Health, Economic and Family Security

The mission of the Health, Economic & Family Security program is to address the increasing insecurity faced by workers and families in the United States through the development of integrated and interdisciplinary policy solutions.


"Advancing the Capabilities of Safety Net Accountable Care Organizations (ACOs)"
The Chief Justice Earl Warren Institute on Law and Social Policy released a new report entitled, "Advancing the Capabilities of Safety Net Accountable Care Organizations." The report reveals the results of a study of the potential for ACOs to form in California's health care safety net. ACOs represent the next generation of health care delivery systems and are quickly being implemented nationwide in both the commercial sector and in Medicare. To ensure that the safety net is not left behind, UC Berkeley researchers have developed a Safety Net ACO Readiness Assessment Instrument for us by providers around the country. The survey instrument, which is included as an appendix to the report, poses questions about a number of capabilities, from IT infrastructure to legal regulatory barriers, to test the readiness of a given organization to become an ACO. For a full listing of all related papers and materials, please follow this linkMore>

Matt Chayt and Ann Marie Marciarille have authored the new report, “Breaking Down Barriers to Creating Safety-Net Accountable Care Organizations: State Statutory and Regulatory Issues.” The report focuses on three major state law issues: tort liability, scope of practice, and the corporate practice of medicine doctrine. The authors argue that statutory and regulatory schemes need to be re-examined to ensure that ACOs can form. For example, lawmakers should ask, in an age when health care is changing dramatically in America, whether the corporate practice of medicine doctrine should be preserved. The authors also offer California as an example of a state that, like many others, has taken tentative steps toward health care innovation but needs to act decisively to ensure that the promise of the Affordable Care Act is realized for all Americans. The report is made possible by a grant from Blue Shield of California Foundation.

Ann O'Leary, Beth Capell, Ken Jacobs, and Laurel Lucia have authored the new report, "The Promise of the Affordable Care Act, the Practical Realities of Implementation: Maintaining Health Coverage During Life Transitions.” Nearly half of all Americans can be expected to go without coverage at least once over a ten year period. Even small bouts of un-insurance can have negative outcomes on individuals’ health and financial stability. Key triggers of loss of coverage include: unemployment, reduction in work hours, changing jobs, moving and divorce. COBRA benefits are currently the main option for people who lose job-based coverage, but take-up rates are low due to high costs at a time of reduced income. The new health insurance exchanges have the potential to provide seamless coverage for those who lose employer-sponsored insurance due to life transitions.

Ann Marie Marciarille and Matt Chayt have authored the new report, “Breaking Down Barriers to Creating Safety-Net Accountable Care Organizations (ACO): Federal Statutory and Regulatory Issues.” The report surveys some of the largest challenges to ACO formation and outlines how the federal government can do more to clear the path for coordinated care. Safety-net health providers will be affected by a host of unique issues as ACOs emerge, from lack of administrative capacity to limited access to specialists and potential threats to their non-profit status. While federal agencies have worked together to partially address some of these challenges, the paper argues that future regulations and policies will need to give special attention to the safety net to guarantee that health reform’s potential is realized for all Americans.  Supplementing this report are Comments submitted to the Centers for Medicare and Medicaid Services and other federal agencies.  The comments argue for full inclusion of federally qualified health centers, and other measures that will support ACO formation in the safety net.

Promoting policies that help workers keep good jobs and support economic recovery is a priority for all Californians. This Berkeley CHEFS policy brief, “ Reforming Family and Medical Leave Laws: Promoting  Health and Economic Security for California’s Working Families,” written in collaboration with the Labor Project for Working Families, presents the key problems and gaps in California's leave laws, and proposes reforms that are essential to making leave accessible and affordable for working families.  Few can afford to lose pay or risk job loss when illness strikes or a family member needs care.  Even in this tough economic climate, the movement for family-friendly workplaces is gaining momentum, and family and medical leave laws are a critical component. 

Ann Marie Marciarille, author of the publication “Healing Medicare Hospital Recidivism: Causes and Cures.” The paper published in the American Journal of Law and Medicine focuses on the attempts to account for the history, source, and magnitude of the preventable readmissions and acute care discharge planning problems for Medicare.

