Metaforix@Health – Medicare Resources Online

Lois C. Ambash is President and Chief Infomaven of Metaforix Incorporated, whose services include organizational assessment and planning activities, web site and e-letter content development, and design and delivery of customized workshops for healthcare, education, business, and community organizations. Lois holds a PhD in American Culture and Writing, Master’s degrees in Library/Information Science and Public Policy, and a Bachelor’s degree in English. She serves on the board of the Internet Healthcare Coalition and on URAC’s Health Web Site Accreditation Committee, and is a frequent writer and speaker on e-health, Internet research, business communications, and organizational culture. Read or subscribe to Lois’s blog, Metaforix@.

Medicare is a topic that has the potential to burst into the headlines at any moment. Not only does Medicare touch virtually every American family and exemplify many aspects of our more global healthcare crisis. The program also highlights key demographic trends, social policy issues, economic realities, and political values.

Ever since last summer, when debate on prescription drug benefits for seniors swept Washington in earnest, barely a week has gone by without a major Medicare policy initiative, study, accusation, or potential scandal. The initial aspects of last year’s “Medicare Prescription Drug, Improvement, and Modernization Act” – prescription drug discount cards and new benefits for low-income seniors – are set to kick in on June 1. The Presidential campaign is in full swing. So, now seems an appropriate time to review some of the many online Medicare resources. The following list includes primarily free resources that emphasize law, policy, and program implementation.

Law and Legislative History

The Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA), provides this link to the full text of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. CMS refers to the new law as MMA, a practice I will emulate for the remainder of this column.

The entire February issue of Congressional Digest (vol. 83, issue 2) is devoted to a brief, balanced summary of MMA. Highlights include a legislative chronology, a program summary, a glossary, fiscal data and projections, a summary of the conference committee report, and selected excerpts from the debate. I could access this freely online only by using my New York Public Library card. Perhaps you have Congressional Digest in your own library or can access it in similar fashion.

Cornell University’s Legal Information Institute has an annotated version of the original Medicare legislation, including updates, regulations, and relevant court decisions. The 2003 updates have not yet been incorporated.

The National Academy of Elder Law Attorneys site offers a “snapshot” of MMA, one of a number of such summaries available on various trade association, professional society, and policy sites. The snapshot links to an annotated AARP analysis of the transitional assistance program for low-income beneficiaries that takes effect on June 1, a year and a half earlier than the program as a whole. To view a summary intended for a different audience, visit the “Policy and Advocacy” page on the web site of the American Academy of Family Physicians.

Policy Tools

The Center for Studying Health System Change (HSC) is a nonpartisan health policy think tank and research center. Take a look at its Medicare page for links to tables, articles, and issue briefs that encompass valuable charts and tables. HSC’s central focus with respect to Medicare is the “effect of payment policy on providers and health plans.” In addition, see Insurance Coverage and Costs for analyses of “private and public insurance coverage, the uninsured and the cost of health care” and of “incremental public insurance expansions.”

Georgetown University’s Center on an Aging Society is a “non-partisan public policy institute that fosters critical thinking about the implications of an aging society.” Although a number of studies available on the site are specifically focused on Medicare, the site has a more diffuse and inclusive approach that places Medicare in a broader cultural and societal context.

The Center on Budget and Policy Priorities “conducts research and analysis” at the federal and state levels “to inform public debates over proposed budget and tax policies and to help ensure that the needs of low-income families and individuals are considered in these debates.” While its mission gives the Center a distinct point of view, articles such as the newly posted “Understanding the Social Security and Medicare Projections” are useful examples of how policy orientation may affect one’s interpretation of statistical data.

The Century Foundation’s Medicare Watch is a policy think tank whose site features studies, news items, and policy analyses with a decidedly progressive slant. In contrast, see the Cato Institute’s “Health Studies” resources on Medicare for a libertarian point of view.

The Dartmouth Atlas of Health Care is a project that “brings together researchers in diverse disciplines – including epidemiology, economics, and statistics” to study “how medical resources are distributed and used in the United States.” In addition to the “Major Topics” page on Medicare reform, see the Interactive Data Base tools that allow users to create graphs, tables, and other displays using the large healthcare database the project has assembled.

Health Affairs is a highly regarded, peer-reviewed policy journal that “explores health policy issues of current concern in both domestic and international spheres.” Not all of the site’s content is accessible without a subscription, but “tables of contents, abstracts, e-alerts, full-text searching, and access to a selection of full-text content” are freely available to the public. Take a look at the Medicare references and consider subscribing to the “e-Alerts” service, which will notify you when new online content is posted in your areas of interest.

