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Kaiser and the Affordable Care Act

Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014 Many of you have commented over the years on my President’s Message on this website which explains our purpose and mission in creating the modern day Kaiser Family Foundation and how we operate. I update it periodically to keep it…

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Pre-X Redux

With the focus now mainly on exchanges, Medicaid expansions, and enrolling the uninsured in newly available coverage arrangements, there is less attention lately to the ACA insurance reforms which have always been the most popular parts of the law – changes which could affect every American’s insurance in some way…

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Covering The ACA May Be Almost As Hard As Implementing It

This Pulling It Together was adapted from a column I published earlier this week in Politico, with a new introduction added. You can read the original Politico column here. The implementation of the ACA is news and the public will demand information about it. Journalists and news organizations have an obligation…

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Poor People Have the Same Needs as Others

Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times’ Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes “Insurance — public or private — provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health.”

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Can We Learn From ACA Implementation and Improve the Law?

Senator Baucus made headlines recently when he predicted a “train wreck” for Obamacare. David Brooks predicted “chaos” in a recent column. In a news conference, the President offered a different perspective.  “There’ll still be, you know, glitches and bumps…. That’s pretty much true of every government program that’s ever been…

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We Still Have a Health-Care Spending Problem

Drew Altman, President and CEO of the Foundation, and Larry Levitt, Senior Vice President, co-authored a Washington Post op-ed that examined how the economy affects the nation’s health spending.  It concludes that the record slow growth rate of recent years stems largely from economic factors beyond the health system, with the…

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                    [post_content] => Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014

Many of you have commented over the years on my President’s Message on this website which explains our purpose and mission in creating the modern day Kaiser Family Foundation and how we operate. I update it periodically to keep it current as we evolve. With the passage, implementation and continuing debate about the Affordable Care Act, I thought I would provide a companion essay about our role on the ACA.

Our mission, stated at the top of our home page, is “filling the need for trusted information on national health issues.” It is inspired by our benefactor Henry Kaiser’s motto: “find a need and fill it.” Henry Kaiser was talking about finding a niche in American industry, but that is also what we try to do in a different time and in the very different world of health policy.

Our mission doesn’t change because of the passage of the ACA or the hyper-partisan environment in which it is being implemented. We have addressed all kinds of health policy legislation over the years, dating back to the Clinton reform effort which unfolded just as we were creating the modern day KFF, and we are accustomed to operating in a highly politicized health policy environment. In fact, when it comes to politicized health policy issues, I can remember earlier election-driven Medicare debates that would give the current ACA discussion a run for its money.

As in these past debates, our role on the ACA is to inform the debate and give the American people information they can use to understand the law and make the best choices for themselves and their families. We do this through the facts and analysis we produce; our polling and survey research; our news service (Kaiser Health News) and our many other efforts to help strengthen news coverage; and through the events we hold and our daily role in the field as explainers and technical experts. Certainly we want to see more Americans have insurance coverage and better protection from the sometimes crushing burden of health care costs. But at Kaiser we take no position on the ACA, or any other law or proposal for that matter. Some laws are good, some bad, and most are a mix of good and less good. Some are popular and some less so. Our role is the same whether we are working on Medicaid, Medicare, the ACA, or any other law or health policy issue.

One difference now is that the ACA is a law that has actually passed and is being implemented. But it is a difference mainly of scale and complexity. We have worked to inform the implementation of other laws in the past, such as CHIP and the Medicare drug benefit, and we have long specialized in Medicaid which like the ACA involves a big role for the states.

With this in mind, we have a five-part strategy for our work on the ACA:

1. PRODUCING FACTS AND ANALYSIS. This is the backbone of what we do. The key to our work, on the ACA or any issue, is picking the right topics to work on so that we are useful and relevant, getting the timing of what we do right, and getting information to our core audiences in understandable and digestible forms, especially policymakers and the media. Many of us have PhDs and have been in academia, but our business is different from the academic enterprise. We do not start with what the unanswered or interesting research questions are, we start with what information is needed by policymakers, the media and the public to inform policy debates. Occasionally we are called a “think tank.” I like to believe we think, but we function differently from most think tanks. We operate large programs such as a national news service, an in-house polling operation and large national media campaigns such as Greater Than AIDS. Another difference from most think tanks is that everything we put out is an organizational product, not the work of individual scholars, authors or opinion leaders.

