Author Archive for Diana Birkett Rakow

Debt ceiling and deficit reduction (semi) end-game

By Diana Birkett Rakow

After weeks of debate, the White House and Congress have agreed to increase the U.S.debt ceiling while ultimately cutting federal spending by $2.4 trillion, according to the Congressional Budget Office’s assessment.

 The House approved the Budget Control Act on Monday evening by a vote of 269-161 (in a wonderful, apolitical moment, Representative Gabrielle Giffords, injured in the shooting in Arizona last January, returned to work for the first time in eight months to cast her vote on this bill). The Senate approved it 74-26 on Tuesday, and it was signed by the President soon thereafter. The last minute deal averted what would have been the first default in U.S.history, but the politically fraught process leading up to yesterday’s default deadline will likely yet have economic and political implications, and the hardest work of identifying specific cuts, revenues, and program changes to reduce the deficit still lies ahead.  Continue reading ‘Debt ceiling and deficit reduction (semi) end-game’

Published on August 3, 2011 in Health Care Reform. 4 Comments

Health Reform and State Flexibility

By Diana Birkett Rakow

On Monday March 7th, President Obama spoke to the National Governor’s Association and acknowledged both the progress with and challenges inherent in implementation of health reform. In a significant step toward working productively with state leaders across the political spectrum, he also announced his support for state flexibility in reform implementation.

Specifically, he supports allowing states to apply for waivers, as early as 2014, that would let them implement health reform differently and in a way that makes sense for their specific state. Such waivers are currently allowed under the existing health reform law, but not until the year 2017. The change to allow such waivers in 2014– which has been proposed in a bill sponsored by Senators Wyden and Brown – would probably still need to be passed by Congress in order to become law, but the chances of this are greatly increased by the President’s support. Continue reading ‘Health Reform and State Flexibility’

Published on March 10, 2011 in Health Care Reform. 0 Comments Tags: .

Federal advisory board considers co-ops

By Diana Birkett Rakow

Last week, I had the great opportunity to testify at the first public hearing of the Federal Advisory Board to the Consumer Operated and Oriented Plan (CO-OP) Program, which was created as part of the Affordable Care Act (ACA) passed last year. The 15-member board includes physicians, former regulators and government officials, consumer representatives, business people, and an actuary, appointed last summer by the US Comptroller General, who leads the Government Accountability Office (GAO). The full membership of the Board is described here. The Board’s job, as outlined in the health reform law, is to provide recommendations to the Secretary of HHS on how to structure the new program, including how to award grants and loans to organizations establishing new, member-run coverage providers that would provide insurance to individuals and small group through Exchanges, as outlined in the ACA. Continue reading ‘Federal advisory board considers co-ops’

Published on January 18, 2011 in Health Care Reform, Medical Home and Uncategorized. 1 Comment Tags: .

Federal support for state Basic Health

By Diana Birkett Rakow
As the State Legislature goes to work this week in Olympia, its biggest challenge will be balancing the state budget. With a nearly $5 billion shortfall for the next biennium, which begins in July 2011, several programs are on the table for reductions, or even elimination. One of those is the Basic Health program, which provides coverage to over 55,000 people around Washington State, about 10,000 of whom get their coverage and care at Group Health. Continue reading ‘Federal support for state Basic Health’
Published on January 14, 2011 in Health Care Reform and Medicaid. 0 Comments

State budget cuts a taste of more to come

By Diana Birkett Rakow

The Washington State Legislature held a one-day special session on Saturday, Dec. 11, to address an anticipated billion dollar shortfall in the current operating budget. Lawmakers enacted a pre-negotiated set of budget bills that cut the anticipated shortfall by approximately $700 million.

The cuts made in this special session spared some state-funded health care programs from being completely eliminated for now, but that may have to change as lawmakers come back to address an expected $5 billion shortfall in the 2011-2013 budget.  We know the Legislature will have even tougher decisions to make when it reconvenes in January.  Continue reading ‘State budget cuts a taste of more to come’

Published on December 14, 2010 in Health Care Reform, Medicaid and Medicaid. 9 Comments Tags: , .

