Blog: The View from Here

  • Paying the Piper

    Feb 28, 2018 | Christopher F. Koller, President

    Because the federal government can print money, the federal government can spend it. And spend it did, when the Affordable Care Act—even as adjusted by the Supreme Court—picked up 100% of the tab for newly eligible Medicaid enrollees, instead of the national average of 55%. But now that federal share is slowly decreasing—to 90% by 2020—and states that expanded Medicaid, lacking the … Read more

  • Exemplary Public Service

    Jan 29, 2018 | Christopher F. Koller, President

    “Don’t steal. The government hates competition.” —Bumper sticker. While grousing about the burden of taxes and shoddy government services like the Department of Motor Vehicles is a popular—and often justified—pastime, a deeper and more serious antipathy to the role of government in our society has again come to the fore in recent years. Some attribute its roots to the Reagan Revolution … Read more

  • Are the States Dancing by Themselves?

    Dec 20, 2017 | Christopher F. Koller, President

    It takes two to tango. The partners must agree on the music and the steps. After spending this fall meeting with state health policy leaders from across the country, I am not sure state or federal officials know the health policy tune, let alone the dance. Every fall, the Milbank Memorial Fund convenes the members of its Reforming States Group (RSG)—state teams of executive and legislative … Read more

  • Medicaid and Merit: Forever Renegotiating

    Nov 29, 2017 | Christopher F. Koller, President

    Who should the Medicaid program serve? And who decides? These questions have been implicit through much of 2017, as we endured a remarkably uninformed “repeal and replace” debate in Congress. The November announcement by the Centers for Medicare and Medicaid Services (CMS) of new policies for section 1115 waiver consideration and review tees them up again. The answers are subject to … Read more

  • State Health Policy Leadership: More Perspiration than Innovation

    Oct 31, 2017 | Christopher F. Koller, President

    A couple of years ago, a graduate school professor with deep and senior health policy experience at the state and federal levels looked at me with raised eyebrows and asked, “Does state health policy even matter?” He was being provocative, implying that federal policies, large socioeconomic factors, and parochial politics could all swamp the well-intentioned efforts of earnest state-level … Read more

  • Saying Yes to Public Leadership

    Sep 26, 2017 | Christopher F. Koller, President

    Sandy Praeger did not seek to be a leader. “Local party officials had to keep asking me,” she said of her first public position as a member of the Lawrence City Council. “The same thing happened when I was asked to run for the Kansas House of Representatives—I thought I was done.” But now public service was in her blood, and she went on to serve as chair of several committees in the … Read more

  • Seeing Purple: Mapping Bipartisanship in State Health Policy

    Aug 29, 2017 | Christopher F. Koller, President

    With the Senate Affordable Care Act (ACA) “repeal and replace” effort collapsing into partisan rubble (how did you learn about the dramatic US Senate vote in the early hours of July 28?), attention will turn to whether and how the states will assemble the pieces of a health policy agenda. A new survey of state legislators may give us some clues and shed insights into what bipartisanship in … Read more

  • Getting More Primary Care-Oriented: Measuring Primary Care Spending

    Jul 31, 2017 | Christopher F. Koller, President

    We all have our obsessions. Many are best not shared, although sometimes airing them is helpful, especially when they are informed by research. One of my persistent professional preoccupations is the US health care system’s stubborn aversion to orient itself to the fundamental importance of primary care. Fortunately, I am not alone in being somewhat haunted by this issue—and a new report by … Read more

  • Total Health Care Spending by State: Wide Variations in Amounts and Trends

    Jun 20, 2017 | Christopher F. Koller, President

    The game of hot potato ends one of two ways—someone drops the potato as it is being tossed or it finally cools off.  But what happens if the potato stays hot? How long can you get everybody to keep playing catch?  How do you get it to cool off? We are playing hot potato with health care costs in the United States—shifting them to whomever we can. Some new analyses on health care spending … Read more

  • Medicaid Costs, Medicaid Benefits

    May 30, 2017 | Christopher F. Koller, President

    Like rising sea levels, Medicaid costs are flooding state and federal budgets. Medicaid reform efforts, such as those in the American Health Care Act (AHCA), promise more flexibility to states to take on these Medicaid cost challenges. They need, however, to be viewed with caution by state policymakers: addressing the problem should not involve leaky sandbags or throwing people into the … Read more