2. INFORMING JOURNALISTS AND NEWS ORGANIZATIONS. We have always placed equal weight on policy analysis and media at Kaiser, and the ACA is no exception. With Washington and the Congress in a hyper-partisan boil, the news media play an even more important role than at any time since we established the modern day KFF at mediating national policy debates and informing the public. One of our biggest and most resource-intensive commitments as an organization is to be an everyday resource for journalists and news organizations as they cover the ACA. Our goal is not to be cited or quoted, it is to improve the quality of health policy information the American people get, and we are keenly aware that anything we do directly ourselves to put out information pales in comparison to the reach of the media, in all of its current day forms. We also have long operated fellowship and other programs to help journalists better understand the intricacies of health policy.

3. PRODUCING OUR OWN JOURNALISM. In June of 2009, we established our own news service, Kaiser Health News (KHN), to provide in-depth coverage of health policy, free of the competitive and bottom line pressures that affect most commercial news organizations. KHN is the successor to kaisernetwork.org, which produced daily news summary reports and webcasting but not original journalism. KHN is a regular foundation program but it is editorially-independent, and a fully credentialed national health policy news service. We distribute our KHN content free through a wide range of partners such as The Washington PostUSA Today, and NPR. An important thrust now at KHN is to cover the ACA story as it unfolds in states and communities beyond the Beltway. To that end, we have established a new regional newspaper network and partnerships with many NPR affiliates across the country, and we are expanding our west coast coverage and developing a California bureau. KHN also produces two highly popular daily news summary reports, as well as original programming from our broadcast studio in our D.C. building.  We are also now producing health policy coverage for the NewsHour. You can catch KHN reporters frequently on C-SPAN or the NewsHour explaining health policy developments. As the ACA gradually fades from the headlines there will be an even greater need for KHN.

4. POLLING AND SURVEY RESEARCH. Our monthly tracking polls are among our most prominent products and familiar to many of you. Our polling group designs our polls not just to monitor opinion, but more importantly to examine people’s experiences with the ACA and their level of knowledge about the law. Because we have been polling about health reform since the early 1990s, we have a well-tested battery of questions and a repository of experience that we can bring to polling about the ACA. We always adhere to the highest methodological standards in our polls and maintain sample sizes that allow us to report confidently on relevant subgroups of the population. In addition to the polls we conduct ourselves, we also conduct in-depth special project surveys with news media partners, most notably The Washington Post, with whom we have conducted twenty-seven survey projects, as well as The New York Times. We are also fielding several large-scale special surveys at Kaiser designed to assess the impact of the ACA, with a focus on the lower income and uninsured populations. Many of you are also familiar with our benchmark annual survey of employer health benefits and premiums, which we release every year around September.

5. CONSUMER INFORMATION. With ACA implementation moving forward and our polls showing that so many people are uninformed or confused about what the law means for them, we are ramping up our consumer information materials. We have made a solid start with our ACA Calculator, our animation narrated by our Trustee Charlie Gibson, our FAQs, and our quizzes. But, we plan to do much more, including translating much of our consumer information into Spanish. Our goal in doing all of this is not to be a direct resource for consumers, since that is generally not our role and we don’t have the means to answer questions from millions of people about their individual circumstances. Rather, we will distribute what we produce through media partners and direct people to local resources that will help them make individual choices. The more time I spend talking about the ACA, the more I am convinced of the need for basic information about what the law does and does not do. Overall this has been one of our greatest discoveries at Kaiser about health policy information: basic facts and explanations are as powerful in our world as the seminal study. We try to do both and everything in between.

