By Douglas McCarthy, Senior Research Advisor for The Commonwealth Fund

The Commonwealth Fund Commission's 2009 State Scorecard shows that in areas of health system performance where we as a nation have made a commitment to reporting and improving performance, we see dramatic results. Since the first State Scorecard was released in 2007, almost all states improved on several indicators of quality of hospital treatment, for example. This change reflects the influence of national consensus on a single set of measures for hospitals, public reporting of results of these measures on the federal Hospital Compare Web site, and widespread hospital participation in reporting following a policy change in which the Centers for Medicare and Medicaid (CMS) linked reporting to Medicare payment updates. Hospital quality has also been the focus of an intense collaborative improvement campaign across the nation.

By Karen Davis

Ensuring that all Americans have access to affordable health insurance and care is one of the major goals of federal health reform, if not the major goal. Under the three bills now before Congress, affordability is achieved through expansion of the Medicaid program, creation of an essential insurance benefit package, and sliding-scale subsidies to make premiums and cost-sharing affordable for low- to moderate-income families. However, the bills recognize that budgetary limitations may still leave some families subject to financial hardship and exempt families from the requirement to purchase insurance if such coverage proves unaffordable.

Determining what is and is not "affordable" for different groups is a challenge that is reflected in the varying levels of coverage and assistance offered across the three bills. In making these calculations, it is important to recognize that affordability is related both to premiums and out-of-pocket costs. If a family’s premium is low but their out-of-pocket expenses are high, their care may ultimately be difficult for them to afford.

By Karen Davis

Cooler weather has arrived and, with it, cooler heads are moving forward with health reform. Despite the summer demonstrations against congressional health care legislation, there is widescale recognition that the U.S. health system cannot continue on its current course. Ever-rising numbers of uninsured, insurance premiums that are out of reach of even middle-income families, and the strain on businesses and government budgets from a health sector consuming a greater and greater share of the nation’s economic resources make the status quo untenable.

Still, most Americans remain perplexed by the different versions of health reform presented in legislation from three committees in the House of Representatives and two committees in the Senate. The daily headlines highlighting differences in opinion on specific provisions suggest bipartisan and even Democratic party agreement is elusive. Yet, even though the Senate Finance Committee is still considering legislation and the final bills going to the House and Senate floors have yet to be formed, there is, in fact, significant consensus on the framework for reform across all the bills moving through Congress. It includes: affordable health insurance coverage for all; increased choices; incentives for accountability; greater transparency; shared responsibility; redirected resources; and opportunities for learning and acting as reform is implemented.