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Brandeis University
Heller Graduate School
STATE HEALTH POLICY MODULE
HS 507
Brian Rosman, J.D.
Government Affairs Director Spring, 2016
Health Care For All Wednesdays
Ph: 617-275-2920 6:00 pm – 8:50 pm
Heller G 54
Course related or routine email:
Urgent messages:
Module Description. In a famous but somewhat mangled quote, Justice Brandeis is said to have called states “laboratories of democracy.” This is particularly true for 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 (to be scheduled) will look at the role of the legislature and advocacy and interest groups in state health policy through a visit to the Massachusetts State House and the offices of Health Care For All and Community Catalyst. The third session looks at coverage issues, examining Medicaid, CHIP and the Affordable Care Act, and the role states play in implementation. The fourth session looks at state roles in cost control and delivery reform. As guest speakers, a staffer in Vermont (and former student in this class) will discuss the Green Mountain Care reform process, and a Massachusetts staffer at the Health Policy Commission will describe their work. The fifth session will dive into states’ role in advancing public health. The guest speaker will be a former Commissioner of the Massachusetts Department of Public Health. The sixth session looks at the role of state legislatures, and will feature a state representative who sits on several key health committees of the Massachusetts legislature, and was herself a former staffer for those Committees. 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 proposed 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; or an advocacy meeting or event. Following the meeting, the student will write a brief (1 or 2 page) report, focusing on his or her reaction to, and analysis of, 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 either the Massachusetts Health Policy Commission, the state agency charged with implementing health delivery system reforms in Massachusetts (under Chapter 224 of 2012), or to the Massachusetts Health Connector. 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 (10 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 health care 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 8 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 .
Session #1
March 16, 2016
Introduction: Federalism and State Health Policy
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
Holahan, John; Weil, Alan; Wiener, Josh. (2003). Federalism and Health Policy, Urban Institute Press, Washington DC, Chapters 1 and 2.
Dropp, Jackman and Jackman (2013). The Affordable Care Act: An Experiment in Federalism? http://www.brookings.edu/~/media/research/files/papers/2013/10/affordable-care-act-experiment-in-federalism/droppjackman-and-jackmanaca-experment-in-federalism102213.pdf
(Note that there is no class on March 23, 2016)
Session #2
State Health Care Advocacy
Tour of the Massachusetts State House, and visit to Health Care For All and Community Catalyst.
(date to be scheduled during class)
Review materials on Health Care For All’s website (http://www.hcfama.org/), and read recent blog posts at http://hcfama.org/blog
Session #3
March 30, 2016
Coverage: Medicaid, CHIP, the Affordable Care Act and beyond
Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer (2013). available at http://www.kff.org/medicaid/7334.cfm)
Kaiser Commission on Medicaid and the Uninsured (2015). Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women (2015) http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip
Kaiser Commission on Medicaid and the Uninsured. State Fiscal Conditions and Medicaid: 2014 Update (April 2014) available at http://kff.org/report-section/state-fiscal-conditions-and-medicaid-2014-update-issue-brief-8572/
Doonan, Michael (2013). American Federalism in Practice, chapters 4 and 9
Massachusetts Medicaid Policy Institute, The Basics of MassHealth (2011) https://www.umassmed.edu/uploadedFiles/CWM_CHLE/About/MassHealth%20Basics%202011-FINAL(1).pdf and review this interactive timeline: http://bluecrossmafoundation.org/publications/ma-medicaid-50th
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
Avik Roy, Six Reasons Why Vermont's Single-Payer Health Plan Was Doomed From The Start, Forbes, Dec 21, 2014, http://www.forbes.com/sites/theapothecary/2014/12/21/6-reasons-why-vermonts-single-payer-health-plan-was-doomed-from-the-start/
Session #4
April 6, 2016
Cost Control and Delivery System Reform
Guest Speakers: Ena Backus (Heller MPP, 2011),
Deputy Executive Director, Vermont Green Mountain Care Board
Lois Johnson, J.D.
General Counsel, Massachusetts Health Policy Commission
Ena Backus was a student in this class in 2011. After finishing at Heller, she returned to Vermont to be a policy analyst, and then the Deputy Director, at their Green Mountain Care Board. The GMCB was created in 2011 to lower health care costs and improve health care quality. GMCBregulates health insurance rates, hospital budgets and major hospital expenditures. They Board alsopromote new ways to pay for and deliver health care.
