Administrative Aspects of Health Reform Deserve Attention, Expert Panel Says

| July 20, 2009

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FOR IMMEDIATE RELEASE: July 20, 2009
CONTACT: Jill Braunstein at (202) 452-8097

WASHINGTON, DC – Administrative issues should receive careful attention when health reform legislation is being drafted, according to a new report released by an expert panel of the National Academy of Public Administration and National Academy of Social Insurance.

“Sound administration needs to be built into the design of health reform,” said William A. Morrill, co-chair of the panel and a senior fellow at Caliber Associates, and ICF International Company. “It shouldn’t be an afterthought.” Robert A. Berenson, Institute Fellow at the Urban Institute, also served as co-chair. “Whatever form the legislation takes,” Berenson said, “the challenging issues of implementation will require continued attention. Government’s ability to administer the plan will be critical to its success.”

In its report, the panel examines administrative functions that are central to a variety of health reform proposals, defines the choices, summarizes what is known about them, and makes specific recommendations. Regardless of the reform proposal at hand, the report provides legislators and policymakers with ways to:

Keep eligibility rules simple to encourage participation and facilitate administration,
Make any health insurance mandates easily enforceable,
Ensure fairness and capacity in a restructured health insurance market,
Choose an appropriate organizational design to administer new health care programs, and
Put mechanisms in place to support health care cost control.

The members of the study panel represent a wide variety of perspectives and include academics, researchers, consultants, and executives of health care companies, foundations, and associations (list attached). Several panel members have had hands-on experience in the administration of Medicare, Medicaid, or private health insurance programs or in the delivery of health care services. The panel’s recommendations fall into seven categories: planning and coordinating implementation of health reform, subsidizing health insurance premiums and cost sharing, administering health insurance mandates, regulating health insurance, restructuring health insurance markets, designing administrative organizations, and simplifying administration and controlling costs.

The panel’s recommendations and their rationale are described in detail in its final report, Administrative Solutions in Health Reform. As part of its work, the panel also commissioned noted experts to prepare background papers on the subjects of its inquiry.

Paying a Fair Share for Health Coverage and Care by Jill Bernstein (consultant)
Administering Health Insurance Mandates by C. Eugene Steuerle (Urban Institute) and Paul N. Van de Water (NASI)
Restructuring Health Insurance Markets by Elliot K. Wicks (Health Management Associates)
Simplifying Administration of Health Insurance by Mark Merlis (consultant)
The Regulation of Private Health Insurance by Timothy Stoltzfus Jost (Washington and Lee Law School)
Cost Containment and Coverage Expansion by Mark Merlis (consultant)
Designing a Mixed Public and Private System for the Health Insurance Market by Bryan Dowd (University of Minnesota)
Re-figuring Federalism: Nation and State in Health Reform’s Next Round by Lawrence D. Brown (Columbia University)
Designing Administrative Organizations for Health Reform by Paul N. Van de Water (NASI)
Recent Changes in Dutch Health Insurance by Kieke Okma (New York University)

These papers have been available since January on NASI’s website. Edited versions of the papers were published in May in a companion volume, Expanding Access to Health Care: A Management Approach, available from M.E. Sharpe, Inc.

Financial support for this project was provided by the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to improving the health and healthcare of all Americans. The National Academy of Social Insurance, founded in 1986, promotes informed policy making on social insurance and related programs, including Social Security, Medicare, Medicaid, and employer-sponsored health insurance. Established in 1967 and chartered by Congress in 1987, the National Academy of Public Administration is a non-profit, independent organization of top public management and organizational leaders who tackle the nation’s most critical and complex public management challenges.

Study Panel on Administrative Issues in Expanding Access to Health Care

Robert A. Berenson+, Co-Chair, Urban Institute

William A. Morrill*, Co-Chair, Caliber Associates

Kenneth S. Apfel*+, University of Maryland

Beth C. Fuchs+, Health Policy Alternatives, Inc.

Thomas R. Hefty, Blue Cross Blue Shield United of Wisconsin (retired)

Feather O. Houstoun*, William Penn Foundation

Robert E. Hurley, Virginia Commonwealth University (emeritus)

Jack Lewin, American College of Cardiology

Catherine G. McLaughlin+, University of Michigan

Sallyanne Payton*, University of Michigan School of Law

Michael C. Rogers*, MedStar Health