Heller State Health Policy Module

3/7/14 Brandeis University Heller Graduate School STATE HEALTH POLICY MODULE HS507f

Brian Rosman, J.D. Research Director, Health Care For All Spring, 2014 Ph: 617-275-2920 Wednesday, Fax: 617-451-5838 6:00 pm – 8:50 pm [email protected] Heller 163

Module Description. In a famous but somewhat mangled quote, Justice Brandeis is said to have called states “laboratories of democracy.” This is particularly true with health care policy. This course provides students with an introduction to the role of states in the development and implementation of US health care policy. Decisions made at the state level have long been major components of our health care system. The Affordable Care Act further empowers states to play key roles in implementing reforms in coverage, cost and quality. Understanding American health policy requires a thorough grasp of intergovernmental relations and the role of the states in program development, regulation and implementation. The course focuses on Massachusetts, a leader in state health policy, but the concepts and policies are applicable to all states. The assignments focus on practical activities required in the field of health policy work.

Course Outline: The first session provides an overview of state functions in the health care system, along with an overview of the policy making process in the context of federalism and the evolving roles and responsibilities of each level of government. The second session looks at the main agencies of state health policy, and explores the role of legislatures and the process of public budgeting as it pertains to health policy. The third session will focus on Massachusetts, which led the country in access reforms and is now pursuing ambitious delivery system reforms. The fourth session is optional, as students may examine the role of interest groups and advocacy in state health care policy by attending a fundraising dinner of Health Care For All, a Massachusetts advocacy organization. This theme will also be explored in a visit to the Massachusetts State House, to be scheduled. The fifth session looks at the coverage issues, examining Medicaid, CHIP and the Affordable Care Act, and the role states play in implementation. The sixth session looks at state roles in public health, cost control and delivery reform. A guest speaker from Vermont will discuss the Green Mountain Care reform process. For the final session, the class will transform itself into the Health Care Committee of a state legislature, and we will hear testimony from each student on a piece of legislation.

Course Assignments and Grading: The course requires four assignments to be completed, in addition to active participation in class sessions, which counts for 20% of the final grade.

A. Field experience and report (10% of grade): Students will attend a state health policy event. Examples include a legislative or regulatory hearing; a formal legislative session where health policy is debated; a meeting of a state regulatory agency, like the Public Health Council, the Health Policy Commission or the Health Connector Authority; or an advocacy meeting or event. Following the meeting, the student will write 3/6/14 a brief (1-page) report and reaction to the meeting. The instructor will help students identify and select field experience opportunities, and must approve the event as appropriate for this assignment.

B. Letter to Editor (10% of grade): Students will write a letter to the editor in response to an article in any major newspaper concerning state health policy. Letters to the editor are generally very short (150 words maximum), and are aimed at the general public. Students are encouraged, but not required, to actually submit the letter for publication.

C. Implementation Policy Memo and Presentation (30% of grade): Students will write a memo (up to 6 pages) to the members of the Massachusetts Health Policy Commission, the state agency charged with implementing health delivery system reforms in Massachusetts (under Chapter 224 of 2012). The instructor will suggest a list of topics, although students may choose other topics. Students may alternatively write a memo to a Governor, agency head, or legislative leader in a state (other than Massachusetts) explaining an ACA implementation issue in the state and making a policy recommendation. Students will make a brief (5 minutes maximum) presentation to the class on their memo, as if presenting to a policymaker. These presentations will be interspersed throughout the last few class sessions.

D. Legislative Testimony (30% of grade): Students will select a bill introduced in the Massachusetts or other state legislature. Students will prepare written testimony in support, opposition, or recommending changes to the bill. Written testimony should not exceed 10 pages. At the final class, students will present oral testimony on their bill, generally not more than 6 minutes. Members of the class will act as legislators, and ask questions of the student testifying.

Academic Integrity: Violations of University policies on academic integrity, described in Section 3 of Rights and Responsibilities, may result in failure in the course or on the assignment, and could end in suspension from the University. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification.

Notice: If you have a documented disability and require any accommodations, please bring them to my attention prior to the second meeting of the class. If you have any questions about learning or other disabilities, contact Doris Breay, disabilities coordinator for The Heller School, at x62773, room 125, or at [email protected].