These roles and strategies – facts and analysis, assisting news media coverage, our own news service, polling and survey research, and consumer information – are the main tools we use to take on ACA implementation. Every day, in each of these areas, we make decisions about what analyses we want to do, what polls and surveys to do next, what news stories we do at KHN, what events to hold, what media appearances to accept or decline, how many journalists and news organizations we can assist that day, and so forth. For an operating organization, all these choices require resource commitments. Many organizations make these kinds of decisions. These tactical decisions translate the strategy into impact. There is no manual for making them; they are the art of what we do and hopefully we mostly make the right calls.

Lastly, across all of the elements of Kaiser’s ACA strategy, we maintain a consistent focus on the issues and developments that most affect people, and especially people with the greatest health and economic needs. The focus on people is the hallmark of our organization. Others will focus on health professionals and health care institutions or the health care industry, all important issues as well. But, with some exceptions, that is not what we emphasize. We put information to work for people and try to focus on the policy issues and choices that affect millions. The choices we make about what we choose to do and choose not to do with our limited staff and financial resources are always guided by this compass.
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                    [post_content] => With the focus now mainly on exchanges, Medicaid expansions, and enrolling the uninsured in newly available coverage arrangements, there is less attention lately to the ACA insurance reforms which have always been the most popular parts of the law – changes which could affect every American’s insurance in some way and which go into effect regardless of the implementation decisions states make.  In this column, I draw on our recent tracking polls to review where the public stands on the most prominent of these insurance reforms – guaranteed issue. This is another area where information could matter because many people with pre-existing medical conditions who stand to benefit from the law don’t seem to know about it.

Forty-nine percent of the American people under the age of 65 report that they or a family member have a pre-existing medical condition such as heart disease, diabetes, asthma, and cancer. Among this group, a quarter (25%) say that they or someone in their household has been denied coverage or had their premium raised because of a pre-existing condition.

Thirty-five percent say they worry that they will have to pass up a job opportunity or forego retirement plans to maintain coverage and nearly one in ten (9%) say they or someone in their household has passed up a job opportunity or decided not to retire in the past year because of “job lock”.

The “guaranteed issue” requirement in the ACA fixes this problem, which is called medical underwriting. It requires insurers to issue health plans to anyone in the individual or group markets, regardless of their health status, and prohibits rate surcharges based on health status in the individual and small group markets.  Like most of the ACA’s major revisions, it kicks in January 1 of next year, with open enrollment beginning this October.

The provision is popular; 66% of the American people support it. It is also one of those ACA provisions Republicans like, with 56% of Republicans supporting it. The President has talked about it often, journalists have publicized it, and experts have debated the impact of eliminating medical underwriting on the costs of insurance since passage of the law.  But like many elements of Obamacare, many people who will benefit from it don’t seem to know about it. Among those who report that someone in their household has a pre-existing condition, four in ten are not aware of the guaranteed issue provision. Just like the other group who will benefit most from the ACA, the uninsured, a large number – in this case half of all people who have someone in their household with a pre-existing condition – say they don’t have enough information about the ACA to know how it will impact them or their family.

Not everyone with a pre-existing condition has had a problem getting health insurance. People with employer-based coverage are protected under the previous law unless they lose their job and experience a coverage gap. Nor does liking the idea of guaranteed issue necessarily mean someone will support the ACA; people like or dislike the ACA for various reasons. And, there are tradeoffs in eliminating underwriting against people with pre-existing conditions. Premiums may rise somewhat to accommodate coverage for people who are sick (the idea is to balance this to some extent by insuring people who are young and healthy as well).

But there is a large constituency of people with major illnesses who will benefit from the law who do not seem to know it, and virtually everyone benefits from the peace of mind of knowing that if they get sick they no longer can be denied coverage or priced out by surcharges, even if they have large group coverage and lose it. Right now, working people who get sick and need to leave their jobs have only expensive COBRA coverage as a temporary solution.

