Can You Figure Out America's Crazily Complex New Health Insurance System? See RWJF

Back when the Affordable Care Act was introduced, RWJF was at battle stations, spending millions to help enroll people in the exchanges and educating the public and providers about the law. Now that the war is largely over—the ACA is in place, it’s effective, and by gosh, it isn’t unconstitutional—RWJF’s health policy pendulum has been swinging again, away from a focus on coverage and toward other issues, such as cost containment and, crucially, improving the kinds of health insurance that are available and how existing options work.

Recently, the foundation put out an RFP for "policy-relevant insurance studies." Read between the lines of this call, and it's clear that the folks at RWJF see the new system as kind of a mess, with new options overlaid on existing ones, creating a daunting level of complexity and many unknowns going forward.

a multitude of questions remain, particularly around possible changes in the employer-sponsored insurance, as well as the potential for increased integration of Medicaid, CHIP and the Marketplace. How are employers likely to respond to new options for employee coverage? Are there ways that states might reduce differences between Medicaid and Marketplace plans in order to mitigate churning and create seamless continuity of coverage?

Thorny questions, right?

But RWJF doesn't want researchers spending years mulling them over. It's seeking projects that are sleek and fast like well-trained racehorses: the type that can run their courses and produce results in a mere six months (some twelve month projects will be considered as well). The pot? RWJF is setting aside $650,000 for this particular RFP, which it aims to mete out in $50,000-$150,000 chunks. We’re not looking at a huge number of gifts, maybe as few as five, but the money is good, especially for the time frame.

In addition to wanting dexterity and speed, RWJF is seeking interdisciplinary mojo. It’s keeping an open mind, advertising its receptiveness to projects coming from a health services research angle, or from economics, sociology, program evaluation, political science, public policy, public health, public administration, law, or business administration.

Here, too, is an implicit admission that America's health system has gotten even more crazily complicated with passage of the ACA. When you're opening the door to sociologists and MBAs, or anyone who can actually figure this stuff out, with so many moving parts, you know you've got serious challenges.

Taking a step back, our sense that is that RWJF is keen on getting a better empirical fix on a range of issues it works on, even as pulls all its work under the broad umbrella of a "culture of health."

The foundation is winding down longstanding meat-and-potatoes human capital programs and socking money instead into more academically (and mathematically) rigorous programs—whether it's sending nurses to Ph.D programs, analyzing personal fitness data, or now this, using data to better understand public and private health insurance systems, and how they interact.

We like it. If anyone’s equipped to build up a geeky health policy brain trust, it’s RWJF. And all signs seem to indicate that a health policy brain trust is something this country could really use right now.

a multitude of questions remain, particularly around possible changes in the employer-sponsored insurance, as well as the potential for increased integration of Medicaid, CHIP and the Marketplace. How are employers likely to respond to new options for employee coverage? Are there ways that states might reduce differences between Medicaid and Marketplace plans in order to mitigate churning and create seamless continuity of coverage?