Perspectives on Health Reform Featured in INQUIRY Summer 2012 Issue

ROCHESTER, NY (08/14/2012)(readMedia)-- Perspectives on the Affordable Care Act (ACA) comprise a special section in INQUIRY's summer issue released this week. Contributors address the issues of health care rationing, the future of employer-sponsored health insurance, employer responses to the "play or pay" mandate of the ACA, and whether the private or public sector ought to be the repository for data that will be used in risk adjusting premiums in the health insurance exchanges. Additional research papers on the financial impact of work-limiting conditions for older workers and the relationship between hospital competition, evidence-based performance measures, and patient outcomes also appear in this issue.

Perspectives on Health Reform and Its Implementation:

"The Debate Over Health Care Rationing: Déjà Vu All Over Again?" by Alan B. Cohen – In this article, Cohen, of Boston University, retrospectively reviews the policy literature on health care rationing over the past 25 years, examines alternative definitions and classification schemes, and traces the debate's evolution. He explores ways to make rationing more rational, transparent, and equitable in the future allocation of scarce health care resources.

"Employment-Based Health Benefits: Recent Trends and Future Outlook" by Paul Fronstin – Fronstin, of the Employee Benefit Research Institute, discusses the roots of U.S. employment-based health insurance (ESI) and the recent trends that show a decline in both the percentage of workers with this coverage and the comprehensiveness of benefits offered. He considers the likely future of ESI in light of the ACA and shifts from defined benefit models to defined contribution models.

"Why Employers Will Continue to Provide Health Insurance: The Impact of the Affordable Care Act" by Linda J. Blumberg, Matthew Buettgens, Judith Feder, and John Holahan – Some experts believe that the ACA encourages employers to drop coverage, thus leaving both their workers and firms better off. However, these Urban Institute researchers have concluded that no such "win-win" situation exists, and that employer-sponsored insurance will remain the primary source of health coverage. They analyze ACA provisions, worker characteristics, and the fundamental economics of competitive markets to support their case.

"How Should Risk Adjustment Data Be Collected?" by Daniel P. Kessler – Risk adjustment is a key element of the ACA's health insurance exchanges, yet little has been written on how data to develop risk-adjusted premiums should be collected. Kessler, a Stanford University professor, supports using a distributed approach, in which insurers retain claims that serve as the basis for risk adjustment, but pass along to a risk adjustment authority summary statistics as needed. (This differs from a centralized approach, where insurers submit raw claims to the authority.) Kessler shows that a distributed approach works as well as a centralized one in terms of controlling errors and misreporting, and has added benefits regarding employee and health plan concerns about privacy and the release of sensitive firm or personal information. He urges states to consider this approach in setting up their health insurance exchanges.

Also featured in INQUIRY's summer issue:

"The Financial Repercussions of New Work-Limiting Health Conditions for Older Workers" by Jody Schimmel and David C. Stapleton – This study compared older workers who experienced a work limitation with those who didn't, and found that two years after onset, earnings for the affected group were 50 percent lower and poverty rates nearly double that of the group without the work-limiting condition. Income from unemployment insurance, workers' compensation, and retirement and disability benefits offset only a small portion of the declines, resulting in lower overall household income.

"The Relationship between Hospital Market Competition, Evidence-Based Performance Measures, and Mortality for Chronic Heart Failure" by Jared Lane K. Maeda and Anthony T. Lo Sasso – Using performance measures from the Joint Commission's ORYX program, this study found that higher adherence with most of the Joint Commission's heart failure performance measurers was not associated with any meaningful mortality reductions, except at hospitals with the highest mortality rates; market competition similarly was not associated with any differences in mortality. The only indicator associated with lower mortality rates was adherence to discharge instructions. Findings suggest that targeting evidence-based processes of care might help improve patient outcomes.

"The View from Here: There We Go Again!" by Alan C. Monheit – In this column, INQUIRY's editor laments our continuing problems with the nation's financial sector, the House budget proposal and the rigidity of congressional Republicans --- and he explains how damaging these problems can be to health care and our population's health. He also shares some thoughts on the Supreme Court's decision upholding the ACA.

INQUIRY, the journal of health care organization, provision, and financing, is in its 49th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."