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Community Living Assistance Services and Support Act (CLASS Act)

The following review of the past year highlights the significant progress that the HCFO program made in achieving its goal of supporting research and policy. Moreover, the year was marked by notable contributions by HCFO-supported researchers whose studies continue to inform policymakers, practitioners and other key stakeholders.

Activities to Support 2009 Policy Reform

As health care costs continue to rise – and employers and consumers search for high quality, low cost care – workplace health centers and wellness programs are gaining attention. Proponents argue that because of the time individuals spend at work and the growing emphasis on preventative measures to improve health, workplace clinics and wellness programs may offer an effective solution to some current health care challenges. Health reform legislation currently under consideration by Congress has included language regarding workplace wellness programs. The House bill, H.R.

Efforts to implement health reforms that improve access, decrease costs, and improve quality must consider whether the supply of the health care workforce is adequate to achieve such outcomes. The experience in Massachusetts—with an increase on only one side of the demand-supply equation—demonstrates that efforts to improve access to care are hindered when there is not an adequate number of health care providers to deliver that care.¹ 

Approximately 17 percent of the US population is spread out over 80 percent of the country’s land mass.¹ Such geographic dispersion, and often isolation, has resulted in unique health care challenges.

Debate continues about the adequacy of community benefits provided by nonprofit hospitals. Critics argue hospitals should be required to meet a specified minimum threshold of community benefits and that their tax relief should be reduced. Hospital administrators challenge those critics. As the economic downturn creates greater health care burdens on individuals, hospitals are becoming increasingly stretched in their efforts to provide care to those unable to pay for it. 

In the United States, the economy shapes the complex interactions among employment, health coverage and costs, as well as financial access to care and health outcomes. Available evidence indicates that, as in previous downturns,^1,2 few employers plan to drop health coverage or restrict employee eligibility. More commonly, they seek to reduce costs by changing benefits and cost-sharing provisions.³  However, in this recession, massive job loss has overwhelmed the capacity of the employment-based system.

Per person spending on health care by individuals and the government is expected to increase from an average of $7,026 in 2006 to $13,101 in 2017, with the burden falling most heavily on public payers. And while the growth rate may not continue accelerating, the real level of health care costs is expected to account for an increasingly larger portion of the U.S.

In an effort to increase access to health insurance, Congress, President Bush, and the 2008 presidential candidates have proposed expanding the individual health insurance market through mechanisms such as state-run purchasing pools, tax credits, and insurance mandates. The individual market is smaller than the group market and subject to different regulations and greater risk selection.

What may be most notable about the disparate care individuals receive in this country is the breadth and complexity of the problem, starting with the lack of a common definition of "health disparity."¹ Research shows that we have an enhanced ability to measure and track the quality of care among vulnerable subgroups of the population, however, much work is needed to develop solutions to eliminate the current inequalities evident at the individual/community level, provider level, and organization level.