Announcements

Please join us for the Spring Forum

The annual Spring Forum in Washington D.C. is coming up April 19-21.  Four preconference seminars on health issues are currently scheduled. 

• Health Information Technology Champions Foundation Partnership
• Rural Health Seminar
• Wellness, Healthy Eating: Active Living Seminar
• Adolescent Development and Mental Health Seminar

For more information or to register please visit http://www.ncsl.org/forum/index.htm.  

Audioconference Series: State Access 2007

Wednesday, 3 P.M. EST (2 PM Central, 1 PM Mountain, Noon Pacific time)
February 14, February 28, March 14

Many legislative leaders and governors have signaled plans to take on access to health care this year.  We’re putting together a series of web-assisted audioconferences to keep you connected with the latest developments and give you an opportunity to share concerns and insights.  Three have been scheduled and we will add topics as interest and state and national policy developments warrant.

February 14-- Expanding the pool: Individual mandates, tax benefits and other incentives

Expanding access lowers average costs if healthy and sick alike get coverage.  Massachusetts enacted an individual mandate.  How does that work?  How are other states expanding their pools?  This will look at individual mandates, parental mandates, and insurance deductions vs. credits including HSAs.

February 28-- Making plans affordable: Connector and other pooling and reinsurance arrangements. 

Mandates and expanded offers only work if people can afford them.  What are states doing to make care affordable and what is working?  We will look at subsidies and multi-sharing plans, risk pools and reinsurance as well as experiments with low-benefit and limited plans that get new groups into insurance.  The session will look at experience in Massachusetts with defining affordability, New York’s experiment in reinsurance and Utah’s offer of an entry-level policy to low income uninsured.

March 14--Healing the system: Quality improvement, safety and effectiveness strategies to contain costs. 

Vermont and Pennsylvania have both placed system reform at the heart of access reform.  Vermont has focused on providing more rational and effective care to people with chronic conditions—the group most likely to use health care.  Pennsylvania’s Governor has focused on making care more affordable by improving hospital safety and quality as well as expanding the use of nurse practitioners.   How are these and other state incorporating a changed approach to delivering care into their reform efforts?

Registration will soon be available. Watch your inboxes for the notice.  Please contact Kala Ladenheim at Kala.Ladenheim@ncsl.org or Laura Tobler at Laura.Tobler@ncsl.org with any questions about the programs.

Health Insurance Connectors

The Heritage Foundation has been sponsoring a series of Friday afternoon consultations on model language to establish health insurance connectors similar to the one in Massachusetts.  For more information, contact Leslie Merkle at Heritage leslie.merkle@heritage.org, or (202) 608-6211 and inquire about Friday calls on the model state health insurance exchange.    

Audioconference:  Medical Homes

Wednesday, February 21, 2007.2 p.m EST, 1 p.m. CST,  12 noon MST, 11 a.m. PST.

The speakers will discuss the American Academy of Pediatrics’ definition and vision of the medical home, demonstrate the benefits of medical homes using a genetics co-management case study, and identify policies that may support efforts to provide all children with medical homes.

Registration will begin through NCSL's website at www.ncsl.org/programs/health/webcast2.htm in early February. Please contact Alissa Johnson at alissa.johnson@ncsl.org with any questions.

Audiconference: Making School Wellness Policies Work

Friday, February 16 12 noon-1:30pm EST (11am-12:30pm CST, 10am-11:30am MST, 9am-10:30am PST)

Beginning with the 2006-2007 school year, federal law requires each local school district participating in federally funded school meals programs—nearly every school district in the country—to establish a local wellness policy. Wellness policies must include goals for nutrition education, physical activity, standards for healthy school foods, and other school-based activities designed to promote student wellness.  This webcast will acquaint listeners with wellness policy requirements, explain their preventive potential, provide a state legislative perspective on wellness policies and a focus on successful implementation of local policies. 

