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The Nelson A. Rockefeller Institute of Government

Health Care: Health Policy, Medicaid Politics, and Finance

Health Policy, Medicaid Politics, and Finance

The Adoption of Mental Health Drugs on
State AIDS Drug Assistance Program Formularies

States differ in their inclusion of drugs to treat mental illness in their programs that cover residents with HIV. Erika G. Martin, of the Rockefeller Institute and the Rockefeller College of Public Affairs & Policy, and Colleen M. Barry, of the Johns Hopkins Bloomberg School of Public Health, found three factors associated with that difference in coverage. Their findings are presented in this article.
Erika G. Martin and Colleen L. Barry, American Journal of Public Health, April 14, 2011

Can We Pay for Expanded HIV Screening?

Routinely testing all Americans for HIV would be cost-effective, according to the Centers for Disease Control and Prevention. But public programs may not be prepared to pay for expanded screening, Martin explains in this Q&A. The biggest costs would arise from treating people who test positive.
An Interview with Erika Martin, November 2010

Not So Sweet: The Failure of a Public Health IPO
in the Political Derivatives Market

New York State Health Commissioner Richard Daines has twice promoted proposals by Governor David Paterson to tax soda and other sugary beverages — and twice seen those efforts defeated. At this Institute public policy forum, Commissioner Daines offered a rationale for increasing the cost of sweetened drinks — which he described as a major contributor to the obesity epidemic — and discussed the political battles and media imagery that worked against the campaign for the tax. He likened the industry reaction and media coverage of the proposal to the financial derivatives that contributed to the housing market bust in 2008.
Tuesday, November 9, 2010

Room for Interpretation: Causes of Variation in County Medicaid Asset Transfer Rates, Opportunities for Cost Reduction

New York State’s assumption of county Medicaid administration could reduce costs, but big savings will depend on improved administrative processes, according to this Institute report. The report examines differences in Medicaid nursing home eligibility denials among counties as an illustration of the challenges the state will face in taking over administration of Medicaid.
Courtney E. Burke, with Barbara Stubblebine and Kelly Stengel, August 2010

Medicaid Policy and Long-Term Care Spending: An Interactive View

Institute experts have applied an interactive measure that proves better at explaining wide variations in states' long-term care spending than individual measures analyzed in previous research. The index considers multiple factors, including coverage policies, nursing home payment rates and others. It may assist states in developing new policies to enhance care for elderly and disabled residents, while limiting costs.
James W. Fossett and Courtney E. Burke, August 2010

Thinking Ahead: Health Care Trends

This presentation for the Albany Medical Center Horizons Strategic Planning Committee provides an overview of the current health system and what will change under federal legislation, and suggests how the health system might change in the next five-10 years.
Courtney Burke, April 20, 2010

Health Care Reform: What You Need to Know and
How it Will Affect New York State

Courtney Burke, who directs the Institute's Health Policy Research Center, discussed federal health reform and its effect on New York State in presentations to the State Academy of Public Administration and the Schenectady Business and Women's Association. The presentation includes a look at similarities and differences in House and Senate bills, the effective dates of various provisions and their potential impacts on the state.
Courtney Burke, January 2010

Q&A: What Federal Health Reform Means for the States

The effort to reform health care at the national level is a complex one. If federal legislation ultimately passes, the states will need to implement mandated changes and pay for them. The Institute's director of health policy research offers a primer of the challenges that states may face.
An interview with Courtney Burke, December 2009

Gold, Silver, and Bronze: The Important Role of Product Standardization in Health Insurance Reform

National health reform will rely on consumer choice and competition to control costs whether or not there is a public insurance option, according to this Institute report. Rational consumer choice, however, is difficult without standardizing health insurance plans, so that value can be easily compared. States may have to play a key role in such standardization.
Courtney Burke with Dina Belloff, November 10, 2009

The Role of States in National Health Reform

Health insurance was the topic of the Tenth Binghamton Symposium on Health Care Management and Policy at Binghamton University's School of Management. Courtney Burke, director of the Rockefeller Institute's Health Policy Research Center, spoke about the role of the states in implementing national health reform efforts. Burke covered such topics as financing, administration, implementation and the need to address issues not covered in federal legislation, like cost and quality considerations.
Courtney Burke, October 10, 2009

Chickens, Eggs, and Institutions:
Minnesota Launches Health Care Homes

Can universal coverage and containment of the rate of growth of health care costs be achieved simultaneously? If not, which comes first, the chicken or the egg? This report, from Institute Co-Director Richard P. Nathan and Columbia University's Lawrence D. Brown, looks at Minnesota's experiment with health care homes as one instructive effort.
Lawrence D. Brown and Richard P. Nathan, August 2009

How States Are Financing Health Coverage Initiatives

Courtney Burke, director of the Institute's Health Policy Research Center, gave a presentation on states' efforts to provide health insurance coverage at the 2009 annual research meeting of AcademyHealth, a professional society for health researchers and policy analysts. In addition to a talk and slide presentation, Burke presented posters on state financing of such coverage efforts and on risk management strategies.
State Financing for Coverage Initiatives: Poster Abstract
Managing Risk: Poster Abstract
Courtney Burke, June 27, 2009

State Financing for Health Coverage Initiatives: Observations
and Options

New York faces steep financial challenges as it works toward universal health care coverage, according to a new report by the Institute's Health Policy Research Center. The report, funded by the New York State Health Foundation, analyzes potential sources of revenue and savings that the state could tap.
June 3, 2009

Mitigating the Effects of High-Risk, High-Cost Populations in the Private Health Insurance Market

