The Patient Protection & Affordable Care Act (ACA) is an unprecedented joint federal-state initiative, with provisions to expand health insurance coverage, control costs, and improve the health care delivery system in the United States. Much of the implementation responsibility lies with states; some are rapidly moving forward with implementation to prepare for the January 1, 2014 start date, while others are opposed to implementation or grappling with the flexibility granted by the Supreme Court’s decision upholding the law.

During the fall 2012 semester, 11 Woodrow Wilson School graduate students addressed some of the challenges facing states in a Graduate Policy Workshop.   To fully understand the issues, they studied the federal regulatory process, Medicaid expansion issues, the development of health insurance exchanges, on-going legal challenges, and Congressional oversight efforts relating to the ACA.

Their work culminated in a final report, with recommendations, written for their “client,” the State of Oregon’s Health Authority. The topics selected were viewed as key opportunities to enhance and expand Oregon’s early implementation successes with reform over the next three to five years.    

The report, “Opportunity for Oregon:   Reforming the Health Care Delivery System and Meeting the Triple Aim,” examined four topics addressing components of Oregon’s reform efforts: measurement of the health care system’s performance, expansion of the Coordinated Care Model (CCM) beyond the Medicaid population, provisions for continuous coverage, and integration of behavioral and physical health care delivery.   Students traveled to Oregon to conduct research for the policy workshop and met with senior state health officials, health care providers, non-profit organizations, research groups, and elected officials, including U.S. Senator Jeff Merkley (D-OR), MPA ’82.

Photo:   Graduate Policy Workshop participants meet with U.S. Senator Jeff Merkley (D-OR), MPA ’82 (center) during visit to Oregon to conduct research for their “client” – the Oregon Health Authority.

Heather Howard, lecturer in public affairs at the Woodrow Wilson School and director of the State Health Reform Assistance Network (State Network) spearheaded the workshop, along with Chad Shearer, the deputy director of the State Health Reform Assistance Network.   Funded by The Robert Wood Johnson Foundation, the State Network is helping states implement key health insurance coverage provisions of the Affordable Care Act.   The program provides states technical assistance on setting up insurance exchanges, instituting insurance market reforms, expanding Medicaid to newly eligible populations, and streamlining eligibility and enrollment systems.

Howard noted that “health reform is perhaps the most transformative domestic policy initiative in decades, and the new law is redefining federal-state relations.   This policy workshop gave students a front row seat in addressing the challenges facing states in implementing the Affordable Care Act.”