New England Journal of Medicine: Medicare Part D Update - Lessons Learned And Unfinished Business - "Since 2006, more than 40 million elderly and disabled people have had the opportunity to enroll in a Medicare Part D prescription-drug plan, as established under the Medicare Modernization Act (MMA) of 2003." At that time, lawmakers focused on several features of the proposed legislation. "Issues that received particular scrutiny were the unprecedented way that the benefit would be delivered (exclusively through private plans) and its design, featuring an unusual gap in coverage (sometimes called the 'doughnut hole')." Four years into the program, "the Obama administration and the Democratically controlled Congress have an opportunity to review the program and identify areas for improvement." This study, The Medicare Policy Project of the Henry J. Kaiser Family Foundation, returns to some of the key questions raised during the congressional debate and in the years that led up to the program's start (Neuman and Cubanski, July 23). (Note: KHN is a program of the Kaiser Family Foundation.)
Commonwealth Fund: Fund Failure To Protect: Why The Individual Insurance Market Is Not A Viable Option For Most U.S. Families -This policy brief compares the experiences of adults ages 19 to 64 who purchased coverage in the individual insurance market to adults covered by employer-based plans, as documented by the Commonwealth Fund 2007 Biennial Health Insurance Survey. In addition to highlighting the difficulty adults face when attempting to purchase insurance on the individual market -- "nearly half (47%) of adults who tried to purchase insurance in the individual market in the last three years found it very difficult or impossible to find a plan that fit their needs; 57 percent found it very difficult or impossible to find a plan they could afford; and 36 percent said they were turned down or charged a higher price because of a preexisting condition." The policy brief found "Adults who do purchase coverage in the individual market pay more out-of-pocket for their premiums, face much higher deductibles, and spend larger shares of their income on health insurance and health care expenses than their counterparts with employer-based group coverage." According to the study, "On average, adults with employer plans spend $2,250 out of pocket for health expenses including premiums" compared to "those with individual market insurance spend an average of $6,750" (Doty, Collins, Nicholson and Rustgi, 7/21).
American Cancer Society Cancer Action Network: A Benchmark For Coverage: How The FEHBP Blue Cross Blue Shield Standard Option Plan Covers Medical Care For Patients With Serious Chronic Conditions - "[T]he most popular health insurance plan among federal employees offers adequate and affordable care for people with serious chronic diseases, making it a good starting point for defining minimum coverage benefits in health care reform legislation," writes an ACSCAN description of its recent report done in collaboration with the Georgetown University Health Policy Institute. When comparing "the adequacy and affordability of coverage held by most federal employees to people with cancer, heart disease and diabetes," researchers found "benefits covered under the Blue Cross Blue Shield Standard Option plan are comprehensive, and that cost sharing for routine care is modest. However, out-of-pocket costs for patients with a serious illness are substantial, totaling $5,000 per year for patients getting all of their care from a subset of network providers designated as 'preferred' and reaching $7,000 per year for out-of-network care" (7/22).
First Focus: Achieving Optimal Health and Healthcare for All Children: How We Can Eliminate Racial and Ethnic Disparities in Children's Health and Healthcare - After compiling data on key racial/ethnic disparities across children's health and health care, the report proposes evidence-based policies to target health disparities in children. Among other things, the author appeals for health care reform to "retain or enhance critical components of current Medicaid and CHIP programs, including consumer protections, language services, standards on access to care and cultural competency, comprehensive benefits, and limited or no cost sharing" and an extension of "insurance coverage to all children, including both documented and undocumented immigrants" (Flores, 7/20).