To broaden coverage, some health reform proposals would require employers to offer coverage or pay to help finance subsidies for those without access to affordable coverage. These types of reforms are often referred to as “pay-or-play” policies.

The brief explains the concept and policy implications of employer pay-or-play proposals, which can vary in terms of the level of coverage required for compliance, the cost of the penalty to employers who do not offer, and whether small firms are exempt from the requirements.

It is part of a series of briefs providing an overview of key issues and concepts related to health reform.

Brief (.pdf)

A key element in any comprehensive health reform plan is defining what health insurance is and the amount of insurance coverage people will have. There are two components to that coverage: the types of services covered (e.g., physician care, hospitalization, prescription drugs, etc.), and the cost sharing required of enrollees (e.g., the annual deductible, the copayments or coinsurance, and the maximum out-of-pocket costs for a year).

The overall approach to reform drives the kinds of policy decisions that must be made concerning the level of coverage people will have. This brief explains the ways in which coverage might be defined under a health reform plan, and some of the policy issues raised by those determinations.

It is part of a series of briefs providing an overview of key issues and concepts related to health reform.

Brief (.pdf)

Issue Briefs Related to Health Reform

This collection of some of our most recent and relevant issue briefs go beyond the basics to provide concise discussions and analyses of key policy topics related to health reform. For a more complete collection of all the Foundation’s health reform resources, click here.Health Reform Roundtables: Charting A Course Forward Health Reform Roundtables: Charting A Course Forward is a series of discussions among federal officials, state officials and outside experts that provides a forum to share insights and explores key issues related to implementing a significant expansion of the Medicaid program as part of the new health reform law and coordinating that expansion with the creation of new state-based insurance Exchanges.

Community Health Centers: Opportunities and Challenges of Health ReformThis issue brief examines the role that community health centers will play in implementing health reform and providing access to care for millions of Americans who will gain insurance coverage under the new law.

Health Reform Issues: Key Issues About State Financing and Medicaid This updated issue brief examines key issues related to state financing and the expansion of the Medicaid program under the new health reform law.

Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach Under Health ReformThis brief summarizes the views of Medicaid program directors and other experts about the opportunities that health reform presents to optimize Medicaid by strengthening its enrollment and renewal operations and recasting it as an affordable health coverage program for working people and families.Expanding Medicaid to Low-Income Childless Adults Under Health Reform: Key Lessons From State ExperiencesThe health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program’s history. This report examines lessons learned to help inform the expansion effort based on past state experience covering childless adults through waiver and state-funded programs.Medicaid Long-Term Services and Supports: Key Changes in the Health Reform LawThis brief examines new opportunities under the health reform law for states to balance their Medicaid long-term care delivery systems by expanding access to Medicaid home and community-based services (HCBS) programs.

Health Reform and the CLASS ActThis issue brief examines the Community Living Assistance Services and Supports (CLASS) program, a component of health reform that establishes a national, voluntary insurance program for purchasing community living services and supports that is designed to expand options for people who become functionally disabled and require long-term help.

State High-Risk Pools: An OverviewThis issue brief provides an overview of the primary components of state high-risk pools, discusses their benefits and challenges, and concludes with a discussion of high-risk pools in national health reform.

Uninsured and Untreated: A Look at Uninsured Adults Who Received No Medical Care for Two YearsThis brief profiles uninsured adults with incomes at or below 133 percent of the poverty level who, because of health reform, will be eligible for Medicaid in 2014 based on income. It focuses on those who received no medical care over a two-year period to help assess unmet need.

Financing New Medicaid Coverage Under Health Reform: The Role of the Federal Government and StatesThis brief examines how the federal government and the states are expected to split responsibility for financing expanded Medicaid coverage under the health reform law.Issues for Structuring Interim High Risk PoolsThis brief examines the role of high-risk pools as a coverage safety net today and reviews key issues involved in implementing a national high risk pool, which would be one of the first provisions to be implemented under pending health reform legislation.How Will Health Reform Impact Young Adults?This paper explains the key ways in which the new law will impact young adults ages 19 to 29, and provides a brief overview of current health coverage for this population.Health Reform and Access to Abortion CoverageThe brief discusses the treatment of coverage for abortion services under the major health reform bills and explores the possible impact of the House- and Senate-passed legislation on public and private coverage for abortion services.

