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The Nelson A. Rockefeller Institute of Government

Health Care


Giving States Flexibility to Change Obamacare without Changing the Law: Examining the Potential Uses of the Affordable Care Act’s State Waiver Process

Section 1332 of the Affordable Care Act is intended to give states the flexibility to achieve the goals of the legislation while adapting to local factors by applying for an innovation waiver. In a new policy brief, Rockefeller Institute researchers Michael Gusmano, John Kaelin, and Thomas Gais explore the waiver’s potential as a tool for widespread, state-level policy change to address challenges in ACA implementation.
Michael Gusmano, John Kaelin, and Thomas Gais, January 19, 2018

The Growing Drug Epidemic in New York

Opioid addiction has become a widespread issue in the United States. A new By the Numbers brief by Rockefeller Institute President Jim Malatras examines the problem specifically in New York State where, despite aggressive state action, drug-related deaths are still on the rise, especially in upstate communities. This is the first in a series of reports by the Institute addressing the opioid crisis and the solutions governments are taking.
Jim Malatras, April 20, 2017

America’s Health Care Cost Crisis and What to Do About It

A new paper by Rockefeller Institute Senior Fellow Richard Nathan examines the difficulty in implementing the Affordable Care Act in the face of so many uncertainties. Nathan proposes the creation of a new institutional mechanism to monitor and react to changing conditions and to provide feedback to Congress and the president on necessary adjustments to meet the goals of the legislation.
Richard P. Nathan, March 2013

How to Rein in Health Care Costs: Empower Consumers

A new paper by former Rockefeller Institute director (and former U.S. OMB official) Richard P. Nathan explains his reasoning for favoring the consumer-choice approach for next-step health reforms and in doing so presents recommendations for cost constraints to help reduce federal deficits over the long term and suggests ways to implement his recommendations. The paper is introduced by Thomas Gais.
Richard P. Nathan, December 2012

The Health Care Challenge Facing America’s Governments

In his third brief on the fiscal challenge caused by rising health costs, Nathan examines how markets operate in our health system. He focuses on ideas that seek to empower consumers — and calls for combining them with what are often seen as opposing approaches based on provider value.
Richard P. Nathan, June 2012

Monitoring HIV Care in the United States

This Institute of Medicine report recommends data to assess the impact of federal policy on HIV care, at the request of the White House Office of National AIDS Policy. The report identifies indicators that show when HIV patients are receiving appropriate care and determines important data sources for those measures. Institute Fellow Erika Martin serves on the committee that produced the report.
Institute of Medicine, March 2012

Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences With Federal Funding

Despite the temporary removal of a ban on federal funds for syringe exchange programs (SEPs), few programs received federal financial support during 2010-2011 as they faced multiple barriers to accessing the money, this study finds. This study, led by researchers at the Rhode Island Hospital and Lifespan/Tufts/Brown Center for AIDS Research, was undertaken to determine discrepancies between the promise of the funding-ban removal and its “street-level impact” in the initial stages of implementation. Through a telephone survey of SEPs around the country, researchers examined several things: whether SEPs currently received federal funding explicitly for syringe exchange and distribution activities; whether SEPs anticipated pursing federal funding; and the barriers to acquiring federal funds under the draft implementation guidelines from the U.S. Department of Health and Human Services (HHS).
Erika Martin and others, American Journal of Public Health, March 2012

Fighting For Our Health: The Epic Battle to Make Health Care a Right
in the United States

This book from the Rockefeller Institute Press offers a vivid, first-person account of how health care reform came to be. The book brings readers inside the biggest and most consequential issue campaign in American history. Fighting for Our Health recounts how a reform campaign led by grassroots organizers played a crucial role in President Obama's signing historic health reform legislation in March of 2010 — defeating powerful industry lobbyists and Tea Party activists.
Richard Kirsch, February 2012

Ideas for Reconciling Two Cultures for Health Reform

Taking the next step to reform health care is, Richard Nathan says in this issue brief, a public management challenge of the highest order. He suggests blending the best of liberal and conservative ideas to create a "Health Choices System" led by a phased two-step process to assure orderly planning and implementation.
Richard P. Nathan, November 2011

Expanding Public Health Insurance Under the Affordable Care Act:
What New York Might Learn from Connecticut, Massachusetts and Vermont

This lively, interactive public policy forum focused on how some states are expanding public health coverage in implementing the federal legislation that passed last year. The forum kicked off with presentations from speakers representing states neighboring New York. Brian Rosman of Health Care for All Massachusetts described the five-year-old Massachusetts law that is the model for federal reform law. Jill Zorn of the Universal Health Care Foundation of Connecticut discussed legislation to establish a public option — a state-run insurance plan that would compete with private insurers — when Connecticut implements federal health reform. Robin Lunge represented Vermont Governor Peter Shumlin, who is expected to sign legislation authorizing Vermont to set up a single-payer health plan, which would cover all state residents and be funded by taxpayers. New York State Senate Health Committee Chairman Kemp Hannon, Assembly Health Committee Chairman Richard Gottfried and Judy Arnold of the New York State Health Department spoke about past and current efforts aimed at expanding health coverage in New York. Also joining the forum were representatives of health insurance, hospital and insurance groups: Mary Clark of Citizen Action of New York, a consumer advocacy group; Jeffrey Gold of the Health Care Association of New York State, a group of hospitals and health care networks; and Paul Macielak of New York Health Plan Association, a trade group for managed care insurance plans.
May 19, 2011

The Adoption of Mental Health Drugs on
State AIDS Drug Assistance Program Formularies

States differ in their inclusion of drugs to treat mental illness in their programs that cover residents with HIV. Erika G. Martin, of the Rockefeller Institute and the Rockefeller College of Public Affairs & Policy, and Colleen M. Barry, of the Johns Hopkins Bloomberg School of Public Health, found three factors associated with that difference in coverage. Their findings are presented in this article.
Erika G. Martin and Colleen L. Barry, American Journal of Public Health, April 14, 2011

Patient-Centered Medical Home Pilot Demonstrations in New York

Patient-centered medical homes (PCMH) are taking hold as a way to transform health care delivery. PCMHs are an approach to health care organized around the core relationship between patients and their primary care providers.This brief looks at efforts to pilot PCMH in eight regions of New York.
Courtney Burke and Wendy Weller, January 2011

Paying for Long-Term Care: Families or Taxpayers?