CMI promises to foster innovation

By Diana Birkett Rakow

Much debate over how best to fix the problems in the health care system has centered around how much to rely on the private market versus the public sector. Advocates for reliance on the private market argue that competition and market forces spur innovation and better solutions.

True, in part. At Group Health, we have made amazing improvements in primary care by testing, evaluating, and finally implementing a new medical home model. Through this model, emergency room visits are down 39 percent and hospitalizations down 19 percent, while patients are healthier and happier with their care. Continue reading ‘CMI promises to foster innovation’

Published on November 22, 2010 in Health Care Reform and Medicare. 2 Comments Tags: , , .

New law provides for safe disposal of prescription drugs

By Diana Birkett Rakow

It is especially great news, as we approach election day and in a year when much Congressional debate on health care policy was frought with disagreement, that federal legislation to provide safe disposal of prescription drugs passed last week with widespread bipartisan support. The final version of S. 3397, the Secure and Responsible Drug Disposal Act of 2010 (a compromise between House and Senate versions of the legislation – S. 3397 and H.R. 5809, the Safe Drug Disposal Act), is expected to soon be signed into law by the President. Continue reading ‘New law provides for safe disposal of prescription drugs’

Published on October 5, 2010 in Quality Health Care. 0 Comments Tags: .

What’s quality got to do with it?

By Diana Birkett Rakow

Medicare Advantage Quality Bonus Payments and the CMS Star Rating System

The federal health reform bill passed in March took a major step forward ‘on the path toward paying for health care not solely based on the cost of delivering care and the volume of services delivered, but by the quality of care provided to patients.  A significant part of this change will take place in the Medicare Advantage (MA) program, where under a new payment system, about 5% of MA plan payments by 2014 will depend on the quality of care and service delivered to people enrolled in that plan – and up to 10% in certain counties.  The new payment system not only drives toward more efficient spending in Medicare, but also toward greater emphasis on quality of care and service. Continue reading ‘What’s quality got to do with it?’

Published on August 4, 2010 in Health Care Reform and Medicare. 0 Comments Tags: , , , .

States need federal support to “bridge” to health reform

By Diana Birkett Rakow

Medicaid, the health care coverage program for low-income individuals, is administered at the state level but funded jointly by the state and federal governments: for every dollar spent by the states for Medicaid, the federal government kicks in a matching amount, according to the Federal Medicaid Assistance Percentage (FMAP) for that state.

The stimulus bill Congress passed in early 2009 included a provision that temporarily increased the FMAP for all states, aiming to help states make it through the economic downturn when less tax revenue is generated and more people are likely to enroll in support programs like Medicaid.

Continue reading ‘States need federal support to “bridge” to health reform’

Published on July 12, 2010 in Health Care Reform and Medicaid. 0 Comments Tags: , .

Medical Loss Ratio – what is it and why is it important?

By Diana Birkett Rakow

The health reform legislation sets a minimum percentage of a health care premium that must go toward medical costs.  This percentage is called the “medical loss ratio.”  Beginning in 2011, 85 percent of premiums for large group and Medicare Advantage plans must go to services and activities related to quality of care. The minimum will be set at 80 percent for small group and individual plans.  The goal of these provisions, which will take effect in 2011, is to limit health insurance administrative costs. Only 15 percent or 20 percent, depending on the plan type, will be allowed administration as well as profit (for for-profit carriers) or sales and marketing costs.

Until now, different companies calculate medical loss ratio (or MLR) differently.  But in the interest of comparing apples of apples and enforcing the new minimum levels, the health reform law also requires the development of a standard new definition. 

Continue reading ‘Medical Loss Ratio – what is it and why is it important?’

Published on July 8, 2010 in Health Care Reform. 2 Comments Tags: , .