Where Are States Today?: Medicaid and State-Funded Coverage Eligibility Levels for Low-Income AdultsThis fact sheet provides a brief overview of low-income adults’ current eligibility for Medicaid and other state-funded coverage programs and a discussion of how this coverage may be impacted by health reform.

Medicaid Beneficiaries and Access to CareThis fact sheet summarizes Medicaid beneficiaries’ experience in obtaining access to care, finding Medicaid compares favorably with private coverage in connecting low-income children and adults with primary and preventive care.

Immigrants’ Health Coverage and Health ReformThis issue brief discusses key questions related to immigrants’ health coverage and health reform, addressing subjects such as how many of the uninsured are non-citizen immigrants and what would happen to coverage for them under current health reform proposals.

Health Reform: Implications for Women’s Access to Coverage and CareThis issue brief highlights key issues for women that arise in the context of health reform, including access to health insurance coverage, health care affordability, scope of benefits, reproductive health and long-term care.

Health Reform and Communities of Color: How might it Affect Racial and Ethnic Health Disparities?This brief examines some of the key provisions of health reform legislation that are likely to have a significant impact on people of color and also highlights the specific provisions that focus on health disparities.

There is lots of apocalyptic talk these days about the collapse of the newspaper industry and the challenges facing news organizations.  There is even talk of the unimaginable, my hometown paper The Boston Globe shutting down. Surely they know that Red Sox Nation cannot exist without the Globe Sports pages.

All kinds of solutions have been proposed, from micro-payments for news stories like songs on iTunes to foundation-endowed daily newspapers.  There is growing talk of newspapers charging for their content on the web. Health journalists are worried too, as our recent survey of health journalists and forum on this topic showed.

Against this background, Kaiser is launching a new nonprofit health policy news service this June, Kaiser Health News (KHN), with the mission of providing in-depth coverage of today’s ever more complex health issues and developments.

Will KHN improve coverage of complex health policy issues and give policymakers, business and health leaders, and the public better access to information about what’s happening in Washington and around the country?  That is our goal so I certainly hope so.  In the midst of the biggest U.S. debate about health care in 15 years — if not ever — insightful coverage will be critical to an informed debate and good policy.

Will KHN be the model for nonprofit journalism?  I’m not so sure.  That’s not our goal, and that in fact is the wrong question, from our perspective at Kaiser.

To appreciate our motivation for creating KHN, it’s important to understand our longstanding commitment to health journalism, our role as an operating foundation and our mission as an information organization. In fact, KHN itself has been long in development; I first brought the idea to our board and made it our top priority for new program development in March 2007, and only then after about a year of internal development.

One of the first operating programs we started after I arrived at Kaiser in 1990 and began remaking the organization was our media fellows program .  Run by Penny Duckham from our Menlo Park headquarters, the program provides journalists with the time and resources to delve into complicated health policy issues, access to experts, and an understanding of what’s happening on the ground in the health system through regular site visits.  Over the last 15 years, many of the nation’s top health policy reporters have come through the program.  We followed the fellows program up with internships for young journalists interested in covering health issues affecting diverse communities.  And we’ve provided similar opportunities for journalists covering global health issues.

But that is hardly our only involvement with journalists and news organizations.  Through our in-house polling operation, we have entered into formal partnerships with many of the nation’s top news organizations, including The Washington Post, NPR, USA Today, and ABC News.  These partnerships are based on surveys and stories resulting from them that go beyond the usual who’s up/who’s down polls and have produced some extraordinary analysis and journalism.  Take a look, for example, at the Being a Black Man series we did with the Washington Post and the Harvard School of Public Health. We have now done eighteen surveys with the Post and Harvard. We pick the topics and analyze the results together (with Molly Brodie’s public opinion research team at Kaiser playing a lead analytic role) and, of course, the Post or our other news partners have final say over what they publish or broadcast.

