Recent Publications

  • What Does Senator Kamala Harris’ Record As California’s Attorney General Tell Us About Her Health Policy?

    By Richard M. Scheffler and Surina A. Khurana | Published October 1, 2020 in Health Affairs BlogLink to Full Article

    Health policy, like most public policy, is autoregressive: The past is usually the best predictor of the future. Democratic vice presidential nominee Kamala Harris’ position on national health policy issues is well known from presidential debates and public statements; less is known about what she actually did while serving as the attorney general for the state of California from 2010 to 2017. Most of her record in health policy as attorney general was in three areas: antitrust (especially mergers and consolidation), pharmaceuticals, and support of the Affordable Care Act (ACA). It is fair to say that she has been very active and effective in all three areas.

  • The Public-Private Option in Germany and Australia: Lessons for the United States

    By Richard M. Scheffler and Taylor L. Wang | Published September 21, 2020 in Milbank Quarterly Opinion | Link to Full Article

    There is little doubt that the cost of health care and universal coverage will be a major topic discussed at the upcoming presidential debates. A key debate will likely center on the Biden-Sanders Unity Task Force’s recommendations released earlier this year proposing a public option to compete against existing private insurers. The recommendations only outline a public option framework, so the details, both logistical and financial, will be key to moving forward. While recent articles have assessed the state-level public options in Washington State and New Mexico, we look internationally to Germany and Australia to evaluate how their health care systems have achieved universal coverage by delivering public health insurance. Both countries have a private component in the health insurance system: Germany allows individuals to purchase substitutive private insurance based on income, and Australia takes it a step further by creating incentives for all citizens to enroll in supplemental private insurance. We examine the framework of each system, how the public-private insurance dichotomy is organized, and some key takeaways for the United States.

  • The Public Option: From Hacker to Biden

    By Richard M. Scheffler and Taylor L. Wang | Published September 21, 2020 | Link to Full Article

    Presidential candidate Joe Biden’s proposal for a public option is likely to be a major topic in the upcoming presidential debate. While the proposal certainly isn’t the first of its kind, in light of the recent COVID-19 pandemic it is especially significant due to the rapid increase in the number of people without insurance. To better understand the arguments for this proposal and other public option or opt out proposals, we discuss the following: (1) Jacob Hacker’s original ideas and arguments for a public option and why it was left out of the ACA, (2) A review of the cost and coverage impacts of various public option reforms conducted by the Urban Institute, (3) An examination of the only state-based public option passed by Washington State, (4) The current version of Biden’s public option, and (5) Final thoughts.

  • The Distribution of Medicare Accelerated and Advance Payment Program Loans Among California Health Systems

    By Daniel R. Arnold, Surina Khurana, and Brent D. Fulton | Published August 3, 2020 | Link to Report

    This report provides a summary of the loans that the largest health systems in California received through Medicare Accelerated and Advance Payment Program. The financial health of these health systems should continue to be monitored during the duration of this pandemic.

  • The Distribution of Provider Relief Payments Among California Health Systems

    By Richard M. Scheffler, Daniel R. Arnold, Surina Khurana, and Brent D. Fulton | Published July 9, 2020 | Link to Report

    California Governor Gavin Newsom issued an executive order on March 19, 2020 that effectively prevented hospitals from performing elective procedures to free capacity for a possible surge of COVID-19 patients (order lifted on April 22, 2020). This report examines the financial status of the largest health systems in California, with a particular focus on their liquid assets for financial solvency. It then reports the amount they have received in CARES Act provider relief payments. Overall, 24% of the estimated reduction in net patient revenue was offset by direct CARES Act grants, but the offset varied widely by hospital. The report then presents the correlation between provider relief payments and a hospital’s private insurance share of patient revenue, operating margin, and the hospital market concentration of the county in which it resides. We find hospitals with a larger share of net patient revenue from private insurers and hospitals residing in highly concentrated hospital markets received larger payments per adjusted patient day. The results suggest that careful monitoring of future relief payments is needed.