Trends and Transitions: December 2012 | STATE LEGISLATURES MAGAZINE

Screening Newborns for Heart Defects

Newborns across the country are routinely screened for all sorts of health problems. Eight state legislatures have recently added a test for congenital heart defects to the list, and others are considering doing so.

Problems with the walls, valves, arteries or veins of the heart are some of the most common types of birth defects, affecting up to nine of every 1,000 births. Of the approximately 4 million babies born in the United States each year, more than 4,800 have a critical heart defect, putting them at higher risk for disabilities and early death. Early treatment is crucial, but often these babies appear healthy and go home before problems are detected. Critical heart disease is responsible for more deaths in the first year of life than any other birth defect.

All states screen for some genetic disorders and hearing problems. The U.S. Department of Health and Human Services’ advisory committee on heritable disorders recommends screenings for 31 core disorders and 26 secondary disorders. The committee added a recommendation for congenital heart disease screening--—known as pulse oximetry—in September 2011, which was endorsed by the American Academy of Pediatrics, the American College of Cardiology Foundation and the American Heart Association.

The pulse oximetry test measures the oxygen saturation in the blood; a low level can indicate additional testing is needed to look for heart problems. The screening detects about 77 percent of all congenital heart defects and is more effective than a basic clinical exam and prenatal tests.

Diagnosing heart problems early may eliminate future health care costs, such as emergency room visits, and may reduce the risk of medical malpractice suits against providers for failing to detect heart problems at birth. Supporters point out that many hospitals already have pulse oximeter machines, and that the test costs only $5 to $10 and takes about three minutes.

There are downsides, however. Smaller hospitals may not have the proper equipment or specialists to conduct follow-up tests, and false positives may require additional costly tests and cause unnecessary stress on parents. A recent study in the United Kingdom, however, found that false positive rates are low, occurring approximately one in 1,000 times.

Connecticut, Indiana, Maryland, New Hampshire, New Jersey, Tennessee and West Virginia passed laws requiring—and California requires offering—pulse oximetry screening of newborns. Another nine states have considered legislation, and two had bills pending at press time. And some states, even without legislation, require the test and are studying the issue. In Minnesota, a group of medical professionals, state officials and administrators developed a pilot program to conduct screenings. The Colorado General Assembly adopted a resolution requesting that the Department of Public Health and Environment develop a screening system, while an Alabama resolution commends the health department for requiring screening. In addition, six states have adopted resolutions to raise awareness about congenital heart defects.

—Jennifer B. Saunders

New Rules for Young Immigrants

A new federal policy allowing certain young illegal immigrants to remain in the country temporarily is stirring up debate—and action—in the states. Called “Deferred Action for Childhood Arrivals” (DACA), it could shield up to 1.7 million young people under age 31 from being deported and allow them to work for two years, after which they would be allowed to reapply for the deferred status.

The U.S. Citizenship and Immigration Service began accepting applications in mid-August from people who meet the following criteria.

◆ They entered the United States before the age of 16.
◆ That as of June 15, 2012, they were under the age of 31 and had continuously resided in the country for at least five years.
◆ They are either in school, have graduated from high school, have earned a GED or have been honorably discharged from military service.
◆ They have not been convicted of a felony, a significant misdemeanor or several misdemeanors.

Meeting the criteria does not necessarily mean deferred status will be granted, as the federal government is making decisions on a case-by-case basis. From Aug. 15 to Sept. 13, the U.S. Citizenship and Immigration Service had accepted 82,361 requests for review and had completed 29 of them. Deferred action does not provide lawful status or a path to citizenship, according to the U.S. Department of Homeland Security.

In addition, the Department of Health and Human Services advised states that the policy does not make young immigrants eligible for the federal Children’s Health Insurance Program or Medicaid, nor will they be able to purchase insurance in the health exchanges mandated by the Affordable Care Act. 

Since the federal policy was announced last June, state legislators, governors and other public officials have been grappling with how to handle the new policy—whether to update their laws and rules to either provide or deny benefits such as in-state tuition, identification cards and driver’s licenses to immigrants who are granted this deferred action status.

In the dozen states with laws prior to the new federal policy allowing illegal immigrant students to be eligible for in-state tuition, those granted deferred status will still be eligible. Other states are reviewing their policies to see whether deferred action would permit or deny in-state tuition.