Speakers: 
David Satcher, MD, Former U.S. Surgeon General, Founding Chair-Action for Healthy Kids
Illinois State Senator Iris Y. Martinez, Chief Co-Sponsor Illinois School Wellness Legislation 
Jacqueline Barnett, Secretary of Education, City of Philadelphia  (Invited)
Dara Bass, Director of Policy Services, Kentucky School Boards Association
Joy Rockenbach, Act 1220 Program Consultant, Arkansas Department of Education

Registration will be through NCSL’s website at http://www.ncsl.org/programs/health/webcast021607.htm.  Please contact Lisa Castro at lisa.castro@ncsl.org for registration questions for this event.  For questions about program content, please contact Amy Winterfeld at amy.winterfeld@ncsl.org

Chronic Care and Quality

Chronic Care:  Providing Incentives to Boost the Health of Medicaid Beneficiaries

As a part of its Medicaid redesign, West Virginia is creating incentives for Medicaid enrollees to improve their health.  On March 1,^st the state will start to phase in it's Medicaid redesign plan whereby beneficiaries are asked to sign an agreement requiring that they practice healthy behaviors, participate in health improvement programs, follow recommended medical treatment, use emergency rooms appropriately and keep appointments.  The plan will soon be introduced in three counties and will be expanded statewide by next summer.  Participants in the plan, called the Enhanced Benefits Plan, will earn credits that can be used to cover co-payments and pharmaceuticals, as well as mental health counseling.  Medicaid beneficiaries who do not participate in the program will get all federally required services but will not be eligible for the enhanced services. 

The pilot project also includes a case management component and requires the establishment of a medical home for beneficiaries.  Each member will be managed with a team approach,  have a care plan developed and have a centralized electronic medical record.   

Kentucky also has a reform plan that provides additional benefits to chronically ill beneficiaries who participate in a disease management program for one year.  Idaho is looking at introducing similar reforms in its Medicaid program, including enhanced benefits for members who practice health behaviors and penalties for inappropriate emergency room use and missed appointments. 

Resources:

West Virginia Medicaid Redesign:

http://www.wvdhhr.org/bms/oAdministration/bms_Redesign.ppt
http://www.kff.org/medicaid/upload/7529.pdf

Kentucky Medicaid reform:
http://www.kff.org/medicaid/upload/7530.pdf

Idaho Plan:
http://www.hhs.gov/news/press/2006pres/20060525.html

New Legisbrief: Money Can Follow the Person in Long-Term Care

Most long-term care services are funded by Medicaid. Through a new demonstration project, "Money Follows the Person," states now have additional support from the federal government for long-term care.

Available free to legisaltors or for purchase by others here.

Healthcare Access

State Approaches to Expanding Access

Legislative successes in Massachusetts, Vermont, Illinois and Maine have encouraged other states to explore ways to improve access to health coverage.  As many as half of the states are expected to consider major access proposals this session.  NCSL is tracking initiatives in the states and is planning a series of audioconferences highlighting these proposals as they develop.  For links to these initiatives, go to http://www.ncsl.org/programs/health/h-primary.htm#2007.  As legislation becomes available, and to see last year’s universal coverage legislation, visit http://www.ncsl.org/programs/health/universalhealth06.htm. 

Below are highlights from four states where governors or legislators have presented plans in 2007.

1. California  Governor Schwarzenegger’s detailed universal health care proposal has gotten considerable attention. Under this plan, the Governor hopes to provide coverage for the 6.5 million uninsured residents in the state. This plan would establish an individual mandate as well as require insurers to guarantee issue coverage regardless of existing health status.  Employers would be required to offer section 125 plans (see note about “Section 125 plans, below.). Furthermore, employers with 10 or more employees who do not provide coverage would be required to contribute a fee of 4% of their payroll to a newly established state purchasing pool.  This state-administered pool would provide low income residents (up to 250% of the federal poverty line) with financial assistance for health coverage.  This proposal would also expand state programs like Medi-Cal to childless adults up to 100% FPL and to children up to 300% FPL (regardless of immigrant status).    This plan raise Medi-Cal provider payment rates and then assesses all doctors 2% and hospitals 4% of their revenue to pay for that rate increase, effectively redistributing provider income. 
   
