Health Politics

Our own Joanne Kenen, Senior Writer for the Health Policy Program, has two articles in the American Prospect this week. The first looks at different responses to health reform on the part of the states, and groups the responders into three general categories: The Ready and Able (like Wisconsin), The Willing but Broke (California) and The Resisters (Georgia, for example). The second article takes a look at Connecticut's effort to make a public health insurance option work. Yes, you heard us -- the public plan. Efforts are already underway to "tweak" the plan into compliance with current federal law -- at this rate, Connecticut could have a public option in place before the rest of the country gets their health insurance exchanges up and running.

You can read more here, and we'll have something more in depth available tomorrow.

You probably all saw the National Council on Aging poll this week showing that seniors were quite confused about health reform (here, Pulse). Not even a third of them knew half the facts deemed “senior pertinent.” I went up to the Washington, D.C. senior center where the results were released in front of a group of seniors, and I couldn’t help thinking, are they really more misinformed than any other segment of the population? Is it really so strange that they can’t quite grasp the legislative niceties about ACA and SGR. (The Accountable Care Act, aka health reform, doesn’t cut doctors pay in traditional Medicare. The SGR formula -- which Congress has been struggling with for years -- does). Do people my age have a better understanding of health care reform and what it means for our future, of what is "millenial pertinent?"

One popular aspect of the Patient Protection and Affordable Care Act (PPACA) is the extension of benefits this year to many adult dependents up to age 26. (See our earlier post on this here). This came as a relief to young adults (and their parents) who are finding it difficult to obtain employment and health insurance in the current economy. It came as a relief, we should add, in the civilian world. For military families in TRICARE it’s a different story.

TRICARE is the part of the military health system that provides care for military service members, retirees, and families. During the long fight over health reform, the Obama administration made sure that the new health law would not affect TRICARE. That “no-change” approach pleased the vast majority of military families -- until some of them realized that in at least one respect they were missing out on something. Military families don’t get that extended coverage of young adult dependents, and some of them began requesting it.

Be sure to tune in to today's alternative town hall event from New America in California, Putting the Care in "Obamacare," where state leaders will discuss the challenges and opportunties associated with the implementaion of health care reform. Panelists will discuss questions such as how the experience of health care will change for patients in California, what we can do to successfully implement reform and promote high quality care, and how reformers can build on the high-value care models already in play in the state.

If health reform implementation is getting you down and you have a moment of nostalgia for the fight for passage...we've put together a link-rich, color-coded guide to what happened,  The History of Health Reform.  Whether you were with us through the whole debate, or you are looking for a retrospective -- the timeline below shows the who, what, and when of the debate about health coverage, cost and quality. We've taken many of  the primary sources we've found useful since the 2008 campaign and assembled them in this timeline. You'll find links to legislation, proposals, CBO scores, letters and reports from stakeholders, relevant articles, transcripts, and videos.

Health reform isn't over. We've got a long way to go with implementation -- and making sure the cost, coverage, and quality promises made by the new reform law are fulfilled over the coming years. The ups and downs of the debate made for an intense and exciting year. As the dust settles, we'd like to offer up our guide to what happened, The History of Health Reform.

A few people have asked me whether and how Don Berwick's "recess appointment" to CMS can be turned into a permanent one. I touched on this yesterday, but here is a bit more for those of you still wondering.

Berwick's recess appointment takes him through the end of 2011. (That's the date that has been widely reported -- I thought it might be until 2012 because the official "Congress" sessions end in even years but I was told by a Berwick associate that 2011 is correct). To continue beyond 2011, he needs to be confirmed by the Senate. If getting him confirmed by the Senate was an easy thing to do (both in terms of getting to 60 votes and avoiding another headline-grabbing politically-damaging battle about rationing and health reform) he would have been confirmed by now and President Obama wouldn't have gone the recess appointment route in the first place.

(Left out the Health Affairs link -- reposting)

Too hot in DC (literally and metaphorically) to think of anything snappier than "good news, bad news" about Don Berwick’s recess appointment to head the Center for Medicare and Medicaid. Good of course because CMS needs a dynamic, visionary (and remarkably optimistic) leader to transform what by many accounts is a somewhat ossified and demoralized bureaucracy into a new era of innovation and improvement. Bad because a recess appointment only lasts until the end of 2011 when the current Congress expires.

And really, really bad because a professional appointment that should have been embraced with a bipartisan Hallelujah choir has become another political volleyball. Even though numerous medical organizations, including the AMA, and his Republican predecessors have sung his praises.

A new Kaiser tracking poll shows growing public support for the health reform law. It follows on the heels of a Gallup poll last week also suggesting that reform’s support now outweighs its opposition.

A map of states that have decided to run the new high risk pools versus the states that have declined falls along fairly predictable red-blue lines. With some exceptions, Democratic governors are embracing the opportunity created by the Obama administration and a Democratic Congress and Republican governors are saying no thanks, Washington, you do it (even though high risk pools are historically quite popular with Republicans).  There are a couple of surprises. Alaska is joining most Democratic states in agreeing, while Delaware (probably for size not ideology reasons) is opting out. Purplish states are in both categories. (Here's the HHS list, although it’s a few weeks old.)

How much does that tell us about what course these states will choose as it comes time to start developing their insurance exchanges, which need to be up and running by Jan 1, 2014?