Doonan, Michael (2013). American Federalism in Practice. Session #1 March 12, 2014 Introduction: Federalism and State Health Policy

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Longest, Beaufort. Health Policymaking in the United States, 2nd edition. Chicago, Health Administration Press. Chapters 1 and 2.

Lipson, Debra. “State Roles in Health Care Policy: Past as Prologue?” in Litman, Theodor & Robins, Leonard, eds. Health Politics and Policy 3rd edition. Delmar Publishers. 176-197.

Doonan, Michael (2013). American Federalism in Practice, chapter 1

Kaiser Family Foundation (2012). A Guide to the Supreme Court’s Affordable Care Act Decision, available at http://www.kff.org/healthreform/upload/8332.pdf

Holahan, John; Weil, Alan; Wiener, Josh. (2003). Federalism and Health Policy, Urban Institute Press, Washington DC, Chapters 1 and 2.

Optional: Supreme Court of the United States (2012) National Federation of Independent Business v. Sebelius (slip opinion) available at http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

Session #2 March 19, 2014 State Agencies, the Legislative Process, and the Budget Process

McDonough, John & Robert McGrath. “State Legislatures and Health Policy in the Market Era.” In Hackey, Robert & David Rochefort, eds., The New Politics of State Health Policy. University of Kansas Press, 2001

Holahan, John; Weil, Alan; Wiener, Josh. (2003). Federalism and Health Policy, Urban Institute Press, Washington DC, Chapter 3. Boyd, Donald. “Health Care Within the Larger State Budget.”

Doonan, Michael (2013). American Federalism in Practice, chapter 8

Kaiser Commission on Medicaid and the Uninsured (2012). Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP), http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8352.pdf

Massachusetts Budget and Policy Center (August 2013). Masshealth And Health Reform Funding in the FY2014 General Appropriations Act, http://massbudget.org/reports/pdf/mmpi_gaa_14.pdf

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State of Massachusetts, Executive Office of Administration and Finance, Fiscal Year 2015 budget presentation (2014). Expanding Access to Affordable, Quality Health Care http://www.mass.gov/bb/h1/fy15h1/exec_15/hbudbrief4.htm

Kaiser Commission on Medicaid and the Uninsured. State Fiscal Conditions and Medicaid, February 2012 (latest version available at http://www.kff.org/medicaid/7580.cfm)

Session #3 March 26, 2014 Massachusetts as an Example of State Health Policy Leadership

Students will attend the “President’s Lecture Series on Health” at Regis College, Upper Student Union Lounge. The program starts at 6:30 pm (arrive early for seating). The speakers are:  Stuart Altman, Ph.D., Brandeis University; discussing the relationship between the 2006 Massachusetts health reform law and the Affordable Care Act  Jean Yang, MBA, Executive Director of the Massachusetts Health Connector; discussing Implementation of the ACA in Massachusetts  Brian Rosman, JD, Health Care For All; discussing the cost control and delivery system reforms enacted in Massachusetts in 2012  Jeannette Clough, MS, DBA, CEO of Mt. Auburn Hospital, Cambridge, MA; discussing a provider’s perspective on implementation of health reforms.

Rodman, Elizabeth (2013). Re-reforming Reform, Part 2: Implementing the Affordable Care Act In Massachusetts http://bluecrossmafoundation.org/sites/default/files/download/publication/Reforming_Ref orm_PtII_FINAL.pdf

Browse recent A Healthy Blog entries on Massachusetts health reform: http://www.hcfama.org/tags/ma-health-reform; and review recent blog posts at Boston.com’s Health Stew: http://www.boston.com/lifestyle/health/health_stew/us_health_policy/

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Session #4 [April 2, 2013] Students are invited optionally to attend the Health Care For All benefit dinner, For The People, to be held at the Boston Sheraton Hotel The instructor will also schedule a visit to the Massachusetts State House for sometime during the term.