The ACA awareness and outreach effort now getting underway is aimed more at the goal of connecting the uninsured to new coverage opportunities than helping people to understand the security of knowing that they can’t be denied coverage if they get sick. There is obvious logic in that, since the law cannot succeed without getting people enrolled. But, many people with pre-existing conditions such as cancer, heart disease, or diabetes are represented by organized and usually very effective disease groups. They have a role to play in informing their constituents about this issue as do health professionals whose patients may benefit from the guaranteed issue provision. Fifteen percent of those with a pre-existing condition say they have talked with their doctor or a medical professional about the ACA.

One reason this is important now: as the economy improves, people will be looking for better job opportunities, and there is a significant group of people still afraid to change jobs because they are sick and who seem not to know that they soon will not have to worry about that anymore.

________________

(Note: In this column, I report data on pre-existing conditions from our March, April and June 2013 Kaiser Tracking Polls and our September 2011 Tracking Poll. I focus on the non-elderly because seniors are protected from medical underwriting by the Medicare program.)
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                    [post_content] => This Pulling It Together was adapted from a column I published earlier this week in Politico, with a new introduction added. You can read the original Politico column here.

The implementation of the ACA is news and the public will demand information about it. Journalists and news organizations have an obligation to cover this story.  As Kaiser CEO I serve as the publisher of our non-profit news service, Kaiser Health News, and also as the head of our large health policy information and analysis enterprise, so I see ACA implementation from a variety of perspectives. The ability of journalists to cover the ACA accurately and in depth will be related to our ability in the health policy community to provide facts, data, and evidence on ACA implementation in near real time, and to provide expert analysis journalists can rely on. Ultimately it will also depend on our ability to evaluate the impact of the law on coverage, access, people’s financial burdens, and overall health care spending, and to do it in a time frame that is not so slow that public and political judgment on the ACA has already been rendered. This column addresses the challenges journalists face covering the ACA, but ACA implementation confronts the health policy community with challenges that are at least as formidable as those faced by journalists. They will be the subject of another column.
Covering The ACA May Be Almost As Hard As Implementing It
President Barack Obama recently predicted “glitches and bumps” when major provisions of the Affordable Care Act are implemented next year. It is always this way. Today we think of Medicare as a popular program that is part of the fabric of American life. But my friend Joseph Califano, who helped create Medicare while working for Lyndon B. Johnson, recalls real problems during the early days of the program, including resistance to desegregating hospitals and physician reluctance to participate. But there is at least one big difference today: Our almost instant and nonstop news cycle, the Internet and the impact of the news echo chamber on the public. As several news organizations learned during last summer’s coverage of the ACA ruling in the Supreme Court, it’s better to be right than to be first. Getting the ACA story “right” will be nearly as difficult as implementation itself. Here are four major challenges all news organizations will face. These are challenges we face too at Kaiser Health News. 1. The biggest challenge is that ACA is no longer a Washington story. As the story moves to the states, national news organizations will need to cover the law’s implementation beyond the Beltway and explain what it means for the American people. Few national news organizations have the “eyes and ears” across the country to do this well, and regional and local news organizations do not have the on-staff health policy expertise, even if they have the local ties. This is a challenge for us at Kaiser Health News, with a staff of reporters and editors based mostly in Washington. We are establishing partnerships with regional newspapers, NPR affiliates and others, so that together we can spot the most relevant state and local stories to report them locally and nationally through our distribution partners. Other news organizations will find their own answers. 