Roundup of health policy research and analyses

Urban Institute/Robert Wood Johnson Foundation: What Would Health Care Reform Mean for Small Employers and Their Workers? - "Small employers and their workers face a broad assortment of barriers to obtaining health insurance coverage today," such as "high administrative costs, limited ability to spread health care risk, and a low-wage workforce." The authors conclude: "A health insurance exchange, such as those proposed in the House and Senate bills, along with insurance market reforms would spread health care risks and reduce administrative costs. … While the bills include some employer contribution requirements, they exempt all small firms of fewer than 50 workers under the Senate bill and will likely exempt most small firms under the House bill as well." As such, "the legislation would make adequate and affordable coverage available to many more workers of small employers than is the case today," the authors conclude (Blumberg and McMorrow, Dec. 2009).

Kaiser Family Foundation has issued a collection of analyses related to the Part D Medicare stand-alone drug plan options available to seniors for calendar year 2010. Each of the spotlights focuses on a key aspect of the drug plans that will be available to Medicare beneficiaries in 2010 and examine relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

Commonwealth Fund: Harnessing Health Care Markets for the Public Interest: Insights for U.S. Health Reform from the German and Dutch Multipayer Systems - "As the United States moves toward health reform, it can glean important insights from other countries," write the authors of this paper that examines the German and Dutch health care systems and markets. "Elements of the German and Dutch approaches offer rich examples that, if tailored to unique U.S. institutions, could work in the United States. These include: insurance boards and exchanges to handle risk, set standards, and facilitate meaningful choice; all-payer payment mechanisms that ensure coherence and prevent undue use of market power; and information systems that inform payment and provide benchmarks to improve overall system performance" (Schoen, Helms and Folsom, Dec. 2009).

Annals of Internal Medicine: Addressing the Primary Care Workforce Crisis for the Underserved - This paper examines a proposal to address the primary care workforce shortage through the establishment of primary care teaching centers in expanded community health centers. Although "the contribution of residency training to the care of the underserved is not a new feature … the association of ambulatory graduate medical education with care for the underserved has been constrained by graduate medical education funding policy," write the authors of this paper. "Current legislative initiatives that are part of health care reform provide a way to achieve this linkage by means of teaching health centers." (Rieselbach, Crouse and Frohna, 12/14).

W. K. Kellogg Foundation: Training New Dental Health Providers In the U.S. -- "There is growing interest in establishing new 'midlevel' dental providers in the U.S." out of "concern about access to care for underserved populations whose higher oral disease rates and unmet oral care needs are well documented," writes the author of this report (.pdf) that examines the roles and training of dental therapists as well as alternative dental providers in other countries. "The report notes that dental therapists in other countries typically receive two years of training for dental therapy alone and three years for combined dental therapy and dental hygiene immediately following secondary school. They work in quasi-independent arrangements with dentists. The advantage of these arrangements is that they expand the reach of dentists, allowing them to delegate basic services to therapists and consult with them as needed while providing more complex services themselves." (Edelstein, Dec. 2009).

Kaiser Family Foundation: Alternatives for Financing Medicaid Expansions in Health Reform - This brief (.pdf) analyzes the proposals in the House and Senate to expand Medicaid to cover low-income populations, noting the wide variation in the costs of expanding the public program across states and "long-term financing inequities across states." The author presents several alternative Medicaid financing options. "A policy that would have the federal government pay for Medicare premiums and for cost sharing for acute care services, eliminate the prescription drug clawback payment, and end the 24 month waiting period for Medicare enrollment of disabled individuals would provide considerable financial support to all states," the author writes. "Somewhat surprisingly, it would provide a disproportionate share of these funds to states in the south, states that will experience the greatest increase in enrollment" (Holahan12/11).

Urban Institute: Potential Impacts of Alternative Health Care Reform Proposals for Children with Medicaid and CHIP Coverage - The health bills being considered by Congress will cut the number of children without health insurance, but for those who are already enrolled in public programs, such as CHIP, "the health reform bills in the House and Senate present both potential benefits and risks in terms of the type of coverage these children would have and their access to needed care," write the authors of this policy brief (.pdf) that uses data from Medicaid/CHIP eligibility rules from 2007 to estimate the number of children that would be affected by the health care proposals under consideration in the House and Senate. (Kenney and Cook, Dec. 2009).

Kaiser Family Foundation: Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps? - This study (.pdf) concludes: "Our results provide empirical evidence that, although Medicaid is often perceived to lag behind private insurance in providing access to health services, the program works at least as well as private insurance in equalizing access to care for African American and Latino children relative to White children. However, the persistence of disparities among insured children indicates that while insurance can increase access to care, it does not necessarily eliminate access barriers that appear to affect children of color disproportionately" (Lillie-Blanton, Paradise, Thomas, Jacobs and DiJulio, Dec. 2009).

Rural Policy Research Institute/Robert Wood Johnson Foundation: Impact of the Patient Protection and Affordable Care Act on Covered Persons -- This paper analyzes the number of uninsured people living in rural areas that would receive health insurance, as laid out in one of the health reform proposals before Congress, H.R. 3590, the Patient Protection and Affordable Coverage Act. Using a simulation model, the author predicts that, following full implementation, H.R. 3590 "would lead to a slightly higher coverage rate for rural than for urban persons (93.4% compared to 92.7%), largely because a lower proportion of rural persons are non-citizens who would not be covered under any of the proposed reform approaches but also because the reform proposal reaches more low-income persons who are more represented among the rural uninsured." (McBride, 12/9).

Mathematica Policy Research: The Demonstration to Maintain Independence and Employment: Implications for National Health Care Reform - This brief examines the preliminary progress of the Demonstration to Maintain Independence and Employment (DMIE) - a grant program administered by CMS that awards funds to states to help connect workers with disabilities with expanded access to medical services and employment support. The study focuses on four states: Hawaii, Kansas, Minnesota and Texas. The authors report: "Although the national evaluation of the DMIE program will not be complete until 2011, early results are promising and suggest that the DMIE is a model of early intervention supports that can be tailored to meet the specific health care needs of different populations in different settings. … Early results also suggest that the DMIE might reduce the rate at which individuals apply for federal disability benefits or delay their entrance onto the federal disability rolls." (Denny-Brown, Gilman, Gimm, Ireys and Croake, Dec. 2009).