Session #5 April 9, 2014 Coverage: Medicaid, CHIP and the Affordable Care Act

Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer (latest version available at http://www.kff.org/medicaid/7334.cfm)

Kaiser Commission on Medicaid and the Uninsured (2013). Medicaid: 3 Issues to Watch in 2013 (available at http://www.kff.org/medicaid/quicktake_medicaid_in_2013.cfm)

Kaiser Commission on Medicaid and the Uninsured (2014). Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults as of January 1, 2014 http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and- chip /

Doonan, Michael (2013). American Federalism in Practice, chapters 4 and 9

McDonough, John and Patel, Kavita. From Massachusetts To 1600 Pennsylvania Avenue: Aboard The Health Reform Express (Health Affairs, 2010) http://content.healthaffairs.org/content/29/6/1106.full.html

William Hsiao et al, What Other States Can Learn from Vermont's Bold Experiment: Embracing a Single-Payer Health Care Financing System, Health Affairs, July 2011 http://content.healthaffairs.org/content/30/7/1232.full.html

Glance at this Vermont single payer presentation: http://www.leg.state.vt.us/jfo/healthcare/FINAL%20VT%20Hsiao%20Presentation %20for%20Jan1911_1.pdf

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Session #6 April 23, 2014 Cost Control, Delivery Reforms and Public Health

Guest Speaker: Ena Backus (Heller MPP, 2011), Deputy Director of Policy & Evaluation, Vermont Green Mountain Care Board

Vermont Green Mountain Care Board (2014), Annual Report of the Green Mountain Care Board to the Vermont General Assembly available at http://gmcboard.vermont.gov/sites/gmcboard/files/2014_GMCB_Annual_Report.pdf

Blue Cross of Massachusetts Foundation (2012) Summary of Chapter 224 of the Acts of 2012, available at http://bluecrossmafoundation.org/publication/summary-chapter-224- acts-2012

Seltz, David (2013). Health Policy Commission Overview and Implementation Timeline (presentation), http://www.ma-ri-hfma.org/edudocs/June%207,%202013%20Meeting %20Handouts/Health%20Policy%20Commission%20and%20Its%20Role%20in%20MA %20Healthcare%20Reform%20%28Seltz%29.pdf

Robert Murray, Setting Hospital Rates To Control Costs And Boost Quality: The Maryland Experience, Health Affairs, 28, no.5 (2009):1395-1405 http://content.healthaffairs.org/content/28/5/1395.full.pdf+html

Association of State and Territorial Health Officials (2010). State Health Agencies Are Critical to America’s Health http://www.astho.org/Display/AssetDisplay.aspx?id=5087

Institute on Urban Health Research and Practice, Northeastern University (2013). The Massachusetts Prevention and Wellness Trust, http://www.northeastern.edu/iuhrp/wp- content/uploads/2013/12/PreventionTrustFinalReport.pdf

Mass Public Health Association Act FRESH Campaign, Priorities for Healthy Places 2013-2014 (2012), available at http://mphaweb.org/documents/ActFRESH13- 14_PrioritiesforHealthyPlaces.pdf

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Session #7 May 7, 2014 Student Testimony

Students will present oral testimony on legislation pending before a state legislature. The class will listen to the testimony and ask questions of the student about the bill and his or her testimony.

Written testimony will be due no later than Monday, May 12, 2014.

Resources

ACA Implementation Supersites

The National Conference of State Legislatures maintains a comprehensive index of state activities on the ACA. Look here: http://www.ncsl.org/issues-research/health.aspx for a good start.

Kaiser Family Foundation health reform central: http://healthreform.kff.org/

NASHP, the National Academy for State Health Policy, has set up Refor(u)m, a site for state officials to share information on ACA implementation. It includes a link to all the state implementation websites: http://www.statereforum.org/ (A similar link to state implementation sites is here: http://www.shadac.org/content/implementation-web- resources-state )

New England Journal of Medicine health reform center: http://healthpolicyandreform.nejm.org/

Robert Wood Johnson Foundation implementation site: http://www.healthreformgps.org/

Commonwealth Fund: http://www.commonwealthfund.org/Health-Reform/Health- Reform-Resource.aspx

State Health Programs

State profiles, data and comparisons on a myriad of factors: http://www.statehealthfacts.org/

State Health Access Data Assistance Center – http://www.shadac.org

State Public Health departments: http://www.astho.org/

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Massachusetts

Health Policy Commission: http://www.mass.gov/anf/budget-taxes-and- procurement/oversight-agencies/health-policy-commission/

Center for Health Information and Analysis: http://www.mass.gov/chia/

National health reform implementation: http://mass.gov/nationalhealthreform

Health Connector (exchange): www.mahealthconnector.org