2. Another challenge will be judgment by anecdote. Critics will feed reporters ACA horror stories and supporters will sell them success stories. Every journalist will be able to find a bad ACA story or a good one. When does “one” person’s experience represent “many,” or “most”? The gold standard is to take examples from a statistically representative group using a scientifically valid survey, but that’s just not going to happen very often with reporters working under deadlines. Journalists will need to do interviews, check with experts, scrape together what early data exist and make judgment calls about whether the anecdote they have is an outlier or representative of broader experience. Let’s say Bill Smith in Arkansas chains himself to the IRS building and refuses to pay his fine in protest of the law’s requirement that Americans buy health insurance, but that overall, the mandate works smoothly, as it has in Massachusetts. No doubt, Smith will be “breaking news” on your favorite cable channel. With complex stories like ACA, there is a temptation to cover only breaking news and not the broader story. These news judgments matter because powerful anecdotes stick in the public mind in ways statistics never will. 3. A third challenge is deciding what to cover. When the “death panel” story broke, many news organizations sprang into action to fact check and debunk the claim. Cable news covered the story day after day. No doubt the repeated coverage of nonexistent death panels contributed to public anxiety about the law. Today, 40 percent of the American people still believe there are death panels in ACA. News organizations need to make their own judgments about what is important to cover and be on guard against being manipulated by the political process. The decision about what stories to cover can be even more important than how to cover them. 4. Finally, there is the “balance trap” — the pressure to present the views of the organized right and left rather than the facts. This is a general problem for journalism today but one that is particularly relevant to ACA because views on it are so sharply divided along partisan lines. I recently moderated a panel with three top journalists from The New York Times, NPR and The Wall Street Journal. All three said that the pressure to do just this was their biggest challenge covering health reform in a hyperpartisan Washington. It is not always easy to find the facts, and sometimes issues are maddeningly gray in health policy. But often the facts are clear in statute or regulations. They are in a government report or a study from a respected organization. Our polls show that the public remains only dimly familiar with the details of ACA, and those who stand to gain the most (the uninsured or people with pre-existing medical conditions) often know the least. As the main elements of the law are implemented, efforts are being mounted by the federal government, states and nonprofit organizations to inform people. As important as these targeted awareness and outreach efforts will be, the news media have always been the public’s main source of health information. And while local TV news has traditionally been the public’s top source of health news, newspapers, radio, online news and cable news are closely bunched as their top sources of information about ACA. How well news organizations step up to these and other ACA coverage challenges will have a big impact on implementation of the law and public judgment about it. [post_title] => Covering The ACA May Be Almost As Hard As Implementing It [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => covering-the-aca-may-be-almost-as-hard-as-implementing-it [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:33 [post_modified_gmt] => 2014-03-04 16:14:33 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=74512 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 71636 [post_author] => 36621681 [post_date] => 2013-05-07 17:31:38 [post_date_gmt] => 2013-05-07 21:31:38 [post_content] => Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times' Room for Debate discussion on More Medicaid, More Health?  In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." New York Times: "Poor People Have the Same Needs as Others" [post_title] => Poor People Have the Same Needs as Others [post_excerpt] => Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times' Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => poor-people-have-the-same-needs-as-others [to_ping] => [pinged] => [post_modified] => 2013-05-08 20:25:41 [post_modified_gmt] => 2013-05-09 00:25:41 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=71636 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 70869 [post_author] => 48572675 [post_date] => 2013-05-07 09:00:20 [post_date_gmt] => 2013-05-07 13:00:20 [post_content] => Senator Baucus made headlines recently when he predicted a “train wreck” for Obamacare. David Brooks predicted “chaos” in a recent column. In a news conference, the President offered a different perspective.  “There’ll still be, you know, glitches and bumps…. That’s pretty much true of every government program that’s ever been set up,” Obama said. “But if we stay with it, and we understand what our long-term objective is, which is making sure that in a country as wealthy as ours, nobody should go bankrupt if they get sick, and that we would rather have people getting regular checkups than going to the emergency room because they don’t have healthcare, if we keep that in mind, then we’re going to be able to drive down costs.” There are always problems in big government programs and unintended consequences that could not be predicted in advance of implementation. The longer term question is not whether there will be problems – there will be glitches and there will be even more successes as people gain coverage and insurance is reformed – but whether the political system today has the capacity to learn from implementation, adapt and make improvements. In the history of domestic programs there are few if any examples of “train wrecks” or “chaos”. Yes, Medicare Catastrophic was, well catastrophic, but it was never implemented.  