I’ve always believed that good journalism is a key to informed debate and good public policy, since it’s through news coverage that most people understand policy. And frankly, as an ex-public official, I have a keen sense of how news coverage influences the public agenda and public officials — almost like a daily umpire of a never ending game — much as we like to deny it when we are in office.

But, to fully understand the genesis of KHN, you have to see it as part of our larger role as an information organization.   People see the word “Foundation” in our name and they think we give out grants. But that’s not what we do.  We are a nonprofit, private operating foundation whose product is information — from the most sophisticated policy analysis, to basic facts and numbers, to daily summaries of developments in the news, to up-to-the-minute expert commentary and analysis from our broadcast studio, to information young people can use to improve their health or elderly people can use to understand their Medicare benefits.  One Kaiser audience knows us mainly for our policy work and knows little if anything about the Emmy and Peabody award-winning media campaigns we operate in partnership with media companies on issues like HIV in the U.S. and around the world.  On the other hand, our more than one hundred media partners across Africa and the Caribbean, or the many partners we have worked with so closely in South Africa since before apartheid fell, probably don’t even know we work on Medicare and Medicaid or health reform in the U.S., much less have a substantial Washington D.C. building and conference center.  But it’s all tied together by a commitment to producing the best possible information, whether for policy or people.

The in-depth news coverage that KHN will provide — along with the kind of daily news summaries, interviews, and webcasts previously produced by kaisernetwork.org that will now be integrated into KHN — is one part of a spectrum of all that we do to better inform the health community and mainstream news coverage, and to equip the public to participate in the policymaking process.  We hope that KHN will help explain the complex policy issues being debated inside the beltway to audiences outside Washington.  As important are the time and resources KHN journalists will have to cover stories where they are happening in the marketplace, the delivery system and in the states, to report on and explain what is happening in health care in the country.

A few specific aspects of KHN are important to mention. KHN will have editorial independence, with control over news content resting with our outstanding executive editors — Laurie McGinley, who came from the Wall Street Journal, and Peggy Girshman, formerly of CQ and NPR, and the Foundation acting as publisher.  Our longtime Senior VP who oversees all our media initiatives, Matt James, will oversee KHN.  KHN will also enable us to build upon our partnerships with news organizations.  We have no desire to supplant what news organizations do; our goal is to support them by producing high-quality, in-depth news reports about health issues that newspapers and other media organizations can use and often don’t have the resources now to produce themselves.  KHN content will appear on a new website we are developing and will be published or broadcast by other news organizations with whom KHN enters into partnership arrangements.  (KHN has already published stories in the Washington Post and  Philadelphia Inquirer and in its “soft launch phase.”)

Fundamental to our underlying philanthropic purpose, all KHN content will be made available for free.  And much of the content previously provided by kaisernetwork.org is being integrated into KHN, from our daily reports to our studio programming and more, with many improvements made.  By integrating kaisernetwork into KHN, we hope to produce a unique home for health news information ranging from original in depth journalism to news synthesis reports to newsmaker interviews and original studio programming.

KHN is in the process of building out its fulltime reporting staff.  In addition to Laurie McGinley and Peggy Girshman we have been fortunate enough to have been able to attract a number of outstanding journalists: John Fairhall, formerly of the Baltimore Sun; Julie Appleby, formerly of USA Today; Mary Agnes Carey, formerly of CQ; Jordan Rau, most recently with the LA Times Sacramento Bureau, with more to come. But KHN will also make wide use of independent journalists, to provide a resource and distribution vehicle for freelance journalists and the many excellent journalists who have lost their jobs in recent downsizings and reorganizations.

To be honest, we are in some ways going against the grain here.  Our aim is not investigative reports, snarky opinion or blogs, or breaking news headlines that can fit on a cable news ticker or Twitter feed, though we have no problem if KHN sometimes “breaks news.”  Nor do we want to cover regular daily health news, a job which will get done without us.  Unlike some others, we do not seek to achieve policy change; indeed, I view that as antithetical to our purpose — excellent in-depth news coverage.  Nor are we putting ourselves forward as a model for the future of nonprofit journalism.  Indeed it is what is most different and un-replicable about us that is probably most striking.