Long-term care represents one of the largest and fastest-growing costs in Medicaid, the government health insurance program intended for low-income people. Much of the cost in the last several decades has derived from more affluent people transferring their assets to heirs before their death; this reduces their personal net worth, qualifies them for Medicaid and requires the public program to cover their nursing home or home-care expenses. At this Institute public policy forum, experts discussed a public-private effort in New York — the New York State Partnership for Long Term Care — that encourages state residents to purchase insurance to cover their long-term care expenses and guarantees they will not need to sell off their assets if the insurance runs out.
December 6, 2010

Not So Sweet: The Failure of a Public Health IPO
in the Political Derivatives Market

New York State Health Commissioner Richard Daines has twice promoted proposals by Governor David Paterson to tax soda and other sugary beverages — and twice seen those efforts defeated. At this Institute public policy forum, Commissioner Daines offered a rationale for increasing the cost of sweetened drinks — which he described as a major contributor to the obesity epidemic — and discussed the political battles and media imagery that worked against the campaign for the tax. He likened the industry reaction and media coverage of the proposal to the financial derivatives that contributed to the housing market bust in 2008.
November 9, 2010

Can We Pay for Expanded HIV Screening?

Routinely testing all Americans for HIV would be cost-effective, according to the Centers for Disease Control and Prevention. But public programs may not be prepared to pay for expanded screening, Institute Fellow Erika Martin explains in this Q&A, based on her recent research. The biggest costs would arise from treating people who test positive.
Erika Martin, November 2010

Implementing Health Reform

Washington and the states are undertaking the complex task of implementing the Patient Protection and Affordable Care Act, the federal law signed by President Obama in March. At this public policy forum, former Institute Director Richard P. Nathan questioned whether the law will accomplish the essential goals of efficiency and cost control, given the wide range of influential constituencies that oppose change in the health-care system. He stressed that federal mandates should not treat states as if they are all the same, but consider how national policies will be implemented differently in varying states. Health-care consultant Deborah Bachrach, formerly deputy commissioner of health and Medicaid director for New York State, detailed some of the implementation tasks that states face, and urged New York legislators to consider immediately the design of legislation that must be in place for reforms that are mandated in 2014.
September 27, 2010

Q&A: What States Face Now in Implementing Health Reform

Major new responsibilities fall to the states in implementing federal health reform. The changes present challenges as well as an opportunity for states to build better, more cost-effective health systems. In this interview, Courtney Burke outlines the main tasks that states must undertake.
Courtney E. Burke, September 2010

Room for Interpretation: Causes of Variation in County Medicaid Asset Transfer Rates, Opportunities for Cost Reduction

New York State’s assumption of county Medicaid administration could reduce costs, but big savings will depend on improved administrative processes, according to this Institute report. The report examines differences in Medicaid nursing home eligibility denials among counties as an illustration of the challenges the state will face in taking over administration of Medicaid.
Courtney E. Burke, with Barbara Stubblebine and Kelly Stengel, August 2010

Medicaid Policy and Long-Term Care Spending: An Interactive View

Institute experts have applied an interactive measure that proves better at explaining wide variations in states' long-term care spending than individual measures analyzed in previous research. The index considers multiple factors, including coverage policies, nursing home payment rates and others. It may assist states in developing new policies to enhance care for elderly and disabled residents, while limiting costs.
James W. Fossett and Courtney E. Burke, August 2010

How Will New York Implement Health Reform?

With relatively generous public health insurance programs, New York may be in a better position than many states to implement changes mandated by the health reform law that Congress passed in March. Yet many questions remain regarding how the state and localities will accomplish implementation — including the issue of how they will pay for it, said speakers at this Institute public policy forum. James Knickman, president and chief executive officer of the New York State Health Foundation, led the discussion with an overview of the changes required by the new law. Joseph D. Morelle (pictured), chair of the New York State Assembly’s Standing Committee on Insurance, stressed the need to balance the desire for more comprehensive insurance coverage with the costs of that coverage. Robert Doar, commissioner of the New York City Human Resources Administration, called for identification of a single agency to oversee all the changes required by health reform, to avoid having implementation get bogged down in bureaucratic red tape.
Tuesday, June 8, 2010

Thinking Ahead: Health Care Trends

This presentation for the Albany Medical Center Horizons Strategic Planning Committee provides an overview of the current health system and what will change under federal legislation, and suggests how the health system might change in the next five-10 years.
Courtney Burke, April 20, 2010

Q&A: What Federal Health Reform Means for the States

The effort to reform health care at the national level is a complex one. If federal legislation ultimately passes, the states will need to implement mandated changes and pay for them. The Institute's director of health policy research offers a primer of the challenges that states may face.
Courtney Burke, January 2010

Health Care Reform: What You Need to Know and
How it Will Affect New York State

Courtney Burke, who directs the Institute's Health Policy Research Center, discussed federal health reform and its effect on New York State in presentations to the State Academy of Public Administration and the Schenectady Business and Women's Association. The presentation includes a look at similarities and differences in House and Senate bills, the effective dates of various provisions and their potential impacts on the state.
Courtney Burke, January 2010