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Commonwealth Fund Annual Report 2012

Commonwealth Fund Annual Report 2012

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Published by Patricia Dillon

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Published by: Patricia Dillon on Dec 30, 2012
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12/14/2013

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2012 ANNUAL REPORTPRESIDENT’S MESSAGE
HEALTH CARE REFORM:
 A Journey 
KAREN DAVIS
 
2 The Commonwealth Fund 2012 Annual Report
Tis year was a dramatic one for health care reformand, for several months around the Supreme Court’sdecision on the constitutionality of the AffordableCare Act, a time in which an unusually large numberof Americans were closely following federal healthpolicy. As we learned last summer, the Supreme Courtultimately upheld the law, enabling vital health caredelivery and health insurance reforms to continueand an estimated 30 million Americans to gain healthinsurance coverage by the end of the decade.It has been rewarding to see the United States finally on the path to joining all other major industrializedcountries in ensuring near-universal health insurancecoverage. his accomplishment is one that U.S.presidents have struggled to achieve over the pasthundred years—and one that I’ve worked towardover the course of my entire career. hanks to thehealth reform law, we as a nation will no longer havea health care system that allows so many Americansto suffer from treatable diseases because they cannotafford health care—or to lose their savings to pay fortreatment.Tis year has also served as a time to reflect on my 18years as president of he Commonwealth Fund. Asan economist with a background in both policy andacademia, my overarching goal for he CommonwealthFund has been to help improve U.S. health systemperformance by identifying and evaluating achievablesolutions to systemic problems of access, quality, andefficiency, especially for the most vulnerable.In many ways, the Affordable Care Act has been thefruition of work that he Commonwealth Fund andothers have conductedover the past 20 years.he law’s principles werearticulated a decade agoin such articles as “ A 2020 Vision for American Health Care” (2000), whichhelped promote the concept of patient-centeredprimary care, and in “Creating Consensus” (2003)and “ A Shared Responsibility: U.S. Employers and the Provision of Health Insurance to Employees” (2005), which outlined an approach to coverage expansionthat included individual and employer mandates, a purchasing pool for affordable coverage, and publicprogram expansions.oday, a number of these principles and recom-mendations are beginning to realize their promise:here has already been substantial progress in the firsttwo years of the Affordable Care Act’s implementation. An estimated 6.6 million young adults gained coveragein 2011 through their parents’ health insurance, thanksto the provision guaranteeing dependent coverageup to age 26. And, after 12 years of increases in theuninsured, the number of people without coveragedropped by 1.3 million in 2011. As of December2012, 18 states and the District of Columbia havesubmitted applications to HHS to operate a state-runexchange in 2014, and six states are pursuing a state–federal partnership exchange. In addition, seven statesand the District of Columbia have used new federalmatching funds to expand eligibility for adults throughtheir Medicaid programs, covering 600,000 people.Nearly all states have taken legislative or regulatory stepsto implement the law’s early insurance market reforms,
PresidentKaren Davis
Health Care Reform: A Journey
President’s Message
 
Health Care Reform: A Journey—2012 President’s Message 3
including a ban on gender and age discrimination,and coverage of preventive care services without cost-sharing. Over the course of 2012, insurers eitherlowered their premiums or paid consumers and smallbusinessesrebates amounting to more than $1 billion under the law’s requirement that they spend at least 80to 85 percent of their premium revenues on medicalcosts, as opposed to administration and profits. Andnearly 94,000 uninsured people with preexisting healthconditions have gained coverage through state-basedpreexisting condition insurance plans.In addition, the Centers for Medicare and MedicaidServices (CMS) is supporting many innovative healthcare delivery and payment initiatives to help identify  what strategies work best to improve care and lowerspending. here is evidence that such federal initiatives,and others in place in states and in the private sector, arealready beginning to slow health care spending growth. Although the fact that health care spending grew atthe slowest rate in 50 years in 2009 and 2010 is partly attributable to more people skipping care because of costs, we may also be witnessing the early impact of thespread of new models of health care delivery, improvedquality and safety, health information technology, andpreventive care.It is gratifying for me to reflect upon the fact that heCommonwealth Fund has—over the past 18 years—contributed significantly to these achievements in a number of ways:
•
providing timely policy analysis
•
identifying promising models of coverage andhealth care delivery and encouraging innovation
•
creating comparative analyses, including national and international comparisons
•
fostering the international exchange of information
•
training future leaders
•
communicating effectively.
PROVIDING TIMELY ANALYSIS
he Commonwealth Fund Commission on a HighPerformance Health System, established in 2005, hasshaped a guiding and unifying vision for the work of the Fund. he Commission, first chaired by thelate James Mongan, M.D., the former president andCEO of Partners HealthCare, and now by DavidBlumenthal, M.D., the Fund’s incoming president,includes experts and leaders representing every sectorof health care, including federal and state policy,business, and academia. Its landmark reports, including 
(2007),
(2007) and
(2009) substantially informedthe debate leading up to enactment of the AffordableCare Act.Te predecessor to the Commission was the ask Forceon the Future of Health Insurance, created in 1999 andchaired by Dr. Mongan. hat body identified strategiesfor expanding and improving coverage for America’s working families and informed Massachusettsgroundbreaking health reform plan. ask Forcemembers included Kathleen Sebelius, current Secretary of the U.S. Department of Health and Human Services.Te Commonwealth Fund has since become knownfor measuring progress on issues related to healthinsurance coverage and access to care. We began theNational Survey of Health Insurance in 1997, whichlater evolved into the Biennial Health InsuranceSurvey—an ongoing source of information on coveragetrends, including high rates of uninsured young adults.In a 2004 report, we proposed extending the age fordependent coverage to address this problem; the idea  was later realized in the Affordable Care Act.Te Biennial Health Insurance Survey also helped usidentify the growing problem of “underinsurance,” which arises when people cannot afford their out-of-

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