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Brandeis University
Heller Graduate School
STATE HEALTH POLICY MODULE
HS507f
Brian Rosman, J.D.
Research Director, Health Care For All
Ph: 617-275-2920
Fax: 617-451-5838
rosman@hcfama.org
Spring, 2014
Wednesday,
6:00 pm – 8:50 pm
Heller 163
Module Description. In a famous but somewhat mangled quote, Justice Brandeis
is said to have called states “laboratories of democracy.” This is particularly true with
health care policy. This course provides students with an introduction to the role of states
in the development and implementation of US health care policy. Decisions made at the
state level have long been major components of our health care system. The Affordable
Care Act further empowers states to play key roles in implementing reforms in coverage,
cost and quality. Understanding American health policy requires a thorough grasp of
intergovernmental relations and the role of the states in program development, regulation
and implementation. The course focuses on Massachusetts, a leader in state health policy,
but the concepts and policies are applicable to all states. The assignments focus on
practical activities required in the field of health policy work.
Course Outline: The first session provides an overview of state functions in the
health care system, along with an overview of the policy making process in the context of
federalism and the evolving roles and responsibilities of each level of government. The
second session looks at the main agencies of state health policy, and explores the role of
legislatures and the process of public budgeting as it pertains to health policy. The third
session will focus on Massachusetts, which led the country in access reforms and is now
pursuing ambitious delivery system reforms. The fourth session is optional, as students
may examine the role of interest groups and advocacy in state health care policy by
attending a fundraising dinner of Health Care For All, a Massachusetts advocacy
organization. This theme will also be explored in a visit to the Massachusetts State
House, to be scheduled. The fifth session looks at the coverage issues, examining
Medicaid, CHIP and the Affordable Care Act, and the role states play in implementation.
The sixth session looks at state roles in public health, cost control and delivery reform. A
guest speaker from Vermont will discuss the Green Mountain Care reform process. For
the final session, the class will transform itself into the Health Care Committee of a state
legislature, and we will hear testimony from each student on a piece of legislation.
Course Assignments and Grading: The course requires four assignments to be
completed, in addition to active participation in class sessions, which counts for 20% of
the final grade.
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A. Field experience and report (10% of grade): Students will attend a state
health policy event. Examples include a legislative or regulatory hearing; a formal
legislative session where health policy is debated; a meeting of a state regulatory agency,
like the Public Health Council, the Health Policy Commission or the Health Connector
Authority; or an advocacy meeting or event. Following the meeting, the student will write
a brief (1-page) report and reaction to the meeting. The instructor will help students
identify and select field experience opportunities, and must approve the event as
appropriate for this assignment.
B. Letter to Editor (10% of grade): Students will write a letter to the editor in
response to an article in any major newspaper concerning state health policy. Letters to
the editor are generally very short (150 words maximum), and are aimed at the general
public. Students are encouraged, but not required, to actually submit the letter for
publication.
C. Implementation Policy Memo and Presentation (30% of grade): Students
will write a memo (up to 6 pages) to the members of the Massachusetts Health Policy
Commission, the state agency charged with implementing health delivery system reforms
in Massachusetts (under Chapter 224 of 2012). The instructor will suggest a list of topics,
although students may choose other topics. Students may alternatively write a memo to a
Governor, agency head, or legislative leader in a state (other than Massachusetts)
explaining an ACA implementation issue in the state and making a policy
recommendation. Students will make a brief (5 minutes maximum) presentation to the
class on their memo, as if presenting to a policymaker. These presentations will be
interspersed throughout the last few class sessions.
D. Legislative Testimony (30% of grade): Students will select a bill introduced
in the Massachusetts or other state legislature. Students will prepare written testimony in
support, opposition, or recommending changes to the bill. Written testimony should not
exceed 10 pages. At the final class, students will present oral testimony on their bill,
generally not more than 6 minutes. Members of the class will act as legislators, and ask
questions of the student testifying.
Academic Integrity: Violations of University policies on academic integrity, described
in Section 3 of Rights and Responsibilities, may result in failure in the course or on the
assignment, and could end in suspension from the University. If you are in doubt about
the instructions for any assignment in this course, you must ask for clarification.
Notice: If you have a documented disability and require any accommodations, please
bring them to my attention prior to the second meeting of the class. If you have any
questions about learning or other disabilities, contact Doris Breay, disabilities coordinator
for The Heller School, at x62773, room 125, or at breay@brandeis.edu.