Lois Johnson is General Counsel of the Massachusetts Health Policy Commission. Her responsibilities include overseeing the Commission’s regulatory development and supporting the full range of the Commission’s policy work. Ms. Johnson came to the Commission from the Health Care Division of the Office of Attorney General Martha Coakley, where she worked on enforcement matters, managed the Attorney General’s Community Benefits Program, and was a member of the team that led the Attorney General’s health care costs examinations and legislative advocacy.
Vermont Green Mountain Care Board (2016), Annual Report of the Green Mountain Care Board to the Vermont General Assembly, available at http://www.gmcboard.vermont.gov/sites/gmcboard/files/Annual-Rpt-011116-Final.pdf
Vermont Green Mountain Care Board (2016), All-Payer Model Term Sheet Proposal, Companion Paper, available at http://www.gmcboard.vermont.gov/sites/gmcboard/files/APM-Companion-Paper-Formatted%20FINAL2.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
Massachusetts Health Policy Commission (2016), Cost Trends Report: Executive Summary, available at http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/publications/2015-ctr-ppv-overview.pdf
Seltz, David (2014). Health Policy Commission Overview, available at http://nyshealthfoundation.org/uploads/general/conversation-with-david-seltz-slides.pdf , and look at slides 6-11 of this 2015 presentation: http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/public-meetings/board-meetings/20151216-commission-document-december-16-presentation-vfinal.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 and look at this presentation that updates the article: http://www.academyhealth.org/files/HCFO/Colmers%20RWJF%20-%20Academy%20Health%20-%20102414%20-%20FINAL.pdf
Session #5
April 13, 2016
Public Health
Guest Speaker: Cheryl Bartlet, RN
Cheryl Bartlett is currently the CEO at the Alosa Foundation, which produces unbiased information on medications. In 2013 and 2014, she was the Commissioner of the Massachusetts Department of Public Health, following several leadership positions at DPH. At DPH, she helped draft the state’s medical marijuana regulations and was instrumental in developing a childhood obesity campaign called Mass in Motion. She also headed the Cape Cod Regional Substance Abuse Prevention program and founded the Nantucket AIDS Network.
Salinsky, An Overview of State and Local Public Health Agencies, National Health Policy Forum (2010), available at https://www.nhpf.org/library/background-papers/BP77_GovPublicHealth_08-18-2010.pdf , and look at the infographics at http://astho.org/Profile/Infographics/
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, MPHA Policy Agenda 2015-2016 (2015), available at http://mphaweb.org/documents/MPHAPolicyPriorities.pdf
Thomas R. Frieden, A Framework for Public Health Action: The Health Impact Pyramid, American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595, available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.185652
Session #6
April 20, 2016
Health Care and State Legislatures
Guest Speaker: Hon. Christine Barber, Massachusetts State Representative
Member of the Public Health and
Health Care Financing Committees
Representative Barber began her career as a staff member for a Massachusetts state representative. In 2005, she began working as a research analyst for the legislature’s Health Care Financing Committee, where she was a key staffer in the formulation of the 2006 state access reform law (“RomneyCare”). She then worked was a Senior Policy Analyst for Community Catalyst, a national health advocacy organization. In 2014, she was elected as a state representative, representing Somerville and Medford. In the legislature, she’s a member of the Public Health and Health Care Financing Committees.
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
Massachusetts Budget and Policy Center (November 2014), Understanding the Actual Cost of MassHealth to the State, available at http://massbudget.org/reports/pdf/NetCost-MassHealth_FINAL.pdf
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
Session #7
May 4, 2016
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 9, 2016.
Resources
State Health Policy Supersites
The National Conference of State Legislatures maintains a comprehensive index of state health policy legislative activities on the ACA and delivery reform efforts: http://www.ncsl.org/research/health.aspx .
Kaiser Family Foundation maintains a “State Health Facts” website, with profiles, data and comparisons on a myriad of factors http://kff.org/statedata; they also have extensive information on ACA implementation by the states: http://kff.org/health-reform/
NASHP, the National Academy for State Health Policy, has set up State Refor(u)m, a site for state officials to share information on ACA implementation and other health reform issues. It includes a link to all the state implementation websites: http://www.statereforum.org/
The State Health Access Data Assistance Center has detailed state-specific data on coverage and other health data: http://www.shadac.org
Robert Wood Johnson Foundation offers its own Data Hub: http://www.rwjf.org/en/how-we-work/rel/research-features/rwjf-datahub.html
State Public Health departments: http://www.astho.org/
Massachusetts
Health Policy Commission: http://www.mass.gov/hpc/
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
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