Blog: The View from Here

  • 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

  • Competence in Government Is Not a Partisan Issue

    Apr 27, 2017 | Christopher F. Koller, President

    We should expect competence as public policies are planned and implemented. Frequently, with state health policies, we get it: heroic responses by public workers reacting to environmental emergencies or outbreaks of infectious diseases; well-executed outreach and enrollment of large populations newly eligible for public programs; well-coordinated and persistently implemented efforts to tackle poor … Read more

  • “Acceptably Cruddy:” The Art of the (Health Care) Deal

    Mar 30, 2017 | Christopher F. Koller, President

    Finding dissenting opinions in a public health class on policy priorities for the US health system is like looking for stars in the night sky of a city—you know they exist in the bigger world, but they are nowhere to be found in the current setting.  Universal health insurance? Heck yes! Centers for Disease Control and Prevention and Agency for Healthcare Research and Quality? Fully funded! … Read more

  • Trending Now: Learning from Medicaid Spending

    Feb 27, 2017 | Christopher F. Koller, President

    From 1997 to 2005, I ran Neighborhood Health Plan of Rhode Island (NHPRI), the state’s largest Medicaid managed care organization. We worked hard to help coordinate high-value health care and we thought we did pretty well. Recently compiled Medicaid spending data, however, points out that success for states may not mean success for the federal government, and might explain why the state-federal … Read more