Keep in Mind...
In some states, costs of individual health plan premiums vary widely, with as much as 17-fold differences based on age, gender, and health status. Even in a tightly regulated state like New York—where individual coverage is available to all—standard individual policies cost about $5,200 per year.
—From Insuring the Healthy or Insuring the Sick?
The Dilemma of Regulating the Individual Health Insurance Market
IN THIS ISSUE:
With Individual Coverage, Affordability Is Always the Issue
The individual health insurance market has long been a troubled one. Such coverage—usually bought by people lacking access to employer-based or other group policies—is often prohibitively expensive and benefits are limited. Many people with preexisting medical conditions cannot buy any kind of individual coverage at all. A new study assesses the effectiveness of state regulations that attempt to make individual policies more accessible and affordable.
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Grantee Spotlight: Stephen Shields
The terms "long-term care" and "nursing home" typically bring to mind visions of unwelcoming, regimented institutions. But a growing movement, known within the industry as culture change, is looking to change that perception by radically transforming how residents are treated and served. Proponents of culture change believe long-term care residents can and should drive their own lives, and recommend replacing institutional units with households of small groups of residents and staff. Recently we spoke with Stephen Shields—one of the pioneers of the movement and the president and CEO of the Meadowlark Hills retirement community in Manhattan, Kansas—about the journey from institution to home.
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Trade Act Tax Credits: Update
Despite its promising start, a federal tax credit program designed to help displaced workers purchase health insurance is still experiencing disappointingly low enrollment rates more than a year after the program's implementation, a new study finds. While federal and state officials have succeeded in preventing the kind of marketing fraud that marred health insurance tax credits in the early 1990s, health plan premiums are apparently too high for most eligible workers to afford—even though the credit covers 65 percent of premium costs.
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Risk-Adjust Medicare Advantage Plans, Save $1.5 Billion
For years, the Medicare program's payments to managed care plans have been higher per enrollee than the costs of beneficiaries in traditional, fee-for-service Medicare—a direct result of managed care plans' "favorable selection" of the healthiest, and least costly, beneficiaries. Recent legislative changes have raised private plan payments even further, to entice more private plans into the market. But a new study questions whether the federal government can fiscally justify and sustain private plan overpayments amid strong pressure to reduce the federal budget deficit.
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Maine: Striving for Sustainable Health Care
When Governor John Baldacci signed the Dirigo Health Reform Act into law in June 2003, he cited the urgent need to address a health care situation he characterized as "not sustainable." As a percentage of state income, Maine is among the highest spenders on health care in the nation, and some 130,000 of its residents—out of a population of only 1.3 million—go without health insurance. The Dirigo plan is seeking to contain costs, while at the same time ensure universal coverage and improve the quality of care. A new report evaluates the strategies and challenges of this ambitious effort.
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Experts Name Their Top Health Care Priorities
Covering the uninsured should be Congress' top health care priority over the next five years, so says the overwhelming majority of respondents to a recent survey of widely recognized health care opinion leaders conducted for the Fund by Harris Interactive, Inc. Among the other top priorities cited were improving quality and safety of care, including increased use of information technologies, and reforms to ensure Medicare's long-run solvency.
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'Healthy Steps' Improves Low-Income Kids' Access to Preventive Care
A number of child health initiatives in recent years have sought to promote greater use of preventive and developmental services by pediatricians, particularly for children in low-income families—a demographic beset with unmet health care needs. One program in particular, Healthy Steps for Young Children, has been making waves.
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New Class of Harkness Fellows Selected
Aimed at developing promising health care policy researchers and practitioners in the United Kingdom, Australia, and New Zealand, the Commonwealth Fund's Harkness Fellowships in Health Care Policy provide a unique opportunity for health policy researchers, clinicians, managers, public health officials, and journalists to spend up to 12 months in the United States. Meet the class of 2005–06.
