The latest elder law – related CRS reports

R40513
State Health Reform Strategies
April 14, 2009

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Summary:

Stateshave taken the initiative to propose and enact health care reforms toaddress perceived problems related to health insurance coverage, healthcare costs, and other issues. These reform efforts vary in scope,intent, and target demographic group. While not all members of Congressagree in the need to reform health care, many have expressed interestin learning about these state efforts to inform ongoing debate at thenational level. Each state has implemented a unique set of reformstrategies to address concerns about health insurance and the healthcare delivery system. However, most health reform discussions, at boththe state and federal level, focus primarily on insurance. Under thisbroad policy area, coverage and cost concerns are paramount.The primary objective related to coverage is reducing the number ofuninsured persons. Related reforms may target a specific group, oraddress the uninsured population as a whole. Cost reforms primarilyaddress concerns about the affordability of health insurance forindividuals, families, and employers. This typically results inpolicies that invest public resources to assist consumers and firmswith the cost of health insurance.This report identifies general approaches proposed at the state levelto reform health insurance, and describes selected reform strategies.These descriptions are intended to be illustrative, not exhaustive.They include examples of both common and innovative initiatives toreflect the diversity of reform approaches, in terms of scope, policylevers used, and populations affected. The reform strategies have beenidentified according to targeted stakeholder groups: consumers,employers, purchasers of health coverage, and health plans. Inaddition, the report explores key design and implementation challengesrelated to coverage and cost, and provides a succinct state example foreach reform strategy.This report will be updated as circumstances warrant.

Health Care Reform: An Introduction
April 14, 2009

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Summary:

Healthcare reform has emerged as an issue in the 111th Congress, driven bygrowing concern about widely discussed problems. Three predominantconcerns involve coverage, cost and spending, and quality. Commonlycited figures indicate that more than 45 million people have noinsurance, which can limit their access to care and their ability topay for the care they receive. Costs are rising for nearly everyone,and the country now spends over $2.2 trillion, more than 16% of grossdomestic product (GDP), on health care services and products, far morethan other industrialized countries. For all this spending, the countryscores but average or somewhat worse on many indicators of health carequality.These concerns raise significant challenges. Each of the concerns ismore complex than might first appear, which increases the difficulty offinding solutions. For example, by one statistical measure, far morethan 45 million people face the risk of being uninsured for short timeperiods, yet by another, substantially fewer have no insurance for longperiods. Insurance coverage and access to health care are not the same,and it is possible to have one without the other. Having coverage doesnot ensure that one can pay for care, nor does it always shield onefrom significant financial loss in the case of serious illness.Similarly, high levels of spending may be partly attributable to thecountry’s wealth, while rising costs, though difficult for many, mayprimarily mean that less money is available for other things.Solutions to these concerns may conflict with one another. For example,expanding coverage to most of the uninsured would likely drive up costs(as more people seek care) and expand public budgets (since additionalpublic subsidies would be required). Cutting costs may threateninitiatives to improve quality. Other challenges include addressing theinterests of stakeholders that have substantial investments in presentarrangements and the unease some people have about moving from animperfect but known system to something that is potentially better butuntried.Health care reform proposals will likely rekindle debate over perennialissues in American health care policy. These include whether insuranceshould be public or private; whether employment- based insurance shouldbe strengthened, weakened, or left alone; what role states might play;and whether Medicaid should be folded into new insurance arrangements.Whether changes to Medicare should occur at the same time may also beconsidered. Concerns about coverage, cost and spending, and quality arelikely to be addressed within the context of these issues.The 111th Congress has already begun work on health care reform.Hearings have been held, and staffs of the committees of principaljurisdiction are working to draft coordinated bills. Some comprehensivereform bills have already been introduced, such as H.R. 15(Representative Dingell), H.R. 193 (Representative Stark), H.R. 676(Representative Conyers), H.R. 956 (Representative Kaptur), H.R. 1200(Representative McDermott), H.R. 1321 (Representative Eshoo), S. 391(Senator Wyden), and S. 703 (Senator Sanders). This report does notdiscuss or even try to identify all of the concerns about health carein the United States that are prompting calls for reform. Otherconcerns may also be important, at least to some, and will likelycontribute to the complexity of the reform debate. The report may beupdated to include other health care reform issues as the debate inCongress unfolds.

Selected Health Funding in the American Recovery and Reinvestment Act of 2009
April 13, 2009

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Summary:

TheAmerican Recovery and Reinvestment Act (ARRA) of 2009, which thePresident signed into law on February 17, 2009 (P.L. 111-5), providedmore than $17 billion in supplemental FY2009 discretionaryappropriations for biomedical research, public health, and otherhealth-related programs within the Department of Health and HumanServices (HHS). ARRA also included new authorizing language to promotehealth information technology (HIT) and establish a federal interagencyadvisory panel to coordinate comparative effectiveness research. ARRAfunds were designated as emergency supplemental appropriations forFY2009. Regular FY2009 appropriations for HHS were included in theOmnibus Appropriations Act, 2009 (P.L. 111-8), enacted March 11, 2009.This report discusses the health-related programs and activities fundedby ARRA, including details of how the administering HHS agencies andoffices plan to allocate, award, and spend the funds. It will beupdated as new information becomes available. Unless otherwise noted,all the funds will remain available through the end of FY2010 (i.e.,through September 30, 2010). Table 1 summarizes ARRA’s discretionaryhealth funding, by HHS agency and office. Table 2 provides more detailson the funding, by type of activity funded, and includes a comparisonof the amounts provided in ARRA, as enacted, with the fundingrecommendations in the earlier House and Senate versions of thelegislation.

RL30922
Retirement Savings and Household Wealth in 2007
April 08, 2009

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Summary:

Onceevery three years, the Board of Governors of the Federal Reserve Systemcollects data on household assets and liabilities through the Survey ofConsumer Finances (SCF). The most recent such survey was conducted in2007, and the survey results were released to the public in February2009. This CRS report presents data from the 2007 SCF with respect tohousehold ownership of, and balances in, retirement savings accounts.Because the majority of assets held in retirement accounts are investedin stocks, trends in stock prices have a significant impact onhouseholds’ retirement account balances. As a result of the broaddecline in stock prices in 2008, the retirement account balances thathouseholds reported on the 2007 SCF may be greater than many of thosehouseholds would report in 2009. The effect of the current recession onhousehold finances will be reflected in the next SCF, which will befielded in 2010. Nevertheless, the 2007 SCF provides the mostcomprehensive and current data available on the amount and type ofretirement assets owned by American households.