Social Security, Medicare, and Medicaid were all implemented reasonably smoothly. In the ACA, like Medicaid or welfare, states bear a lot of responsibility for implementation and administration and there will be substantial variation in performance across the states. Some view that as a problem and some see it as a strength. One under-appreciated aspect of the ACA is how fundamentally the Supreme Court changed the law when it made the Medicaid expansion a state option. Many governors also waited for the outcome of the election to decide what they would do. The result is that the program being implemented is, in important respects, not the same as the one originally envisioned in the statute. There is no doubt states will make adjustments as implementation proceeds and they learn what is working and what is not in their exchanges and Medicaid expansions. Right now only seven states are planning “active purchaser” exchanges that, among other things, more aggressively try to control premium increases among plans offering business in their exchanges. One prediction I will make (it could be wrong) is that over time more states running their own exchanges will move away from the passive Expedia.com model exchange towards a more active purchaser model. HHS will also have the ability to make changes through administrative authority, waivers, and new regulations. The question is the Congress. Typically the process of learning from experience culminates in Congress with new legislation. Welfare reform legislation, for example, began in the Reagan years but was revisited comprehensively in the Clinton years. And both Medicare and Medicaid have been substantially modified through successive waves of legislation over the years. Laws are changed as we learn what works, as needs and circumstances change, and as political support for needed changes coalesces. Can today’s hyperpartisan, largely paralyzed Congress agree on legislation to improve ACA as we learn from implementation? Would Republicans agree to anything Democrats want? Would Democrats open up the ACA for legislative tinkering? It is not easy to envision agreement on ACA-related legislation any time soon. One thing that could change the picture somewhat is the current negotiations occurring between several states and the administration over the Medicaid expansion. If HHS and these states can successfully negotiate arrangements that give the states the flexibility they want and at the same time provide adequate protections for beneficiaries, it will bring more red states and their governors into the fold and create a much more bipartisan base for the ACA in the states than it has had in Washington, as well as a broader constituency for changes to improve the law over time. This will not happen overnight. Another factor that will affect the ability to learn and adapt as implementation proceeds is media coverage. If journalists focus on both what is working well as well as what is not, they can make a real contribution not only to public judgment about the ACA but future efforts to improve it. If they focus only on gotcha outlier horror stories that do not reflect general experience with the ACA, their reporting will do more to fuel political partisan debate than inform future policy. Of course the Congress itself could change in coming years, but with only thirty to forty seats up for grabs in the House of Representatives and the others mostly safe districts that lean right or left, redistricting has baked a certain degree of polarization into Congress for the immediate future. As implementation unfolds there are as many questions about the ability of our political system to learn from implementation and respond intelligently to the ACA as there are about the ACA itself. [post_title] => Can We Learn From ACA Implementation and Improve the Law? [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => can-we-learn-from-aca-implementation-and-improve-the-law [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:34 [post_modified_gmt] => 2014-03-04 16:14:34 [post_content_filtered] => [post_parent] => 0 [guid] => http://kaiserfamilyfoundation.wordpress.com/?post_type=perspective&p=70869 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 68482 [post_author] => 36622400 [post_date] => 2013-04-22 19:00:49 [post_date_gmt] => 2013-04-22 23:00:49 [post_content] => Drew Altman, President and CEO of the Foundation, and Larry Levitt, Senior Vice President, co-authored a Washington Post op-ed that examined how the economy affects the nation’s health spending.  It concludes that the record slow growth rate of recent years stems largely from economic factors beyond the health system, with the economy explaining 77 percent of the slowdown, and more rapid growth expected in coming years if the economy strengthens as expected.  The op-ed was based on a related Foundation Issue Brief.