Governors in Arizona and Nebraska have stated they will not allow driver’s licenses or state public benefits to be issued to deferred action recipients. On the other hand, the California Legislature passed a law to allow deferred action immigrants without Social Security numbers to obtain driver’s licenses. And state agencies in Alabama, Colorado, Florida, Illinois, Indiana, Michigan, Ohio, Texas, Virginia and Wisconsin have announced plans to offer recipients driver’s licenses. 
New Mexico and Utah are the only states that do not require proof of legal immigration status to obtain a driver’s license, and Utah offers a driving privilege card to those who cannot prove lawful status.

—Ann Morse

Blowing the Whistle on Child Abusers

By the time former Penn State University assistant football coach Jerry Sandusky was convicted of child abuse in October, many state lawmakers already had responded to the scandal by introducing legislation either to tighten existing mandatory reporting laws or establish new ones. This year alone, state lawmakers in at least 30 states and the District of Columbia introduced 107 bills, of which 32 have passed in 17 states.

Most of the legislation: 1) Adds to the list of who is required to report known or suspected child abuse, such as higher education staff and coaches; 2) Sets penalties for failing to report abuse or neglect; 3) Requires training for mandatory reporters; or 4) Requires reporting child abuse or neglect to law enforcement officers.

Florida’s new law, considered by some to be the toughest in the nation, imposes a $1 million fine on colleges and universities that “knowingly and willfully” fail to report known or suspected child abuse or prevent another person from doing so. In addition, anyone suspecting abuse must call a Florida Department of Children and Families hotline or face third-degree felony charges and a $5,000 fine.

All states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands have laws on who must report abuse, and 48 of them penalize those who knowingly fail to do so. At least 18 states require anyone suspecting child abuse to report it. 

                                                        —Nina Williams-Mbengue

Sales Tax Holidays:  Help or Hindrance?

Looking to give retailers and consumers a break, 18 states offer annual sales tax holidays—usually two or three days to a week when specific goods are exempt from state and sometimes local sales taxes. The products range from clothing and school supplies to guns and ammunition.

Sales tax holidays are popular with consumers and have broad support among lawmakers, who have supported them to improve sales for retailers, help low-income consumers save money and promote economic growth. But a recent report from the Tax Foundation, a non-partisan tax research group based in Washington, D.C., asserts that the tax breaks only distract policymakers from making more substantive and permanent tax changes.

New York established the first sales tax holiday in 1997, when the Legislature instituted a tax-free week for clothing and shoes originally priced under $500. Other states followed, reaching a peak in 2010, when 19 states and Puerto Rico allowed some sort of tax holiday. Some states have allowed holidays in the past, but have repealed them because of declining revenues during the recent economic downturn.

Which products go on holiday varies greatly, according to the Federation of Tax Administrators. Clothing, however, is most often exempted; Puerto Rico and 17 of the 18 states that conducted a sales tax holiday this year exempted clothes. Thirteen states exempted clothing purchases up to $100; Connecticut exempted up to $300; Florida, up to $75; and South Carolina had no limit. Many states also include school supplies in the holiday. Other products exempted include Energy Star products in Georgia, Maryland, Missouri, North Carolina and Virginia, for example, and hurricane supplies in Alabama, Louisiana and Virginia. Massachusetts exempts most personal property purchases under $2,500.

“The opportunity to provide goods and services to consumers without the added cost of the state sales tax for one weekend a year creates an economic boost welcomed by the commonwealth’s small businesses,” says Massachusetts Senator Gale Candaras (D). “Not only do tax holidays benefit residents of the state who can enjoy a substantial reduction in actual cost for big ticket purchases they might not have otherwise made, these holidays also serve to bring in consumers from outside Massachusetts.”

The Tax Foundation report, however, argues that sales tax holidays do little to stimulate new sales, because consumers often wait for tax holiday periods to buy goods they would normally purchase anyway. In addition, the tax holidays force some low-income consumers to decide between purchasing goods at a discounted rate or paying important bills. Businesses are burdened with operating under more than one set of sales tax laws a year, which may require the added costs of reprogramming cash registers and computers for a short period of time.  

The report suggests that a voucher or rebate system would be a more effective tax tool for low-income consumers, making benefits available to them regardless of when they shop.

Because of their popularity among consumers and lawmakers, the report concludes that sales tax holidays are likely to remain for the foreseeable future. “The sales tax holiday serves as a $20 million stimulus for consumers and businesses,” says Massachusetts Senator Michael Knapik (R). “I am in favor of a permanent sales tax holiday in Massachusetts because I think the citizens deserve the relief and every store deserves the uptick in business.”                        

— Aron Snyder