   

   More information on this proposal is available at
   *http://gov.ca.gov/index.php?/press-release/5057/
   *http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=42119

2. Iowa  Senator Jack Hatch and Representative Ro Foege, co-chairs of the joint Health and Human Services Appropriations Subcommittee,  have begun committee work on LSB 1043, which proposes to fund universal access with a $1 increase in the cigarette tax.  A bipartisan commission would be formed to identify ways to make coverage more affordable for small business and families and for all Iowans.  Meanwhile, safety net programs would be strengthened.  Expanded eligibility would allow an additional 20,000 children to enroll in the Healthy and Well Kids in Iowa (HAWK-I) program, and coverage may also be extended to approximately 9,000 parents.  Mental health parity, dental home and increased provider payments are also in the legislative package.
   
   

   Further information about this plan is available at 
   *http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=2007701110379&template=printart
   *http://desmoinesregister.com/apps/pbcs.dll/article?AID=/20070118/NEWS10/701180395/-1/SPORTS01

3. Minnesota   Governor Pawlenty recently announced a health care plan to increase access to coverage.  Under this plan, MinnesotaCare premiums for children would be reduced by one third and MinnesotaCare coverage would be expanded to 300% FPL for children up to age 21.  Children with family income above 200% FPL would also be eligible for the MinnesotaCare II – subsidized private coverage that has lower premium rates than traditional MinnesotaCare.  This proposal would also create the Minnesota Health Insurance Exchange, modeled on the Massachusetts Connector.  In addition, employers with 11 or more employees would be required to offer 125 plans. The Governor expects this plan to provide coverage for about 23,000 uninsured Minnesota residents.
   
   

   Further details on this proposal are available at
   *http://www.governor.state.mn.us/mediacenter/pressreleases/PROD007915.html
   *http://www.startribune.com/561/story/940495.html

4. Pennsylvania  Governor Rendell has announced a proposal to cover about 1 million uninsured residents and lower costs through reduced hospital infections (Pennsylvania has been a leader in tracking this quality indicator) and expanded roles for nurse practitioners including ER staffing.  This proposal would create the Cover All Pennsylvanians program, which would offer small businesses (less than 50 employees) and uninsured individuals basic health insurance through the private market.  Uninsured individuals who earn less than 300% FPL would be eligible for discounts and subsidies based upon a sliding scale of income for premiums.  In addition, this proposal would include a phased-in mandate for health coverage for residents above 300% FPL as well as for full-time undergraduate and graduate students.  The plan would also include an assessment on employers who do not offer health coverage to their employees.
   
   More information on this proposal is available at 
   *http://www.governor.state.pa.us/governor/cwp/view.asp?a=1115&q=451062 
   *http://www.philly.com/mld/inquirer/16217976.htm

Section 125 Plans  Referring to section 125 of the IRS code, section 125 plans allow employees to purchase health insurance using pre-tax wages.  These plans are often referred to as Cafeteria plans. The recently passed Massachusetts plan requires employers with 11 or more employees to offer sec.125 plans, but this provision does raise some ERISA concerns.  More information about section 125 plans is available at http://www.irs.gov/govt/fslg/article/0,,id=112720,00.html#4  or at http://www.crbenefits.com/125.htm.

