Just days after the November elections, states will have to make final (or reasonably final) decisions about whether they are going to run their own health insurance exchange and what that will look like – or whether the federal government will take responsibility for all or part of the exchange.
States also are grappling with decisions about the essential benefits packages, and although there’s no deadline, expect the pace of their Medicaid expansion decision making to pick up after elections.
If President Obama is re-elected, states will probably pick up the pace of implementation. If Mitt Romney wins, they will probably anticipate repeal – but what happens to all the preparatory work they’ve been doing for the past two years, and will it contribute to new state-based solutions that Romney says he wants?
In a special webcast on Thursday, we’ll talk to three experts who are doing hands-on work with both “red” and “blue” states. AHCJ members will listen in on the call and be able to submit their own questions. You also can send questions in advance to email@example.com. A recording of the webcast will be available to AHCJ members shortly after it is over.
Joanne Kenen, AHCJ topic leader/health reform and deputy health care editor at Politico Pro, will moderate a discussion with:
- Joel Ario, managing director, Manatt Health Solutions
- Cheryl Smith, director, Leavitt Partners
- Heather Howard, lecturer in public affairs, Princeton University; director, State Health Reform Assistance Network
Here are two more resources before the presidential debate and the final weeks of trying to untangle the health policy claims in the campaign. Both come from the Journal of the American Medical Association (and neither require a password).
The first is a straightforward two-page essay summing up Obama vs. Romney on the health law/private insurance, Medicaid and Medicare. It’s by Aaron E. Carroll, who is a physician and policy expert, and Austin B. Frakt, a health care economist. (Both are part of The Incidental Economist blog, which I like a lot – and it’s searchable!)
“Fundamentally,” they write, “the candidates disagree on the role of government as the guarantor of affordable access to health insurance, as evidenced by their plans for private insurance markets, Medicare, and Medicaid.” They also note the two candidates have different starting points for policy – Obama prioritized covering more people, and Romney stresses cutting federal spending on health.
The second is an infographic from the Kaiser Family Foundation, part of its Visualizing Health Policy collaboration with the journal. It shows how voters rank health care as a campaign issue this year, which health issues are most salient and how Americans perceive Obama and Romney on these issues. It includes historical contact for the past five elections (back to Bill Clinton in 1992). Cost, as you may guess, is key. I particularly liked this chart, which showed how issues rose and fell with voters every four years. (Moral values beat out economy/jobs for the top spot in 2004. Health care placed 5th and last that year – after terrorism and Iraq.)
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to firstname.lastname@example.org.
Governing magazine has joined the ranks of publications turning a spotlight on the aging of America.
Especially worth reading is its just-published story on the politics of greying baby boomers. What could be more timely in this election season?
Some highlights of this nuanced, well-reported piece by Rob Gurwitt:
“More than half the nation’s voting-age population is now over 45 – the first time that’s ever happened. As the immense bulge of the baby boom ages, politics in every state, county, city and town will reflect its influence. Yet what’s most interesting about this is that no one really knows how.”
…”‘Really, the senior vote is something of a myth,’ says Frederick Lynch, a professor of government at Claremont McKenna College and author of One Nation Under AARP: The Fight Over Medicare, Social Security, And America’s Future. ‘It breaks apart by education, class, ethnicity and family structure. And among pre-seniors, you’ve got elite boomers who got good degrees, bought into globalization and were able to adjust to a changing economy, versus the white working class, which is mostly boomers who have been completely dislocated by cheap immigrant labor and their jobs sent overseas. In numbers, the senior and pre-senior bloc is a sleeping giant, but the question is will it awaken and mobilize?'”
…”There is no shortage of potential flash points that could see state and local voters polarize along age-related lines. Taxation, schools, long-term care, Medicaid, urban design, transportation – all carry the potential for conflict. Even ethnicity could be a sensitive topic. Pew’s research suggests that boomers are generally less tolerant of the increasingly diverse, multi-ethnic character of the U.S. than the cohorts that follow them – though they are more accepting than their elders.”
What a rich vein of reporting lies here for reporters willing to go out and ask baby boomers about their views on these and other topics.
Other stories in the new Governing series look at Continue reading
Kaiser Health News’ Phil Galewitz spotlights a 50-year-old federal effort to provide health care to migrant farmworkers, one which provides funds to 156 health centers (list) throughout the country. There are 13 each in Texas and Florida and 27 in California, and in 2010 the government contributed $166 million to the care of about 900,000 migrant and seasonal laborers. “Such clinics,” Galewitz writes, “have become the latest flash points in the national immigration debate.”
Health center officials across the country describe how local, state and national law enforcement authorities have staked out migrant clinics, detained staff members transporting patients to medical appointments and set up roadblocks near their facilities and health fairs as part of immigration crackdowns.
Proponents say the clinics help ensure the health of the people most responsible for the handling and production of the American food supply, while conservative groups argue that the federal government shouldn’t be providing benefits for illegal immigrants, a group that makes up about half of the 3 million-strong migrant farm labor force.
In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.
After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.
Lieberman says it best:
If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.
She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:
Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.