At this Institute Public Policy Forum, Katherine Swartz, professor of health policy and economics at the Harvard School of Public Health, provided an overview of the "Massachusetts experience" with ensuring universal health coverage, with a focus on the need to manage — and contain costs — for people with high medical expenses. In response, New York officials representing the departments of Health and Insurance — Troy Oechsner, Jay Laudato and Eileen Hayes — shared perspectives on New York's challenges in expanding care to more high-risk patients.
May 21, 2009

Health System Reform in a Budget Crunch

The impact that New York State’s budget problems will have on the state’s health care system was the focus of a Public Policy Forum sponsored by the Institute’s New York State Health Policy Research Center.
December 9, 2008

Executive Federalism and Medicaid Demonstration Waivers: Implications and Democratic Process

This paper examines the use of Medicaid 1115 demonstration waivers during the presidencies of William J. Clinton and George W. Bush, documenting and comparing waiver activities from the perspective of policy performance and democratic processes.
Frank Thompson and Courtney Burke, Journal of Health Policy, Politics, and Law, Vol. 32, No. 6, December 2007

"Federal" Health Care Reform Will Rely On the States

Health care is one of the most talked-about issues in the 2008 presidential campaign. And for all the differences among the leading candidates, there are also important similarities. Among these, one stands out: the central role the 50 states will play in health care reform, regardless of who wins the White House.
Courtney Burke, November 2007

Medicaid and State Budgets: Clearing Storm, Foggy Forecast

Health care is one of the most talked-about issues in the 2008 presidential campaign. And for all the differences among the leading candidates, there are also important similarities. Among these, one stands out: the central role the 50 states will play in health care reform, regardless of who wins the White House.
Courtney Burke, August 2007

Medicaid Funding for Nonprofit Healthcare Organizations

Understanding the extent of the financial affiliation between Medicaid and nonprofits is the first step in understanding the organizational effects — but doing so is difficult because the monetary relationship may vary by the type of service provided, state, or industry. Adding to the difficulty of estimating and understanding the financial relationship between Medicaid and nonprofits is the fact that no single database exists to track the flow of Medicaid money to nonprofits. The lack of a dedicated data system necessitates the use of various sources to estimate the amount of Medicaid money going to nonprofits, which each have several caveats and only allow for imprecise estimates. Taking these caveats into account, this paper uses existing literature, analyses from industry trade organizations, data from state officials, Census data, and Medicaid expenditure data to make rough estimates of the potential amount of Medicaid money going to nonprofit healthcare providers.
Courtney Burke, June 2007

Medicaid and Nonprofits: Dollars or Nonsense?

Presentation at the National Center on Nonprofit Enterprise Conference, Washington, DC.
Courtney Burke, September 27, 2007

Medicaid Policy: Recent Trends & Developments, Future Directions

Presentation at the Medicaid Reform Conference, New York, NY.
Courtney Burke, September 10, 2007

Medicaid Funding for Nonprofit Healthcare Organizations

Presented by Courtney Burke for the Aspen Institute, Washington, DC.
Courtney Burke, June 28, 2007

The Medicaid Spending Slowdown: Is it Unusual? Will it Continue?

Medicaid per capita spending (adjusted for inflation) was lower in Fiscal Year 2006 than in the previous year, only the second drop in the program's history. The only other time Medicaid per capita spending fell was between 1995 and 1996. But the decline between 2005 and 2006 was more substantial than the decrease between 1995 and 1996. The fall in Medicaid spending in 2006 represents a significant reversal from recent trends, when growth rates were in the double digits only three years ago. At that time (2001-2003), states were in the midst of a fiscal crisis marked by declining revenues and large increases in Medicaid costs. Prior to 2001, the last time Medicaid grew at a high rate was from 1990-1992.
Courtney Burke, April 2007

What It Takes to Run a Hospital

A Public Policy Forum at the Rockefeller Institute of Government
Steven P. Boyle, President and CEO, St. Peter's Health Care Services; Gary Kochem, Executive Vice President and COO, Albany Medical Center; and Robert E. Smanik, President and CEO, Ellis Hospital, December 14, 2004

Medicaid and State Budgets in FY 2004: Why Medicaid Is So Hard To Cut

This report assesses how Medicaid was treated in fiscal year 2004 in the budgets of ten states. Drawing on detailed analyses of state budgets, it examines state budget-balancing strategies, with particular attention to changes in Medicaid spending and eligibility compared to other government functions.
James W. Fossett and Courtney E. Burke, July 2004

A Divided Community: The Effects of State Fiscal Crises on Nonprofits Providing Health and Social Assistance

This paper examines the current state revenue crisis, demand for social services, the distribution of social assistance nonprofits, and both long-run and short-run changes in state expenditures to estimate the effects of state fiscal crises on the nonprofit sector associated with human service programs. This study finds divisions among nonprofits that affect the severity of these effects. These divisions are both functional and geographic.
Thomas Gais, Courtney Burke, and Rebecca Corso, The Aspen Institute, November 2003

Is Medicaid Retrenching? State Budgets and
Medicaid Enrollment in 2002

This paper examines the sustainability of Medicaid and CHIP enrollment efforts in the large majority of the states where enrollment initiatives have been examined in earlier publications in this series. This paper will review recent trends in state revenues and Medicaid spending in these states, then examine state actions to balance their FY 2003 budgets, with particular attention to changes in Medicaid spending and activities affecting Medicaid and CHIP enrollment initiatives.
James W. Fossett and Courtney E. Burke, February 2003

Is Medicaid Retrenching?

This presentation looks at whether or not Medicaid is retrenching in various states and how Medicaid affects state budgets.
Courtney Burke and James Fossett, December 3, 2002

Health Spending and State Budgets, FY 2003

This presentation sketches recent state budget problems, examines state budget balancing actions in 2003, and assesses state budget outlook and prospects for health spending for FY 2004.
James W. Fossett, presentation at National Academy for State Health Policy, August 2002