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Opening day for national health spending analysis comes every year in early January, when the actuarial team at the Centers for Medicare and Medicaid Services(CMS)  throws out the first ball of figures to Health Affairs readers. This also triggers several early rounds of rear-view interpretation in major media outlets, primarily aimed at reconciling the latest factoids with seasonally adjusted … [Read more...] about Thomas Miller and Catherine Griffin: US national health care spending continues trend of slow growth

Texas Medicaid spending is on an unsustainable trajectory. The program’s expenditures now consume 25 percent of the state budget, making it increasingly difficult to adequately address other vital state needs. With the recent recession and a slowly recovering economy, Texas is struggling to close budget gaps. The problem has been exacerbated by an increase in Medicaid enrollment and spending, … [Read more...] about Jim Capretta: Assuring a Future for Long-Term Care Services and Supports in Texas

This month, the post-election rollout of the Obama administration’s plans to implement insurance exchanges under the Affordable Care Act (ACA) in time for January 1, 2014 enrollment was met with substantial state government opposition, more questions than answers, and warning signs of a train wreck ahead. A clear majority of states (32) are not fully on board with running their own ACA-compliant … [Read more...] about Tom Miller: Beyond Defeat or Defiance

The Wall Street Journal has weighed in on the controversy about whether states should set up their own exchanges and comes down solidly against “ObamaCare's Faux Federalism.” For those governors who think that they will have more flexibility if they set up their own ObamaCare exchanges, the Journal says:  “HHS's idea of flexibility is telling the states they can make the exchanges even more … [Read more...] about More reasons for states to say “no” to ObamaCare exchanges

Medicare is at the center of the ongoing debate over the country’s fiscal future, but there is a palpable fear that any change could “end Medicare as we know it.”[1] Policymakers worry that an honest assessment of Medicare’s finances would be punished at the polls by seniors who do not want their health benefits threatened. As a result, the debate over Medicare has been couched in comforting but … [Read more...] about Joe Antos: Saving Medicare: A market cure for an ailing program

On its face, the low-key discussion around a conference table in Miami last month did not appear to have national implications. Eight men and women, including a diner owner, a chef and a real estate agent, answered questions about why they had no health insurance and what might persuade them to buy it. But this focus group, along with nine others held around the country in November, was an … [Read more...] about Abby Goodnough: Next Challenge for the Health Law: Getting the Public to Buy In

Federal and state governments are under increasing pressure to limit Medicaid spending without negative health consequences. We examine a unique policy effort in West Virginia aimed at reducing spending and improving health through personal responsibility and preventive care. These efforts show promise for reducing emergency-room (ER) visits among those who chose the personal-responsibility plan … [Read more...] about Tami Gurley-Calvez: Medicaid reforms and emergency room Visits: evidence from West Virginia’s Medicaid redesign

Amid a protracted rollout, the real-world evidence keeps mounting: the Affordable Care Act (Obamacare) is too costly to finance, too difficult to administer, too burdensome on doctors, and too disruptive of health care arrangements that Americans prefer. The need to replace it has never been stronger, yet full repeal is unviable in the short-term. The long-term task for reformers is to lay out a … [Read more...] about Tom Miller: When Obamacare fails: The playbook for market-based reform