Washington Post Op-Ed

 washingtonpost_logo [post_title] => We Still Have a Health-Care Spending Problem [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => we-still-have-a-health-care-spending-problem [to_ping] => [pinged] => [post_modified] => 2013-05-09 18:55:04 [post_modified_gmt] => 2013-05-09 22:55:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://kaiserfamilyfoundation.wordpress.com/?post_type=perspective&p=68482 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 82451 [post_author] => 36621681 [post_date] => 2013-08-14 12:37:33 [post_date_gmt] => 2013-08-14 16:37:33 [post_content] => Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014 Many of you have commented over the years on my President’s Message on this website which explains our purpose and mission in creating the modern day Kaiser Family Foundation and how we operate. I update it periodically to keep it current as we evolve. With the passage, implementation and continuing debate about the Affordable Care Act, I thought I would provide a companion essay about our role on the ACA. Our mission, stated at the top of our home page, is “filling the need for trusted information on national health issues.” It is inspired by our benefactor Henry Kaiser’s motto: “find a need and fill it.” Henry Kaiser was talking about finding a niche in American industry, but that is also what we try to do in a different time and in the very different world of health policy. Our mission doesn’t change because of the passage of the ACA or the hyper-partisan environment in which it is being implemented. We have addressed all kinds of health policy legislation over the years, dating back to the Clinton reform effort which unfolded just as we were creating the modern day KFF, and we are accustomed to operating in a highly politicized health policy environment. In fact, when it comes to politicized health policy issues, I can remember earlier election-driven Medicare debates that would give the current ACA discussion a run for its money. As in these past debates, our role on the ACA is to inform the debate and give the American people information they can use to understand the law and make the best choices for themselves and their families. We do this through the facts and analysis we produce; our polling and survey research; our news service (Kaiser Health News) and our many other efforts to help strengthen news coverage; and through the events we hold and our daily role in the field as explainers and technical experts. Certainly we want to see more Americans have insurance coverage and better protection from the sometimes crushing burden of health care costs. But at Kaiser we take no position on the ACA, or any other law or proposal for that matter. Some laws are good, some bad, and most are a mix of good and less good. Some are popular and some less so. Our role is the same whether we are working on Medicaid, Medicare, the ACA, or any other law or health policy issue. One difference now is that the ACA is a law that has actually passed and is being implemented. But it is a difference mainly of scale and complexity. We have worked to inform the implementation of other laws in the past, such as CHIP and the Medicare drug benefit, and we have long specialized in Medicaid which like the ACA involves a big role for the states. With this in mind, we have a five-part strategy for our work on the ACA: 1. PRODUCING FACTS AND ANALYSIS. This is the backbone of what we do. The key to our work, on the ACA or any issue, is picking the right topics to work on so that we are useful and relevant, getting the timing of what we do right, and getting information to our core audiences in understandable and digestible forms, especially policymakers and the media. Many of us have PhDs and have been in academia, but our business is different from the academic enterprise. We do not start with what the unanswered or interesting research questions are, we start with what information is needed by policymakers, the media and the public to inform policy debates. Occasionally we are called a “think tank.” I like to believe we think, but we function differently from most think tanks. We operate large programs such as a national news service, an in-house polling operation and large national media campaigns such as Greater Than AIDS. Another difference from most think tanks is that everything we put out is an organizational product, not the work of individual scholars, authors or opinion leaders. 2. INFORMING JOURNALISTS AND NEWS ORGANIZATIONS. We have always placed equal weight on policy analysis and media at Kaiser, and the ACA is no exception. With Washington and the Congress in a hyper-partisan boil, the news media play an even more important role than at any time since we established the modern day KFF at mediating national policy debates and informing the public. One of our biggest and most resource-intensive commitments as an organization is to be an everyday resource for journalists and news organizations as they cover the ACA. Our goal is not to be cited or quoted, it is to improve the quality of health policy information the American people get, and we are keenly aware that anything we do directly ourselves to put out information pales in comparison to the reach of the media, in all of its current day forms. We also have long operated fellowship and other programs to help journalists better understand the intricacies of health policy. 