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President's Forum: Transforming the U.S. Health Care System
The United States spends more than any other nation on health care—well over twice the per capita average among industrialized nations. Yet while the U.S. health care system excels in some areas, on many measures of quality it delivers poor-to-middling results. What Americans want—and what our high spending should buy—is the best health care in the world. Work by The Commonwealth Fund and others suggests a 10-point strategy for transformational change.
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Recent and Forthcoming Commonwealth Fund Publications, Fall 2004
Fund Reports
J. E. Craig, Jr., Regulating Foundations: A Delicate Balance, December 2004 (reprint from the 2004 Annual Report)
K. Davis, Transformational Change: A Ten-Point Strategy to Achieve Better Health Care for All, January 2005 (reprint from the 2004 Annual Report)
S. Dorn, T. Alteras, and J. A. Meyer, Early Implementation of the Health Coverage Tax Credit in Maryland, Michigan, and North Carolina: A Case Study Summary, March 2005 (forthcoming)
R. B. Friedland and L. Summer, Demography Is Not Destiny, Revisited, March 2005 (forthcoming)
E. LeCouteur and M. Perry, Report from Focus Groups with Mainers About the Dirigo Health Plan, December 2004
Midwest Business Group on Health, Finding Doctors in Chicago: A Project to Improve Online Physician Directories, March 2005
J. Rosenthal and C. Pernice, Designing Maine's DirigoChoice Benefit Plan, December 2004
N. C. Turnbull and N. M. Kane, Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market—Findings from a Study of Seven States, February 2005
N. C. Turnbull, N. M. Kane, M. M. Koller, and A. M. Tiedemann, Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market—Short Case Studies of Six States, February 2005
Journal Articles and Other Publications
R. A. Berenson,"Medicare Disadvantaged and the Search for the Elusive 'Level Playing Field,' Health Affairs Web Exclusive (December 15, 2004):W4-572—W4-585
J. R. Betancourt, A. R. Green, J. E. Carrillo et al.,"Cultural Competence and Health Care Disparities: Key Perspectives and Trends," Health Affairs 24 (March/April 2005):499–505
B. Biles, G. Dallek, and L. H. Nicholas,"Medicare Advantage: Déjà Vu All Over Again?" Health Affairs Web Exclusive (December 15, 2004):W4-586–W4-597
E. H. Bradley, M. Schlesinger, T. R. Webster et al., "Translating Research into Clinical Practice: Making Change Happen," Journal of the American Geriatrics Society 52 (November 2004):1875–82
O. Carrasquillo and S. Pati., "The Role of Health Insurance on Pap Smear and Mammography Utilization by Immigrants Living in the United States," Preventive Medicine 39 (November 2004):943–50
C. R. Horowitz, L. Tuzzio, M. Rojas et al., "How Do Urban African Americans and Latinos View the Influence of Diet on Hypertension?" Journal of Health Care for the Poor and Underserved 15 (November 2004):631–44
R. L. Johnson, D. Roter, N. R. Powe, and L. A. Cooper, "Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits," American Journal of Public Health 94 (December 2004):2084–90
E. Krupat, J. Hsu, J. Irish et al., "Matching Patients and Practitioners Based on Beliefs About Care: Results of a Randomized Controlled Trial," American Journal of Managed Care 10 (November 2004, Part 1):814–22
K. T. McLearn, D. M. Strobino, N. Hughart et al., "Developmental Services in Primary Care for Low-Income Children: Clinicians' Perceptions of the Healthy Steps for Young Children Program," Journal of Urban Health 81 (June 2004):206–21
K. T. McLearn, D. M. Strobino, C. S. Minkovitz et al., "Narrowing the Income Gaps in Preventive Care for Young Children," Journal of Urban Health 81 (December 2004):556–67
A. N. Trivedi, B. Gibbs, L. Nsiah-Jefferson et al., "Creating a State Minority Health Policy Report Card," Health Affairs 24 (March/April 2005):388-96
B. Zuckerman, G. D. Stevens, M. Inkelas, and N. Halfon, "Prevalence and Correlates of High-Quality Basic Pediatric Preventive Care," Pediatrics 114 (December 2004):1522–29