UC Berkeley Center for Labor Research and Education and Berkeley CHEFS released the first in a series of policy briefs, "Maximizing Health Care Enrollment through Seamless Coverage for Families in Transition: Current Trends and Policy Implications," that discusses seamless health care insurance coverage for families lacking coverage due to a work or life transition. In this brief, Ken Jacobs, Laurel Lucia, Ann O'Leary and Ann Marie Marciarille review the literature on the prevalence of uninsurance caused by work or life transitions

Ann O'Leary co-authors a new publication, "A Guide To Implementing Paid Family Leave Lessons From California," released January 13, 2011 offering a primer on the nation’s first paid family leave program, implemented six years ago in California, and the do’s and don’ts other states should consider as they pursue similar proposals. The guide, from the Labor Project for Working Families and Berkeley CHEFS, sees California as a model for how Americans can juggle work and family responsibilities in the 21st century. Download the publication here. Click here to view video of the event.

On Thursday, December 2, the Berkeley Center on Health, Economic and Family Security (Berkeley CHEFS) and the Georgetown Law’s Workplace Flexibility 2010 released a new report entitled, “Family Security Insurance: A New Foundation for Economic Security.”  The report provides a blueprint for establishing and financing a new national insurance program to provide wage replacement for time off for health and caregiving needs.  Click here to read the report.

Berkeley CHEFS releases, Cutting Child Care Out from Under Californians. The California budget battle is continuing with no clear end in sight.  To help patch a nearly $20 billion shortfall, the Governor proposed to cut $1.2 billion in child care funds, a move that would eliminate most subsidized child care.  He also proposed to terminate California’s welfare program, CalWORKs, which serves 1.4 million people, 1.1 million of whom are children.  Included in the CalWORKs cuts are child care subsidies for families receiving or successfully transitioned off welfare.  In total, 240,000 children would lose access to subsidized child care.  This paper outlines the impact these child care cuts would have on working parents, children, and the state's economy. Download the paper here

In Gains, Gaps and New Choices: The Impact of the Affordable Care Act in California,  Berkeley CHEFS focuses on the human face of health care reform: the millions of individuals and families who lack affordable insurance coverage.  The report finds that the Patient Protection and Affordable Care Act of 2010 will go a long way toward filling coverage gaps in California and makes recommendations for further action. Download the brief here.

In the face of concerns over rising health care costs, the new health care reform law offers one answer: the Accountable Care Organization (ACO).  The health care reform law encourages fee-for-service Medicare providers to create ACOs and also sets up a pediatric demonstration project.  In Implementing Accountable Care Organizations, authors Stephen Shortell, Lawrence Casalino, and Elliott Fisher provide guidance to the federal government, states, and health care providers engaged in the work of developing ACOs. Download the brief here.

How Would Health Care Reform Impact California Senior Citizens? This issue brief analyzes how health care reform will impact senior citizens in California, and findings reveal that the Senate health reform bill and the reconciliation bill would lower out-of-pocket prescription costs for seniors in California, ensure greater access to primary care and preventive services, protect the solvency of Medicare, increase the options for long-term care, and protect the benefits of seniors eligible for both Medicare and Medi-Cal. Download the brief here.

Ann O'Leary and Heather Boushey, co-editors of the Shriver Report publish, Our Working Nation, How Working Women are Reshaping America's Families and Economy and What It Means for Policymakers. This policy roadmap is written in response to the plea for detailed, specific solutions that will help American workers and families meet the dual demands of work and family and, in turn, will strengthen our economy and the well-being of our families and our children. They outline a set of policies that address the needs of today's workers and working families as they really are, not as we imagine them to be. Download the Executive Summary here. Download the paper here.

The Costs and Benefits of a Public Option in Health Care Reform: An Economic Analysis.  In the most recent brief in the Advancing National Health Reform series, economist Ethan Kaplan and Berkeley CHEFS Associate Director Melissa Rodgers argue that including a public option in health care reform is likely to generate greater benefits and cost savings to the American people than has been projected by the Congressional Budget Office (CBO) and other independent analysts.  Download the brief here.

Berkeley CHEFS Faculty Co-Director Stephen M. Shortell published an article in the New England Journal of Medicine, Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform.  The article, by Diane R. Rittenhouse, Stephen M. Shortell, and Elliott S. Fisher discusses the “patient-centered medical home” (PCMH) and the “accountable care organization” (ACO), two models for delivery-system reform that take complementary approaches to improving the quality and coordination of health care and slowing the growth of spending.  The article is available online.