The University of Michigan’s Health and Retirement Study is a huge “longitudinal study of health, retirement, and aging” sponsored by the National Institute on Aging. The project site has an impressive bibliography of resources based on the data collected by the study. Many datasets are available to researchers and the public upon registration. Other data is restricted, but may be made available to researchers under certain conditions. Follow this link for detailed information about Medicare-specific data.

Health Hippo is an enormous “collection of policy and regulatory materials related to health care,” with attitude and a sense of humor to boot. While the site is in desperate need of updating and has many broken links, there are enough working links to current and sometimes offbeat information that Health Hippo is worth a look nevertheless.

The Kaiser Family Foundation’s Medicare Policy Project “conducts research and analysis on current Medicare policy issues, monitors key trends, and produces fact sheets, resource books and reports to inform policy discussions.” The publications available on its site offer an extraordinarily rich and up-to-date array of fact sheets, charts, tables, and analyses.

In addition, Kaiser has just launched a new site,, aimed primarily at health policy students and faculty. Judging by its initial “issue modules,” “reference libraries,” and “tutorials,” this site promises to be an outstanding, user-friendly policy resource. See the issue module on the new prescription drug benefit and the Medicare reference library for a large and balanced array of text and multimedia resources produced by the Kaiser Family Foundation, its grantees and partners, and other relevant policy and polling organizations.

The National Library of Medicine (NLM) site has an outstanding set of links to “Related Health Services Research Web Sites.” While there is no Medicare topic per se, pay special attention to the sections labeled “Epidemiology and Health Statistics,” “Funding,” “Health Policy and Health Economics,” “Informatics,” and “Public Health.” I am familiar with many of the sites included here and explored some new ones while preparing this column, without even scratching the surface. This is a cornucopia of authoritative information that addresses a variety of Medicare-related policy issues and tools.

While you are visiting the NLM site, take a look at Dan Melnick’s useful tutorial on “Finding and Using Health Statistics.” Aimed at librarians, it is also suitable for others who may not be familiar with the range of resources and tools available to the statistically sophisticated as well as the mathematically challenged.

The Presidential candidates’ official web sites offer policy statements on everything under the sun, Medicare included. President Bush’s web site covers Medicare in this health issue brief and in transcripts of some two dozen speeches and ceremonial occasions. Senator Kerry’s site has a “four-step plan” for Medicare” and a prescription drug plan for seniors, along with coverage in accounts of speeches and video clips.

RAND Health calls itself “the nation’s most trusted source of objective health policy research.” Among its main research areas are “Healthcare Organization, Economics, and Finance” and “Law and Health.” See, for example, the 2002 study, “Costs of a Medicare Prescription Drug Benefit: A Comparison of Alternatives.”

The Robert Wood Johnson Foundation “seeks to improve the health and health care of all Americans” by funding projects that “concentrate on health care systems and the conditions that promote better health.” Among other Medicare-related resources on the RWJ site, see the report produced for RWJ by the Institute for the Future, “Health and Health Care 2010: The Forecast, the Challenge.”

Program Implementation

AARP provides consumer-friendly information about the MMA changes, in a manner that appears to distinguish clearly between facts about the law and the organization’s controversial policy advocacy in this arena. Articles from the AARP member bulletin are collected here. A separate Policy and Research section of the site offers research data and analysis and a summary of AARP’s advocacy stance.

CMS, a division of the Department of Health and Human Services, administers Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), the Health Insurance Portability and Accountability Act (HIPAA), and the Clinical Laboratory Improvement Amendments (CLIA). The large and complex CMS site addresses at least four distinct audiences: healthcare providers and businesses; government agencies at various levels; the media; and consumers.

The “official U.S. government site for people with Medicare,”, may be accessed directly or through a link from the CMS site. As of April 29, the site will add an online calculator so that Medicare beneficiaries can compare the cost of drugs using the various discount cards during the transitional period that begins on June 1 and ends on December 31, 2005.

Medline Plus is a site created by the National Library of Medicine to assist consumers and other users in locating authoritative health information. Links are prescreened for quality and accompanied by user-friendly features such as glossaries, tutorials, reading level indicators, Spanish-language content, and images produced by A.D.A.M. A large portion of the Medicare information accessible through Medline Plus is drawn from the CMS site, but Medline Plus is far better organized, more visually appealing, and easier to use.

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