Health Care Reform Policy Briefs, Research & Other Materials
"Advancing the Capabilities of Safety Net Accountable Care Organization (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 use 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. The project team developed the instrument through collaboration with two counties in California. UC Berkeley researchers discovered that while providers are beginning to make the necessary changes, they have much work to do to ensure they are ready for the IT, legal and financial challenges that integrated care will bring. Based on the findings of the study, this report makes additional policy recommendations to encourage ACO formation. The project is funded by Blue Shield of California Foundation and has produced two earlier reports focusing on federal and state legal issues affecting ACO formation in the safety net. For a full listing of all related papers and materials, please follow this link.
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.
Maximizing Health Care Enrollment through Seamless Coverage for Families in Transition
By Ken Jacobs, Laurel Lucia, Ann O'Leary and Ann Marie Marciarille
This brief is the first in a series discussing seamless health care insurance coverage for families lacking coverage due to work or life transitions. In this brief, we review the literature on the prevalence of uninsurance caused by work or life transitions. We also provide initial recommendations for state and federal policymakers on how best to ensure seamless health coverage under the Affordable Care Act for individuals and families who lose health insurance because of a work or life transition. A more detailed set of recommendations will follow in a policy brief to be released in the summer.
Implementing Accountable Care Organizations
By Stephen M. Shortell, Lawrence P. Casalino, and Elliot S. Fisher. May 13, 2010
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. This brief provides guidance to the federal government, states, and health care providers engaged in the work of developing ACOs.
How Would Health Care Reform Impact California Senior Citzens?
By Zachary L. Baron, Dylan H. Roby, and Melissa A. Rodgers. March 19, 2010
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.
Addressing California’s Health Coverage Gaps: The Impact of National Health Care Reform
By Annette Gardner, Melissa A. Rodgers, and Ken Jacobs. November 30, 2009
Political scientist Annette Gardner, Berkeley CHEFS Associate Director Melissa Rodgers, and Berkeley Labor Center Chair Ken Jacobs focus on the human face of health care reform: the millions of individuals and families who lack affordable insurance coverage. The report analyzes how well the bills moving forward in Congress will succeed in filling coverage gaps in California and what effects the bills will have on California’s safety net system.
The Costs and Benefits of a Public Option in Health Care Reform: An Economic Analysis
By Ethan Kaplan and Melissa A. Rodgers. October 30, 2009
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.
Reforming the Private Insurance Market: Lessons from California for National Health Reform
By Janet M. Coffman. August 26, 2009
Janet Coffman, of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, reviews California’s experience regulating health insurance and points to five major lessons for national health reform that are critical to ensure Americans have access to comprehensive, affordable coverage.
Golden Gate Restaurant Association v. City and County of San Francisco
Brief for Zazie and Medjool Restaurants as Amici Curiae in Support of Respondents. August 24, 2009
Berkeley CHEFS filed an /amicus /brief in the Healthy San Francisco case on behalf of two San Francisco restaurants opposing a petition that asks the U.S. Supreme Court to decide whether San Francisco's Health Care Security Ordinance should stand. The restaurants, Zazie and Medjool, support the law's requirement that employers contribute a minimum amount toward employee health care. The 9th Circuit has ruled that the San Francisco law does not violate ERISA. Click here to read the press release.
Beyond the Public Plan: A Pathway to Contain Costs and Transform the Delivery System
By Harold S. "Hal" Luft, PhD. July 29, 2009
Internationally renowned health economist Hal Luft proposes a publicly chartered major risk pool that uses voluntary mechanisms to lower the costs of coverage expansions, and begins transforming the delivery system by encouraging providers to accept bundled payments.
Public Plan Choice and Play-or-Pay: Critical Elements to Ensure Accountability and Affordability and to Control Costs
Testimony by Jacob S. Hacker before the House Education and Labor Committee. June 23, 2009
Professor and health care expert Jacob Hacker testified before the House Education and Labor Committee at a hearing on its draft proposal for health care reform.
Prescription for Success: Lessons from California for National Health Reform
By Melissa A. Rodgers and Jacob S. Hacker. June 22, 2009
Melissa Rodgers and Jacob Hacker analyze California's recent experience with comprehensive health reform and offer ten lessons from California that are essential to the success of national health reform.
How to Structure a "Play-or-Pay" Requirement on Employers: Lessons from California for National Health Reform
By Ken Jacobs and Jacob S. Hacker. June 16, 2009
In a new health reform policy brief by Berkeley CHEFS and the UC Berkeley Center for Labor Research and Education, Ken Jacobs and Jacob S. Hacker examine the policy design, economic effects, and political ramifications of employer requirements.
Healthy Competition: How to Structure Public Health Insurance Plan Choice to Ensure Risk-Sharing, Cost Control, and Quality Improvement
By Jacob S. Hacker. April 8, 2009
Recently, the debate over health care reform has increasingly focused on what a “public plan choice” would mean for Americans. In this brief Jacob Hacker, a nationally recognized expert on the public plan, describes how the nation can structure and implement a public health insurance option as part of overall health care reform. The brief was released in collaboration with the Institute for America’s Future.
The Case for Public Plan Choice in National Health Reform
By Jacob S. Hacker. December 17, 2008
Berkeley CHEFS founding faculty co-director Jacob Hacker makes a vital case for a public plan in any health care reform proposal by Congress or president-elect Barack Obama. The brief says that a Medicare-like public insurance option, offered alongside private health plans, is crucial to controlling health care costs and improving quality. This brief is a joint project of the Center on Health, Economic & Family Security at the UC Berkeley School of Law and the non-profit Institute for America’s Future.
Read the Q&A about the Case for Public Plan Choice.
The President's Health Reform Proposal: Impact on California Small Businesses, their Employeers and the Self-Employed
By Ken Jacobs, Laurel Tan, and Dave Graham-Squire
This new issue brief published by the UC Berkeley Center for Labor Research and Education, Ken Jacobs examines the effects of the President's health reform proposal would have on California small businesses, their employees and the self-employed. The President's proposal would make it more affordable for California small businesses to offer coverage by reducing administrative costs for small group health plans and offering $4.4 billion in health insurance tax credits over ten years.
Budget Solutions and Jobs
By Ken Jacobs, T. William Lester and Laurel Tan.
This new policy brief published by the UC Berkeley Center for Labor Research and Education analyzes the impact of California budget solutions on jobs and the economy. Spending cuts for health and social services programs, such as In-Home Supportive Services, Medi-Cal, Health Families and CalWORKS, would result in significantly greater loss of jobs and state and local sales tax revenue, compared to equivalent revenue increases such as a tax on upper income households or an oil severance tax.