KHN’s objective is simply to report, inform and explain.  And unlike other nonprofit “models,” we are not dependent on the largesse of outside benefactors whose interests may change over time, if for no other reason than a leadership change at the funding organization.  KHN’s core costs are built into our ongoing operating budget funded from our own endowment and KHN itself is integral to our long-term strategic plan as an information organization.

Despite our differences, what is common to all nonprofit models is that we have the luxury to fill a need — in our case for in-depth health policy journalism — in creative and effective ways without needing to worry about ad revenue, rating points, or how our stock is faring on Wall Street.  If we follow that opportunity — our essential difference from the commercial news media and comparative advantage — there is a chance to make a tremendous difference for journalism and the public.

The Washington Post published an op-ed authored by Foundation President and CEO Drew Altman which examines how the health industry’s voluntary commitment to curb health care spending is similar and different from past efforts.

Read the Article

Medicaid is the health insurance safety net for nearly 60 million of the nation’s poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate.

This paper, based on years of research and analysis from the Kaiser Commission on Medicaid and the Uninsured, summarizes the problems that low-income individuals face in today’s health care system and explores policy opportunities to expand the Medicaid program to cover more of this population as a base for broader health reform efforts.

Many leading health reform proposals rely on a combination of public and private approaches to expand coverage, control costs and improve quality, with shared responsibilities across employees, employers, consumers and the insurance markets. Medicaid can provide a strong foundation that can help assure the success of broader reform efforts by maintaining coverage for the poor and sick while providing a vehicle to reach low-income adults with affordable coverage.

Health Reform: State Financing and Medicaid

Executive Summary (.pdf)

Paper (.pdf)

Low-income adults (those with incomes below 200 percent of poverty, or $33,200 for a family of three in 2007) account for just over half of the non-elderly uninsured in the United States. This brief reviews the health coverage of non-elderly low-income adults and discusses the implications for national health reform efforts of broadening coverage for this population by filling gaps in Medicaid eligibility.

Low-income adults are more than twice as likely to be uninsured as low-income children. Many low-income adults have significant health needs, and yet lack access to employer-sponsored coverage and cannot afford or access private coverage in the individual market.

Although Medicaid covers some low-income adults, parent eligibility levels are below poverty in 34 states and childless adults are excluded from the program under federal rules. Eliminating the categorical exclusion of childless adults, increasing income eligibility levels and enhancing the federal financing available to support coverage for adults could enable Medicaid to cover more of the low-income uninsured and help establish a strong floor of coverage upon which additional expansion efforts could build.

Summary (.pdf)

Policy Brief (.pdf)

This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates.

The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children.

Report (.pdf)

This policy brief examines the structure and experience of Community Care of North Carolina, an enhanced medical home model of care that North Carolina began implementing in 1998 as part of its Medicaid program.

Evaluations of the initiative, which includes a heavy emphasis on care coordination, disease and care management and quality improvement, suggest that it has resulted in both improved care and cost savings.

The program provides important lessons for broader health reform efforts and demonstrates Medicaid’s ability to incorporate quality improvement strategies that enhance its ability to provide coordinated, cost effective care to low-income individuals with significant health needs.

Summary (.pdf)

Policy Brief (.pdf)

These related research papers examine the policy opportunities for expanding Medicaid to cover more low-income and high-need people in ways that would enable the program to serve as a platform for larger national health reform efforts.

As congressional leaders work on proposals for universal coverage, some policymakers have suggested that strengthening Medicaid’s coverage of the poorest Americans and those with special health needs could provide a base for broader health reform efforts to expand coverage, control costs and improve quality. How many of the uninsured should be covered through public programs and how many through private insurance is an issue of debate in the designing of health reform legislation.

The new resources include:

Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

The Coverage and Cost Impacts of Expanding Medicaid

Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility

Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid

The Kaiser Family Foundation released the papers May 12 at a public briefing on Medicaid as a Platform for Broader Health Reform. An archived webcast is available.

Podcast

Transcript (.pdf)