Text:
Doonan, Michael (2013). American Federalism in Practice.
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Session #1
March 12, 2014
Introduction: Federalism and State Health Policy
Longest, Beaufort. Health Policymaking in the United States, 2nd edition. Chicago,
Health Administration Press. Chapters 1 and 2.
Lipson, Debra. “State Roles in Health Care Policy: Past as Prologue?” in Litman,
Theodor & Robins, Leonard, eds. Health Politics and Policy 3rd edition. Delmar
Publishers. 176-197.
Doonan, Michael (2013). American Federalism in Practice, chapter 1
Kaiser Family Foundation (2012). A Guide to the Supreme Court’s Affordable Care Act
Decision, available at http://www.kff.org/healthreform/upload/8332.pdf
Holahan, John; Weil, Alan; Wiener, Josh. (2003). Federalism and Health Policy, Urban
Institute Press, Washington DC, Chapters 1 and 2.
Optional: Supreme Court of the United States (2012) National Federation of Independent
Business v. Sebelius (slip opinion) available at
http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
Session #2
March 19, 2014
State Agencies, the Legislative Process,
and the Budget Process
McDonough, John & Robert McGrath. “State Legislatures and Health Policy in the
Market Era.” In Hackey, Robert & David Rochefort, eds., The New Politics of State
Health Policy. University of Kansas Press, 2001
Holahan, John; Weil, Alan; Wiener, Josh. (2003). Federalism and Health Policy, Urban
Institute Press, Washington DC, Chapter 3. Boyd, Donald. “Health Care Within the
Larger State Budget.”
Doonan, Michael (2013). American Federalism in Practice, chapter 8
Kaiser Commission on Medicaid and the Uninsured (2012). Medicaid Financing: An
Overview of the Federal Medicaid Matching Rate (FMAP),
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8352.pdf
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Massachusetts Budget and Policy Center (August 2013). Masshealth And Health Reform
Funding in the FY2014 General Appropriations Act,
http://massbudget.org/reports/pdf/mmpi_gaa_14.pdf
State of Massachusetts, Executive Office of Administration and Finance, Fiscal Year
2015 budget presentation (2014). Expanding Access to Affordable, Quality Health Care
http://www.mass.gov/bb/h1/fy15h1/exec_15/hbudbrief4.htm
Kaiser Commission on Medicaid and the Uninsured. State Fiscal Conditions and
Medicaid, February 2012 (latest version available at
http://www.kff.org/medicaid/7580.cfm)
Session #3
March 26, 2014
Massachusetts as an Example of State
Health Policy Leadership
Students will attend the “President’s Lecture Series on Health” at Regis
College, Upper Student Union Lounge. The program starts at 6:30 pm
(arrive early for seating). The speakers are:
 Stuart Altman, Ph.D., Brandeis University; discussing the
relationship between the 2006 Massachusetts health reform law
and the Affordable Care Act
 Jean Yang, MBA, Executive Director of the Massachusetts Health
Connector; discussing Implementation of the ACA in
Massachusetts
 Brian Rosman, JD, Health Care For All; discussing the cost
control and delivery system reforms enacted in Massachusetts in
2012
 Jeannette Clough, MS, DBA, CEO of Mt. Auburn Hospital,
Cambridge, MA; discussing a provider’s perspective on
implementation of health reforms.
Rodman, Elizabeth (2013). Re-reforming Reform, Part 2: Implementing the Affordable
Care Act In Massachusetts
http://bluecrossmafoundation.org/sites/default/files/download/publication/Reforming_Ref
orm_PtII_FINAL.pdf
Browse recent A Healthy Blog entries on Massachusetts health reform:
http://www.hcfama.org/tags/ma-health-reform; and review recent blog posts at
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Boston.com’s Health Stew:
http://www.boston.com/lifestyle/health/health_stew/us_health_policy/
Session #4
[April 2, 2013]
Students are invited optionally to attend the Health Care For All benefit
dinner, For The People, to be held at the Boston Sheraton Hotel
The instructor will also schedule a visit to the Massachusetts State House for
sometime during the term.
Session #5
April 9, 2014
Coverage: Medicaid, CHIP and the Affordable Care Act
Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer (latest version
available at http://www.kff.org/medicaid/7334.cfm)
Kaiser Commission on Medicaid and the Uninsured (2013). Medicaid: 3 Issues to Watch
in 2013 (available at http://www.kff.org/medicaid/quicktake_medicaid_in_2013.cfm)
Kaiser Commission on Medicaid and the Uninsured (2014). Where are States Today?
Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults as of
January 1, 2014 http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-andchip /
Doonan, Michael (2013). American Federalism in Practice, chapters 4 and 9
McDonough, John and Patel, Kavita. From Massachusetts To 1600 Pennsylvania
Avenue: Aboard The Health Reform Express (Health Affairs, 2010)
http://content.healthaffairs.org/content/29/6/1106.full.html
William Hsiao et al, What Other States Can Learn from Vermont's Bold Experiment:
Embracing a Single-Payer Health Care Financing System, Health Affairs, July 2011
http://content.healthaffairs.org/content/30/7/1232.full.html
Glance at this Vermont single payer presentation:
http://www.leg.state.vt.us/jfo/healthcare/FINAL%20VT%20Hsiao%20Presentation%20f
or%20Jan1911_1.pdf
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Session #6
April 23, 2014
Cost Control, Delivery Reforms and Public Health
Guest Speaker: Ena Backus (Heller MPP, 2011), Deputy Director
of Policy & Evaluation, Vermont Green Mountain Care Board
Vermont Green Mountain Care Board (2014), Annual Report of the Green Mountain
Care Board to the Vermont General Assembly
available at
http://gmcboard.vermont.gov/sites/gmcboard/files/2014_GMCB_Annual_Report.pdf
Blue Cross of Massachusetts Foundation (2012) Summary of Chapter 224 of the Acts of
2012, available at http://bluecrossmafoundation.org/publication/summary-chapter-224acts-2012
Seltz, David (2013). Health Policy Commission Overview and Implementation Timeline
(presentation), http://www.ma-rihfma.org/edudocs/June%207,%202013%20Meeting%20Handouts/Health%20Policy%20
Commission%20and%20Its%20Role%20in%20MA%20Healthcare%20Reform%20%28
Seltz%29.pdf
Robert Murray, Setting Hospital Rates To Control Costs And Boost Quality: The
Maryland Experience, Health Affairs, 28, no.5 (2009):1395-1405
http://content.healthaffairs.org/content/28/5/1395.full.pdf+html
Association of State and Territorial Health Officials (2010). State Health Agencies Are
Critical to America’s Health http://www.astho.org/Display/AssetDisplay.aspx?id=5087
Institute on Urban Health Research and Practice, Northeastern University (2013). The
Massachusetts Prevention and Wellness Trust, http://www.northeastern.edu/iuhrp/wpcontent/uploads/2013/12/PreventionTrustFinalReport.pdf
Mass Public Health Association Act FRESH Campaign, Priorities for Healthy Places
2013-2014 (2012), available at http://mphaweb.org/documents/ActFRESH1314_PrioritiesforHealthyPlaces.pdf
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Session #7
May 7, 2014
Student Testimony
Students will present oral testimony on legislation pending before a state legislature. The
class will listen to the testimony and ask questions of the student about the bill and his or
her testimony.
Written testimony will be due no later than Monday, May 12, 2014.
Resources
ACA Implementation Supersites
The National Conference of State Legislatures maintains a comprehensive index of state
activities on the ACA. Look here: http://www.ncsl.org/issues-research/health.aspx for a
good start.
Kaiser Family Foundation health reform central: http://healthreform.kff.org/
NASHP, the National Academy for State Health Policy, has set up Refor(u)m, a site for
state officials to share information on ACA implementation. It includes a link to all the
state implementation websites: http://www.statereforum.org/ (A similar link to state
implementation sites is here: http://www.shadac.org/content/implementation-webresources-state )
New England Journal of Medicine health reform center:
http://healthpolicyandreform.nejm.org/
Robert Wood Johnson Foundation implementation site: http://www.healthreformgps.org/
Commonwealth Fund: http://www.commonwealthfund.org/Health-Reform/HealthReform-Resource.aspx
State Health Programs
State profiles, data and comparisons on a myriad of factors:
http://www.statehealthfacts.org/
State Health Access Data Assistance Center – http://www.shadac.org
State Public Health departments: http://www.astho.org/
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Massachusetts
Health Policy Commission: http://www.mass.gov/anf/budget-taxes-andprocurement/oversight-agencies/health-policy-commission/
Center for Health Information and Analysis: http://www.mass.gov/chia/
National health reform implementation: http://mass.gov/nationalhealthreform
Health Connector (exchange): www.mahealthconnector.org
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