being offered the chance to sign up for a Health Savings Account (HSA) in conjunction with a high deductible health plan. Research has identified factors that influence take-up; including wages, premiums, health status, and education level. Findings raise questions about adverse selection, decision-making ability, and usefulness as a savings tool.

October 2005
Medicare Part D: Enrollment and Implementation
On September 23rd, the Centers for Medicare and Medicaid Services (CMS) announced the plan options available to Medicare beneficiaries who choose to enroll in the Medicare prescription drug benefit. The enrollment period for prescription drug coverage begins November 15th and continues through May 15th, after which enrollees will incur a penalty for late enrollment.

September 2005
Health Information Technology on the Radar Screen of Policymakers
On July 29, 2005, President Bush signed into law The Patient Safety and Quality Improvement Act of 2005. The Act establishes a network of databases to hold data on medical errors and encourages voluntary reporting of those errors by patient safety organizations and health care providers.

August 2005
Developing Pay-for-Performance Programs
As pay-for-performance systems continue to evolve, HCFO-funded research helps to shed light on the role of public report cards and other systems used to evaluate physicians.

July 2005
Long-Term Care Housing and Service Evolution Addresses “Longevity Revolution”
The estimated average cost for a private room in a nursing home is now more than $70,000 a year. Demographic trends amplify concerns about the mounting costs of traditional long-term care delivery.

June 2005
Medicaid Reform: Balancing Care, Coverage, and Cost
In 2004, the total costs nationally for Medicaid were about $295 billion.¹ In addition, Medicaid is growing rapidly as a portion of state budgets. However, despite the large overall expense, the challenge with Medicaid reform efforts is to cut costs from what is "already a lean program, spending less per person than private insurance after adjusting for age and health status." ²

May 2005
Estimating the Number of Americans without Health Insurance: Not a Simple Count
In any year, reports on the number of Americans without health insurance show varied numbers. Government estimates of the number of uninsured in 2003 ranged from 19 million, reported in the Survey of Income and Program Participations, to 45 million in the Current Population Survey (CPS)¹. This discrepancy in reporting is partly a result of differing definitions of uninsurance, the fluidity of the uninsured populations, and the difficulty in tracking individuals who were uninsured for an entire year.

April 2005
Genetic Information Meets Insurance Underwriting
As genetic information becomes a more prominent component of an individual's medical history, Congress has stepped in to ensure that such information does not become a factor in health insurance underwriting.

March 2005
Medicare Part D: Can the new outpatient prescription drug benefit effectively manage costs?
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) will, for the first time in the 40 years of Medicare history, provide outpatient prescription drug benefits to seniors. Although recent budget estimates suggest that Medicare Part D, the prescription drug benefit, will cost more than $1.2 trillion over the next ten years, Mark McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS), suggested that predicted savings will offset part of the $1.2 trillion estimate, bringing the cost down to $724 billion.

February 2005
Planning to Retire Early? Better Think About Health Care Costs
Some older Americans who had hoped for early retirement are finding they can no longer leave the workforce as early as planned due to rising health costs that have caused their employers to drop employer-sponsored retiree health benefits.

January 2005
Malpractice Reform: Solution to our Health Care Cost Problem?
As health care costs continue to rise at a startling rate, the American public, policymakers, health plans, and health providers are aggressively pursuing possible solutions to reduce costs within the current system. One proposed solution to ease America's ailing health system is medical malpractice reform. President Bush has called upon Congress to approve his medical malpractice reform bill; states have struggled to develop their own medical malpractice legislation; and medical liability reform is the American Medical Association's top legislative priority.

December 2004
Medicare Modernization Act Offers New End-of-Life Care Provisions
Perhaps the most talked about provisions of the recent Medicare reform legislation are Medicare coverage of prescription drugs and health savings accounts. However, important provisions addressing end-of-life care were also included.

November 2004
Health Care Agenda for the New Administration
During the campaign, President Bush outlined his health care priorities - reducing health care costs and providing incentives for increased coverage to low-income families and children, small businesses, the self-employed, and people who do not get health care benefits through their employer. While campaign promises are often far-removed from actual policy, it is clear that there will be discussion, and likely Congressional debate, about the President's health care proposals. There is significant HCFO work to inform the debate.

October 2004
Coverage Decisions: How is Evidence Used? Why the Variation?
Making coverage decisions in an era of shrinking dollars-HCFO research directly informs policy.

September 2004
FTC/DOJ Administer a Dose of Competition
In July 2004, following two years of hearings, workshops and research, the Federal Trade Commission and Department of Justice released a comprehensive report on the role of competition in the health care market. HCFO has funded a large body of related work.

August 2004
Do Other Countries Hold the Cure to Rising Prescription Drug Costs?
As prescription drug costs continue to soar, recently proposed legislation legalizing importation has received bipartisan support in hopes of lowering drug costs and expanding access to those who cannot afford medications. City and state governments have begun to sponsor importation programs, ignoring FDA safety warnings in order to lower cost and improve access for their citizens. With nearly 80 percent of citizens over the age of 50 supporting the legalization of importation and citing it as an important election concern, current political attention is likely to increase in the upcoming months.

