Assessing Health Reform’s Impact On Four Key Groups Of Americans

Abstract

Health reform can be assessed from the perspective of four groups that collectively include most Americans. For those who are now in Medicaid or who are uninsured, reform will be a major gain. For those who obtain health insurance in the individual and small-group markets, reform should bring improvements. For those who have health insurance from midsize-and large-group insurers, reform will bring little change. Finally, for Medicare beneficiaries, reform promises to bring positive change. However, financing future health spending overall, and Medicare spending in particular, poses a formidable challenge. Although not a panacea, all-payer rate setting, in which a federal or state agency establishes standard payment rates for each class of payer, may be the only feasible alternative, at least in the short run.

The Pragmatist's Guide to Comparative Effectiveness Research

“…The implausibility of the marginal tax rates needed to finance government-provided health insurance-reaching 70 percent or more by 2060 (as discussed in Newhouse, 2010;Baicker and Skinner, 2011)-leads one to question not whether a fundamental shift in cost-growth will occur, but when. Comparative effectiveness research and its half-sibling cost-effectiveness research will provide a solid foundation for reform, once politicians and voters understand how dismal is the alternative.…”

Medicare and the Affordable Care Act

“…The major concern for beneficiaries is whether these cuts will reduce the willingness of providers to continue serving Medicare beneficiaries. These reductions are proportionately lower than reductions that have been made in the program several times over the years (Kaiser Family Foundation, 2009b) and-in contrast to past payment reductions-will be offset by improved revenues to providers from expanded coverage for the younger population (Newhouse, 2010).…”

“…Just as with the earlier drug legislation, many elements of the ACA were chosen to achieve the goal of meeting specific budget targets. This more than sound policy analysis often dictated the specifics of the legislation (Newhouse, 2010).…”

The Obama Presidency and Health Insurance Reform: Assessing Continuity and Change

“…Interestingly, for the first three years the federal government will bear the extra costs involved and, after that, will pay 90 per cent of the costs that are additional to Medicaid costs that would be paid for from the current Medicaid pool. States will therefore be protected from the full expense of helping the expanded Medicaid population, but they will incur extra administrative costs and eventually some of the share of covering more people, which may cause problems for cash stricken states with a constitutional obligation to balance their budgets (Newhouse, 2010(Newhouse, : 1415. The CBO estimates that the extra cost incurred in the expansion of Medicaid will be $29 billion in 2014, with an aggregate additional cost of $434 billion through 2019 (CBO, 2010b).…”

“…Certainly, while various cost-cutting efforts have slowed the momentum of increased Medicare spending (Jacobs and Skocpol, 2010: 169-70), from 1999 to 2008 the program still grew at a rate that was 2.8 per cent per year higher than the annual growth in the rate of GDP. The question is whether it really is politically feasible to stop that growth rate, potentially incurring the wrath of seniors, or to find extra revenues to continue funding that growth (Newhouse, 2010(Newhouse, : 1420.…”