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I. INTRODUCTION/BACKGROUND ON NEW YORK STATE and brief comparison of New York to nation [2 pages]
b. Percent Uninsured
c. Medicaid spending per enrollee
d. Population size and health status
e. Fiscal capacity of state
f. General size of public sector/type of tax structure
II. PRIOR HEALTH CARE REFORM POLICY [OR POLICIES] [2 pages]
a. Give names/dates—waivers or other key reforms
b. Explain some detail – how it worked – what it changed?
c. State goals of reform/expected effects regarding:
III. OUTCOMES OF PAST REFORM [3 pages]
a. What has been achieved?
b. Present measured outcomes where possible
a. Efficiency in allocation or production
b. Equity in insurance, access, health
IV. CURRENT STEPS UNDER ACA [2 pages]
a. Insurance exchange
b. Medicaid expansion
c. Other [Global budget, managed care, premium assistance]
d. Financing changes (taxes, DSH, etc.)
V. Health Policy Reform Evaluation (1 page)
Effects of prior reform
What were key effects?
a. Efficiency Effects
e.g., expansion of insurance coverage
e.g., decrease costs/similar care
b. Equity effects
e.g., access to health care
e.g., burden of financing health care
VI. ANTICIPATED EFFECTS OF REFORM UNDER ACA [2 pages]
a. Insurance coverage, premiums, access
b. Medicaid coverage, efficiency/ cost , equity
c. Other –effects of innovation in reform (on efficiency and equity)
VII. FACILITATORS AND BARRIERS TO REFORM UNDER ACA [1 page]
What lessons from their earlier reform led them to their current approach?
What are the facilitators or barriers to reform under ACA?
a. Fiscal capacity
b. Political realities
c. Tax structure.
What are your Recommendations for other changes to reform effort in your state?
a. What are the pros and cons of the reform?
b. How might you like to see it changed?
Make sure you use Daniels – Nine Benchmarks
a. Background on state—population/fiscal capacity/general size of public sector/type of tax structure
II. HEALTH CARE REFORM POLICY [OR POLICIES] PAST and PRESENT
a. Waivers or other key reform, effects on efficiency and equity
b. Summarize reform under ACA—Medicaid expansion, exchanges, waivers
III. WHAT ARE EXPECTED OUTCOMES OF REFORM UNDER ACA
? Will it change some sectors affecting public health?
Reduce inequalities in social determinants and risk factors that ultimately affect health such as
Clean water, housing, information infrastructure?
? Will it reduce financial barriers to equal access?
Define a basic package to be received by all, uniform benefits; moving more of the population into this formal, insured sector?
? Will it change non-financial barriers to equal access?
These could include geographical, gender-based, cultural or discriminatory practices that reduce equity in access [e.g. distribution of providers, gender based differences in care, racial/ethnic disparities];
? Will it ensure comprehensiveness of benefits across ‘tiers’ ?
That is, will it reduce inequality in coverage and quality of care-’tiering’; the latter is more of an issue if small, wealthy group does better than others (e.g. UK) than if relatively larger, poorer group is worse off than rest of society (e.g. working uninsured in US);
? Is it based on equitable financing?
Is financing based on ability to pay? Progressive taxes, community-rated premiums, how much out- of-pocket?
? Does it improve efficacy, efficiency and quality of care?
Does it help the state get more out of its resources, ensure appropriate allocation of resources, provide incentives for efficient production, focus on primary health care, evidence-based practice and include assessment/monitoring of quality?
? Does it ensure administrative efficiency?
Will there be efficiency in management of resources, will the effort minimize overhead costs, minimize abuse and avoid duplication of services?
? Does it allow for democratic accountability and empowerment?
Will it include a fair appeals process, adequate privacy protection, enforcement of regulations, empowerment of society—make resource allocation decisions publicly accountable (provider reports, public hearings, etc.)?
? Does it ensure patient and provider autonomy: informed choice necessary for markets—
Does it provide choice and provider autonomy without conflicting with other benchmarks?
Make sure that information used in the paper are updated
Check your work for plagiarism before you give it to me
My paper is about New York State
You can use unlimited number of resources
? Holahan and Pohl: States as Innovators in Low-Income Health Coverage” Discussion Paper 02-08, Assessing the New Federalism, Urban Institute, Washington DC, June 2002.
? State Specific Websites and Reports
? http://www.kff.org/ and especially: http://www.statehealthfacts.org/
Sources for Updates under ACA:
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