July 2004
Reviving the Patient Rights Debate
On June 21, 2004, the Supreme Court unanimously struck down a Texas state law placing liability on health maintenance organizations (HMOs) for harm caused by denied care and medical negligence. The ruling has brought increased pressure on Congress to deal with HMO regulations possibly reviving a nine-year-old debate on the “patient’s bill of rights.”

June 2004
Long-Term Care – Finally on its Way to the Altar?
A follow-up to the July 2003 Hot Topic, Long-Term Care: Always the Bridesmaid, Never the Bride. Through their recent activities, HCFO and AcademyHealth, the national program office for HCFO, strive to move long-term care higher on the policy agenda.

May 2004
Association Health Plans Revisited: Jump-Starting Congress' Health Agenda
For the second time in less than a year, the House of Representatives has passed legislation on May 14, 2004 to allow federally regulated association health plans (AHPs) for small firms. The bill allows small firms to pool together in associations across state lines to offer health insurance, exempt from most state insurance mandates.

April 2004
Becoming an Educated Health Care Consumer in an Information Filled-World
Educating consumers about strategies to ensure they obtain good health care may lead to lower costs and higher quality. But the task is not without challenges.

March 2004
Value-Based Purchasing: Can Medicare Be the Spark?
Many purchasers are implementing strategies they hope will improve the quality and value of the health care they receive, yet there is not a preponderance of evidence that suggests these strategies are working-at least yet-to improve health care quality. With new authority, can Medicare further the value-based purchasing movement?

February 2004
Will the New Medicare Legislation Stem the Flow of Eroding Benefits?
Fully one-third of Medicare beneficiaries rely on employer-sponsored health insurance (ESI) for vital services not covered under traditional Medicare. These retirees face an increasingly dismal future as employers decrease retiree benefits or subsidies in response to increasing health care costs and an increasingly competitive global economy. Will employer subsidies under the new Medicare legislation be enough to reverse this trend?

January 2004
Employer Responses to Rising Insurance Costs
After a few years of relatively low health care inflation, double-digit increases in health care costs have returned. This year represents the fifth straight year of health insurance premium increases greater than ten percent. What actions are employers taking to address rising insurance costs?

December 2003
Health Savings Accounts —A Sleeping Giant?
The creation of Health Savings Accounts (HSAs) under the new Medicare legislation doesn’t have anything to do with Medicare but could have a significant impact on health insurance for many Americans under 65.

November 2003
The Uninsured: An Unsolvable Dilemma?
Despite a great deal of attention and effort over the past decade by policymakers, foundations, and researchers, the number of Americans without health insurance continues to rise.

October 2003
Rising Malpractice Premiums: Will Your Doctor Be Available If You Get Sick?
Malpractice premiums for physicians began increasing dramatically in 2000, after leveling off for nearly a decade. In addition, jury awards have risen significantly and some contend that physician behavior has changed as a result of the malpractice environment. Does this threaten access to medical care or contribute to overall health care cost inflation?

September 2003
Hospital and Health Plan Conversions
The decade-long trend of non-profit to for-profit conversions by hospitals and health plans is a phenomenon with considerable implications for the accessibility, availability, and affordability of health care services. HCFO grantees are at the forefront of this issue, generating findings to help inform policymakers who struggle to decide whether such conversions help or hurt their communities.

August 2003
Medicare Drug Bill Poised to Pass: What's Next?
After five years of deadlock, Congress seems ready to pass a Medicare prescription drug benefit. Regardless of what the final package looks like, HCFO-funded research will help decision-makers understand its implications and help shape the implementation process.

July 2003
Long-Term Care - Always the Bridesmaid, Never the Bride
Although millions of Americans rely on long-term care services to meet their health and personal assistance needs, the topic of how quality long-term care services should be provided and financed rarely reaches the top of the policy agenda.

June 2003
Association Health Plans - A Remedy for Covering the Uninsured?
Bipartisan legislation currently moving its way through Congress attempts to address the critical problem of millions of uninsured in America through the creation of federally certified association health plans. As legislation is debated, HCFO work helps decision-makers understand the strengths and weaknesses of these plans.

May 2003
Managed Care Plans Challenge Any Willing Provider Laws
States recently got a green light for "any willing provider" laws when the U.S. Supreme Court upheld a challenge by managed care organizations to that provision of the Kentucky Health Care Reform Act of 1994. Important questions arise about the likely impact of this court decision on plans' ability to manage quality while containing costs, as well as about the likelihood that additional states will adopt 'any willing provider' legislation for some or all providers.

March 2003
Disease Management in Medicare: The Solution to Escalating Costs?
Skyrocketing Medicare costs are once again making headlines. CBO estimates that Medicare spending will more than double by 2030. Some view disease management as a way to control escalating costs, but the evidence is mixed.

February 2003
Physician Payment under Medicare
Will projected cuts in Medicare physician payment limit Medicare beneficiaries' access to physicians? HCFO-funded work may provide insight into this complex issue.