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Study Examines Choice in Health Care
Proposals to expand the individual health insurance market and promote health savings accounts are intended to provide consumers with more choice. But according to a new analysis of survey data, "Choice" in Health Care: What Do People Really Want?, by George Washington University researcher and Fund grantee Jeanne M. Lambrew, Ph.D., having a choice of providers matters more to people than having a choice of health plans. Moreover, two of three survey respondents preferred an employer-selected set of plans over an employer-funded account that they would use to find coverage on their own. Lambrew says this suggests individual market insurance and health savings accounts may do little to improve consumers' satisfaction with the health system.

Staying Insured Hard for Many
Much like being uninsured, having unstable health insurance coverage limits access to care. According to the Fund-supported analysis, Entrances and Exits: Health Insurance Churning, 1998–2000, 22 percent of the U.S. population experienced at least one spell without any health coverage over a two-year period, in addition to the 9 percent who were uninsured for the full two years. Young adults, Hispanics, people with low levels of education, those who transition into and out of poverty, and those with private, nongroup insurance were most likely to have unstable coverage. The authors say that in addition to helping people get health insurance, we need policies that help people retain their existing coverage.

Dual Eligibles' Unmet Need
So-called dual eligibles—individuals who qualify for both Medicare and Medicaid—are often poor, sick, and living alone. Despite being eligible for two public programs, many dual eligibles have unmet long-term care needs, according to a Fund-supported article, Unmet Long-Term Care Needs: An Analysis of Medicare-Medicaid Dual Eligibles (Inquiry, Summer 2005). Harriet Komisar, Ph.D., and colleagues found that more than half of respondents who needed assistance with basic life tasks said they were not receiving enough help. Many faced serious consequences, like not being able to bathe or shower, or even going hungry. Expanded access to paid home care, the authors say, would help greatly.

Tax Credit Feeling Unwanted
The first comprehensive enrollment estimates for the federal Health Coverage Tax Credit program are in, and the numbers, though higher than some had expected, remain disappointingly low. Approximately 22 percent of eligible individuals (certain early retirees and workers displaced by international trade) received the credit in September 2004, the most recent month for which complete data are publicly available. In a Fund issue brief, Limited Take-Up of Health Coverage Tax Credits: A Challenge to Future Tax Credit Design, analyst Stan Dorn and colleagues say future tax credit programs could reach more of their target populations if they limit premium costs; provide coverage that people value (for example, care for preexisting conditions); conduct more outreach to eligible individuals; and offer a simple application process.

Opinion Leaders Talk Medicaid
Medicaid—and the growing cost burden it places on government budgets—has been the subject of extensive public debate. More than half of participants in the Fund's latest Health Care Opinion Leaders Survey say that Medicaid and the State Children's Health Insurance Program have been successful in meeting their overall goals. But reform is needed: nearly all (95%) are in favor of simplifying eligibility and re-enrollment, and the vast majority (85%) endorses federal funding to expand coverage to all uninsured below 150 percent of the poverty level.

The "Simple Truth" About Our Health System
"Nearly everyone in health care knows one simple truth—we could do so much better. And if we can do better, we should," James Mongan, M.D., president and CEO of Partners HealthCare and chair of the Fund's Commission on a High Performance Health System, says in a new commentary. High health costs have not translated into better care, as documented in a recent chartbook, A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency. Mongan argues that providers need to demonstrate value to consumers and payers and cites several initiatives—including clinical decision support and disease management—that could help to improve the quality, safety, effectiveness, and efficiency of care.

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