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The Nelson A. Rockefeller Institute of Government

Health Care

Health Reform

The Institute has a long history of providing unbiased and in-depth research on the role of state and local governments in administering, financing and implementing health reforms. The Institute’s experts target their research to state and local policymakers, on topics that include Medicaid managed care, Medicaid and state budgets, long-term care and private insurance coverage. This page highlights some of the Institute’s most recent work on issues relevant to health reforms enacted in 2010.

America’s Health Care Cost Crisis and What to Do About It

A new paper by Rockefeller Institute Senior Fellow Richard Nathan examines the difficulty in implementing the Affordable Care Act in the face of so many uncertainties. Nathan proposes the creation of a new institutional mechanism to monitor and react to changing conditions and to provide feedback to Congress and the president on necessary adjustments to meet the goals of the legislation.
Richard P. Nathan, March 2013

How to Rein in Health Care Costs: Empower Consumers

A new paper by former Rockefeller Institute director (and former U.S. OMB official) Richard P. Nathan explains his reasoning for favoring the consumer-choice approach for next-step health reforms and in doing so presents recommendations for cost constraints to help reduce federal deficits over the long term and suggests ways to implement his recommendations. The paper is introduced by Thomas Gais.
Richard P. Nathan, December 2012

The Health Care Challenge Facing America’s Governments

In his third brief on the fiscal challenge caused by rising health costs, Nathan examines how markets operate in our health system. He focuses on ideas that seek to empower consumers — and calls for combining them with what are often seen as opposing approaches based on provider value.
Richard P. Nathan, June 2012

Fighting For Our Health: The Epic Battle to Make Health Care a Right
in the United States

This book from the Rockefeller Institute Press offers a vivid, first-person account of how health care reform came to be. The book brings readers inside the biggest and most consequential issue campaign in American history. Fighting for Our Health recounts how a reform campaign led by grassroots organizers played a crucial role in President Obama's signing historic health reform legislation in March of 2010 — defeating powerful industry lobbyists and Tea Party activists.
Richard Kirsch, February 2012

Ideas for Reconciling Two Cultures for Health Reform

Taking the next step to reform health care is, Richard Nathan says in this issue brief, a public management challenge of the highest order. He suggests blending the best of liberal and conservative ideas to create a "Health Choices System" led by a phased two-step process to assure orderly planning and implementation.
Richard P. Nathan, November 2011

Expanding Public Health Insurance Under the Affordable Care Act:
What New York Might Learn from Connecticut, Massachusetts and Vermont

This lively, interactive public policy forum focused on how some states are expanding public health coverage in implementing the federal legislation that passed last year. The forum kicked off with presentations from speakers representing states neighboring New York. Brian Rosman of Health Care for All Massachusetts described the five-year-old Massachusetts law that is the model for federal reform law. Jill Zorn of the Universal Health Care Foundation of Connecticut discussed legislation to establish a public option — a state-run insurance plan that would compete with private insurers — when Connecticut implements federal health reform. Robin Lunge represented Vermont Governor Peter Shumlin, who is expected to sign legislation authorizing Vermont to set up a single-payer health plan, which would cover all state residents and be funded by taxpayers. New York State Senate Health Committee Chairman Kemp Hannon, Assembly Health Committee Chairman Richard Gottfried and Judy Arnold of the New York State Health Department spoke about past and current efforts aimed at expanding health coverage in New York. Also joining the forum were representatives of health insurance, hospital and insurance groups: Mary Clark of Citizen Action of New York, a consumer advocacy group; Jeffrey Gold of the Health Care Association of New York State, a group of hospitals and health care networks; and Paul Macielak of New York Health Plan Association, a trade group for managed care insurance plans.
May 19, 2011

Implementing Health Reform

Washington and the states are undertaking the complex task of implementing the Patient Protection and Affordable Care Act, the federal law signed by President Obama in March. At this public policy forum, former Institute Director Richard P. Nathan questioned whether the law will accomplish the essential goals of efficiency and cost control, given the wide range of influential constituencies that oppose change in the health-care system. He stressed that federal mandates should not treat states as if they are all the same, but consider how national policies will be implemented differently in varying states. Health-care consultant Deborah Bachrach, formerly deputy commissioner of health and Medicaid director for New York State, detailed some of the implementation tasks that states face, and urged New York legislators to consider immediately the design of legislation that must be in place for reforms that are mandated in 2014.
September 27, 2010

Q&A: What States Face Now in Implementing Health Reform

Major new responsibilities fall to the states in implementing federal health reform. The changes present challenges as well as an opportunity for states to build better, more cost-effective health systems. In this interview, Courtney Burke outlines the main tasks that states must undertake.
Courtney E. Burke, September 2010

How Will New York Implement Health Reform?