3. PRODUCING OUR OWN JOURNALISM. In June of 2009, we established our own news service, Kaiser Health News (KHN), to provide in-depth coverage of health policy, free of the competitive and bottom line pressures that affect most commercial news organizations. KHN is the successor to kaisernetwork.org, which produced daily news summary reports and webcasting but not original journalism. KHN is a regular foundation program but it is editorially-independent, and a fully credentialed national health policy news service. We distribute our KHN content free through a wide range of partners such as The Washington PostUSA Today, and NPR. An important thrust now at KHN is to cover the ACA story as it unfolds in states and communities beyond the Beltway. To that end, we have established a new regional newspaper network and partnerships with many NPR affiliates across the country, and we are expanding our west coast coverage and developing a California bureau. KHN also produces two highly popular daily news summary reports, as well as original programming from our broadcast studio in our D.C. building.  We are also now producing health policy coverage for the NewsHour. You can catch KHN reporters frequently on C-SPAN or the NewsHour explaining health policy developments. As the ACA gradually fades from the headlines there will be an even greater need for KHN. 4. POLLING AND SURVEY RESEARCH. Our monthly tracking polls are among our most prominent products and familiar to many of you. Our polling group designs our polls not just to monitor opinion, but more importantly to examine people’s experiences with the ACA and their level of knowledge about the law. Because we have been polling about health reform since the early 1990s, we have a well-tested battery of questions and a repository of experience that we can bring to polling about the ACA. We always adhere to the highest methodological standards in our polls and maintain sample sizes that allow us to report confidently on relevant subgroups of the population. In addition to the polls we conduct ourselves, we also conduct in-depth special project surveys with news media partners, most notably The Washington Post, with whom we have conducted twenty-seven survey projects, as well as The New York Times. We are also fielding several large-scale special surveys at Kaiser designed to assess the impact of the ACA, with a focus on the lower income and uninsured populations. Many of you are also familiar with our benchmark annual survey of employer health benefits and premiums, which we release every year around September. 5. CONSUMER INFORMATION. With ACA implementation moving forward and our polls showing that so many people are uninformed or confused about what the law means for them, we are ramping up our consumer information materials. We have made a solid start with our ACA Calculator, our animation narrated by our Trustee Charlie Gibson, our FAQs, and our quizzes. But, we plan to do much more, including translating much of our consumer information into Spanish. Our goal in doing all of this is not to be a direct resource for consumers, since that is generally not our role and we don’t have the means to answer questions from millions of people about their individual circumstances. Rather, we will distribute what we produce through media partners and direct people to local resources that will help them make individual choices. The more time I spend talking about the ACA, the more I am convinced of the need for basic information about what the law does and does not do. Overall this has been one of our greatest discoveries at Kaiser about health policy information: basic facts and explanations are as powerful in our world as the seminal study. We try to do both and everything in between. These roles and strategies – facts and analysis, assisting news media coverage, our own news service, polling and survey research, and consumer information – are the main tools we use to take on ACA implementation. Every day, in each of these areas, we make decisions about what analyses we want to do, what polls and surveys to do next, what news stories we do at KHN, what events to hold, what media appearances to accept or decline, how many journalists and news organizations we can assist that day, and so forth. For an operating organization, all these choices require resource commitments. Many organizations make these kinds of decisions. These tactical decisions translate the strategy into impact. There is no manual for making them; they are the art of what we do and hopefully we mostly make the right calls. Lastly, across all of the elements of Kaiser’s ACA strategy, we maintain a consistent focus on the issues and developments that most affect people, and especially people with the greatest health and economic needs. The focus on people is the hallmark of our organization. Others will focus on health professionals and health care institutions or the health care industry, all important issues as well. But, with some exceptions, that is not what we emphasize. We put information to work for people and try to focus on the policy issues and choices that affect millions. The choices we make about what we choose to do and choose not to do with our limited staff and financial resources are always guided by this compass. 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