Health Care
Basics

The American health care is a notorious underachiever—marked by unusually high costs, unacceptably high rates of insurance or underinsurance, and surprisingly poor outcomes.  In a nutshell, we spend more and get less than almost any other country (see animated chart on following tab for details).  These circumstances spurred the passage of the national Affordable Care Act in 2010.  The federal reform rolls out a range of changes, beginning with new insurance regulations (such as coverage of children to age 26, and elimination of pre-existing conditions for children) and culminating (in 2014) with the establishment of mandated coverage, and health care exchanges to facilitate  the purchase of that coverage.

For states, health policy options are largely shaped by federal law.  The federal ERISA law prohibits states from regulating or mandating employment-based health plans.  States can adopt their own income and demographic thresholds for public programs (Medicaid and the State Children’s Health Insurance Program or SCHIP).  And States interested in experimenting with more expansive coverage can request waivers allowing them to use Medicaid funds to explore options not otherwise allowed under the law.  These waivers, along with an array of other policy options, are—for the moment—overshadowed by the larger challenge of implementing reform at the state level.

 

Current Landscape

The recession has had a big impact on health provision and policy.  As the labor market stumbles, so too have rates of job-based health coverage.  As health costs continue to escalate, those covered at work are shouldering an every-growing burden.  And health coverage has been a special target of the backlash against public sector workers who—in many states—face higher out of pocket costs or have seen health care stricken from the scope of collective bargaining.  Even in this climate, a few states have pushed ahead with important innovations, including California, which is using a Medicaid waiver to expand coverage to low income adults; and Vermont, which is planning to use a similar waiver as the foundation for a state-level single payer system.

 

Learn More

The Henry J. Kaiser Foundation is a key resource for both state policy developments and basic data on health care in the states.  Its www.statehealthfact.org site presents a wide array of data, and includes an interactive tool for generating custom fact sheets on state Medicaid programs.  A similar range of research, data, and commentary is provided by the Commonwealth Fund, which tracks state policy, and is especially strong in issues regarding state-level implementation of the Affordable Care Act.

 

Video: Health Care 101

Recent Research Highlights

A Healthier Iowa Labor Market: Medicaid Expansions and the Impact on Incomes and Work Choices (June 2009)

Added July 13, 2011 Source:
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Affordable Care Act Medicaid Expansion: A Win for the State and Its Low‐Income Residents (September 2012)

Added September 17, 2012 Source:
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Better Jobs for In-Home Direct Care Workers

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Critical Condition: Primary Health Care in Alabama (February 2010)

Added July 19, 2011 Source:
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Employer-Sponsored Health Insurance in Wisconsin

Added August 22, 2011 Source:
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Estimated Impact of Health Reform Bills Passed by the House and Senate on New Jersey (February 2010)

Added January 31, 2012 Source:
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Fending for Themselves: Nonstandard Workers, Health Insurance Coverage, and the Labor Market (2011)

Added November 10, 2011 Source:
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FMAP and the Education Jobs Fund: State Fiscal Relief to Strengthen the National Economy, Reduce State Budget Cuts and Create Jobs (September 2010)

Added July 28, 2011 Source:
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Good Medicine: The impact of the Patient Protection and Affordable Care Act on New Jersey’s working families with children (March 2011)

Added January 31, 2012 Source:
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Health insurance exchange will improve access and affordability (March 2012)

Added May 15, 2012 Source:
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