With relatively generous public health insurance programs, New York may be in a better position than many states to implement changes mandated by the health reform law that Congress passed in March. Yet many questions remain regarding how the state and localities will accomplish implementation — including the issue of how they will pay for it, said speakers at this Institute public policy forum. James Knickman, president and chief executive officer of the New York State Health Foundation, led the discussion with an overview of the changes required by the new law. Joseph D. Morelle (pictured), chair of the New York State Assembly’s Standing Committee on Insurance, stressed the need to balance the desire for more comprehensive insurance coverage with the costs of that coverage. Robert Doar, commissioner of the New York City Human Resources Administration, called for identification of a single agency to oversee all the changes required by health reform, to avoid having implementation get bogged down in bureaucratic red tape.
Tuesday, June 8, 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

The Impact of Health Reform: A Few Things We Don’t Know

On the topic of the new federal health-care legislation, there are all kinds of questions for which “I don’t know” is the only answer that President Obama, or the Democratic and Republican leaders in Congress, or anyone else can honestly provide.
Robert Ward, March 2010

Note to Health Reformers: All High-Risk Pools are Not Equal

Creating pools to insure high-risk, high-cost patients is a health reform proposal with broad support from Democrats and Republicans. Many states already have these, and not all of them have gotten it right. This Observation highlights what works well about Minnesota’s high-risk pool.
Courtney Burke and Lynn Blewett, March 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.
Courtney Burke, January 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

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
Companion piece: State Case Studies: Product Standardization in Small Group and Individual Insurance Markets

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

The Overlooked Reversal:
Obama’s Support for Requiring the Purchase of Health Insurance

In his speech on health care reform, President Obama expressed support for a mandate that everyone have health insurance. That was a switch from his position during the presidential campaign. What would such a mandate mean for health-care reform, and for states? This observation discusses the individual mandate.
Courtney Burke, September 2009

Managing Risk in Health Insurance Markets:
A Challenge for States in the Midst of Health Care Reform

States seeking to manage health-insurance risk while providing coverage to more residents should apply several strategies at once, say the Institute's Courtney Burke and Harvard University's Katherine Swartz in this report. Strategies include a requirement that individuals purchase insurance, creation of an insurance exchange, and merger of small group and individual markets.
Courtney Burke and Katherine Swartz, September 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

Playing Ball with a Full Team: States and Federal Health Reform

“Frenetic” could describe the pace with which congressional committees have made deals to advance health reform. This observation highlights important role states will play on the health reform team.
Courtney Burke, August 2009

A Quick Primer on Health Reform

Got two minutes? That's enough time to learn these six terms that define what the health reform debate is about. Yet while simple to learn, all six parts of the puzzle are hotly controversial and intrinsically complex. Moreover, if any one of them isn't in the mix, the grand plans will be foiled.
Richard Nathan, August 2009

How States Are Financing Health Coverage Initiatives

Courtney Burke, director of the Institute's Health Policy Research Center, gave an invited presentation on states' efforts to finance 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 2009

Remedy for Health Reform Planning

The politics, finances, and management challenges of health care reform have bedeviled the nation for 60-plus years. The power of the moneyed, vested interests in the status quo are extraordinary — and, if anything, have increased. A special decision-making mechanism is needed.
Rochard Nathan, May 2009

Health Care Reform: Thinking Long-Term

With the aging of the baby boom generation and a growing federal deficit that is largely driven by health-related programs, issues surrounding long-term care should be front and center in discussions about health reform. For decades, states have been experimenting with ways to improve long-term care quality and reduce its costs. State innovations could serve as models for nationwide reforms. This Observation highlights some innovations that states may want to consider.
Courtney Burke, March 2009

Continuing Role of the State vs. Federal Government in Health Care

Courtney Burke, director of the Institute's New York State Health Policy Research Center, addressed a forum sponsored by the League of Women Voters, reviewing the state role in health care and offering an overview of the Obama and McCain health care proposals.
October 2008