Health care reform


Paul Ryan holding a copy of the American Health Care Act

What Americans Will Really Dislike About 'Trumpcare'

May 8, 2017

An article in the Washington Post co-authored by University of Minnesota health policy professor Sarah Gollust analyzes the bill that passed the US House of Representatives last week. Gollust and her co-researchers conducted a national survey in March asking 1,588 Americans what they knew about the Affordable Care Act (ACA, also known as Obamacare) and the proposed American Health Care Act (AHCA, also known as Trumpcare), whether their views of these programs were favorable or unfavorable, and how completely they understood each. The results? Among those surveyed, even those who were aware of the ACA requirement to purchase insurance or pay a penalty prefer the ACA to the AHCA. Of particular concern regarding the AHCA was its penalty for enrollment gaps, fines that would be paid to insurers. The authors conclude the enrollment gap could be used as an additional line of attack by anti-AHCA activists, noting "the public is already concerned about protections for people with preexisting conditions, huge cuts to the Medicaid program, and citizens losing insurance. Highlighting the AHCA’s coverage-gap penalty could drop public support further."


American flag with stethoscope

Video Available for Lecture on the Past, Present, and Future of the Affordable Care Act

March 27, 2017

Given the drama of the past several weeks, during which Congress wrestled with repealing, replacing or reforming the Affordable Care Act (ACA), it's an opportune time to look at the trajectory of that legislation. On March 23, the seventh anniversary of the ACA's signing, the former General Counsel for the US Department of Health and Human Services (HHS), William B. Schultz, lectured at Harvard Law School in an event sponsored by the Petrie-Flom Center. He described what he saw from his front-row seat during five years at HHS, during which time the repeal of ACA was the number one priority of the Republicans in Washington, and it was deeply unpopular across the nation. Mr. Schultz also considered what's likely to happen now that the Republicans have control of all branches of government and the repeal agenda is complicated by the new support for the law by voters and some Republican governors. He concluded with a discussion of health policy options for the future. A video of the lecture and discussion can be viewed here


Logo for Affordable Care Act

Medical Device Tax Under Fire

January 9, 2017

A 2.3% excise tax on medical devices is among the many aspects of the Affordable Care Act (ACA) likely to be repealed during the current congressional session. The tax was collected starting in 2013, with the intention of offsetting expected ACA-driven profits for companies benefiting from expanded federally-funded Medicare and Medicaid payments. However, Congress passed a two-year repeal of the tax that was enacted in 2015 in an effort led by legislators representing states, like Minnesota, with robust medical device industries. According to the Star Tribune, "With [medical device excise tax] collections set to start again in January 2018, [Republican GOP Representative Erik] Paulsen is going for the coup de grace with a GOP-controlled House, Senate and White House that have made repealing the ACA a top priority." The article notes that the bill's co-sponsors, Paulsen and Wisconsin Democrat Ron Kind, "adopted the industry’s talking points in opposing the tax as a job killer that also took money away from research and development."


Obamacare logo

Obama Lays Out Next Steps for the Affordable Care Act in JAMA

July 12, 2016

In an article that "is apparently the first by a sitting president to be published by the [Journal of the American Medical Association (JAMA)]" according to NPR, Barack Obama, JD, reviews the effects the Affordable Care Act (ACA) has had since it was passed in 2010. He notes, "Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms." The article goes on to describe remaining "major opportunities to improve the health care system," including offering a government-run insurance plan, the so-called public option, as part of the ACA. While Obama advocates for Congress to revisit the idea of "a public plan to compete alongside private insurers in areas of the country where competition is limited," the public option has been controversial thus far and was dropped from the health law prior to its passage because of fears it represented a step toward fully government-run system.



Prof. Don Postema

"Ethics, the Electronic Health Record, and Karl Marx"

March 14, 2016

On Friday, March 11, Don Postema, PhD described how Karl Marx can help us understand the alienation providers experience when working with electronic health records (EHRs). While EHRs are intended to improve the efficiency and safety of health care practices, they have raised concerns about confidentiality issues related to data theft and the computer’s intrusion into the clinician-patient relationship. Dr. Postema, HealthPartner's Program Director of Medical Ethics, discussed these challenges and asked, "can the EHR be humanized?" His lecture was sponsored by Consortium member the Center for Bioethics; more information here


Kathleen Call

Health Insurance Complexity Demands Consumer Literacy

January 1, 2016

As we move through the health insurance enrollment season, parsing terms like "coinsurance" and an alphabet soup of acronyms (FSA, HSA, HRA, HDHP) can present real obstacles to making informed decisions. An article from National Public Radio (NPR) provides some comfort for the bewildered, noting that even those who work in health care fields struggle with the terminology. Kathleen Call, a professor in the University of Minnesota's School of Public Health, notes: "We've created a monster, and it's not surprising to me that there's literacy issues. I've studied this stuff, and sometimes I make mistakes." Among Call's areas of study is the way complexity compromises public health and increases health disparities. Luckily, the article includes a graphic that explains the terms that most frequently cause confusion; you can view it here



Sign outside of hospital emergency room

Consortium Grant Supports High Utilizers Study

May 7, 2015

A group of University of Minnesota graduate students in law and health is conducting a study of high-frequency healthcare utilizers with funds obtained through the Consortium's Research Awards program. The grant is "Twin Cities High Utilizers: A Patient-Centered Approach to Address the High Cost of Health Care" and the work is being conducted by UMN Hotspotters, who are utilizing a methodology originally developed by Dr. Jeffrey Brenner, MD (interviewed here on Freakonomics Radio) of the Camden Coalition of Healthcare Providers (CCHP). The ultimate goal of hotspotting is to identify patients for whom socioeconomic factors are causing overuse of emergency rooms, rather than more effective and less expensive healthcare options. An article in today's Minnesota Daily describes the UMN Hotspotters pilot study and their plans to expand upon it. 


Reception area at U of M nurse-led clinic

U of M Health Opens Nurse-led Clinic

April 6, 2015

Today marks the official opening of a new, nurse-led clinic in Minneapolis. In the past, nurse practitioners -- many of whom have earned the credential Doctor of Nursing Practice (DNP) -- were required to work under the supervision of a physician. A Minnesota law that went into effect on Jan. 1, 2015, removed that requirement. The clinic is intended to reduce health care costs and help address a shortfall of primary care providers; it will also provide training opportunities for interprofessional medical teams.