Addiction Prevention and Treatment

Combating Substance Abuse in New Mexico

New Mexico legislators will consider a package of proposals from Gov. Bill Richardson to provide more than $20 million to combat substance abuse and increase access to treatment. Modeled on U.S. Rep. Steve Pearce’s “Clean Town Act,” Richardson’s plan would create registries of convicted felony drug dealers and of meth-affected properties. The registries would be available to law enforcement authorities and members of the public. The Governor also wants to spend more than $28 million on behavioral health programs, with $20 million going to the prevention and treatment of substance use disorders. New Mexico’s “Total Community Approach” program would get $8 million to help individual localities tackle the specific substances that are abused in their area, and another $9 million would go to building a bed treatment center and community-based outpatient program. “Law enforcement plays a big role in our fight against illegal drugs,” Richardson said. “However…we also must invest in treatment for people who wish to reclaim their lives and become productive members of society.”

Study Questions “Gateway Theory” of Drug Use

A new study suggests that a child’s behavioral patterns and neighborhood have as much to do with whether he or she tries marijuana than if the child has tried alcohol or cigarettes first. The study, which appeared in the December American Journal of Psychiatry, questions the “gateway” theory of drug abuse, which theorizes that a child will use legal drugs first, then proceed to soft drugs like marijuana, and then on to harder drugs such as cocaine and heroin. Instead, the researchers support the “common liability” model, which hypothesizes that behavioral deviancy and genetic risk have the greatest influences on whether an individual will use drugs, legal or non.

The study followed 224 boys from ages 10-12 until they turned 22. Of these, 99 used legal drugs only (alcohol and tobacco); 97 used legal drugs before they started using marijuana; and 28 used marijuana first before using legal drugs. The researchers concluded that a child’s neighborhood – specifically one of poor quality – had the biggest impact on whether a child used marijuana. Patterns of delinquency also had a greater impact on marijuana use than prior use of legal substances. As a result, the researchers recommend early intervention for kids with conduct problems, writing “in effect, the greater the deviancy, the more likely an individual is to use an illegal drug. These findings underscore the need to prevent conduct problems in early childhood to diminish the risk of later illicit drug use.”

Providers and Workforce

Rural Areas Targeted for More Provider Education

A bill, set to be introduced in North Dakota, aims to create more rural health care workers and provide assistance to existing rural providers to move up the career ladder.  The legislation, co-sponsored by the bipartisan team of Senator Judy Lee and Senator John Warner, would provide about $2.6 million to train emergency medical technicians and licensed practical nurses in rural communities to become registered nurses or gain more training in other ways. 

Rural residents employed in other fields would also be targeted for a health care worker education.  “It’s hard to get a 22-year-old single person to move to a small area if they have no connection there.  But you’ve got people in those rural areas who are unemployed or looking for a career shift.  In essence, we’d be growing our own in these rural areas,” Senator Lee said in the Grand Forks Herald.

The bill is made up of three phases, although the third phase is not funded by the current legislation.  The first phase is a survey of 15,000 rural EMTs and nurse assistants to measure interest in a local RN training program.  The second phase is the creation of a mobile classroom for students—a large bus filled with medical training technology and lifelike mannequins that would travel between the state’s hospitals and nursing campuses.  The third phase will create a number of online and distance education courses to help nursing students better integrate training into their rural community lifestyle.  For more information see:

Bill Takes Aim At Rural Health Care
January 17 article from the Grand Forks Herald
http://www.grandforksherald.com/articles/index.cfm?id=24171&CFID=15623361&CFTOKEN=57421862&jsessionid=88302c3b97b847651c5f

Which Training Programs Produce Rural Physicians? A National Health Workforce Study 
This study, done by Dr. Gary Hart of the University of Washington, looks at which medical schools and residency programs tend to produce more rural physicians.
http://www.rural-health.org/database/projects.jsp?view_id=100000779

In Other News:

A Georgia panel studies ways to improve the trauma center network.  For more information, go to http://www.macon.com/mld/macon/news/local/16468126.htm.

A New York study finds that there are enough doctors in the state, but problems may rest in the distribution of doctors, especially among certain specialties.  For more information go to http://www.timesunion.com/AspStories/story.asp?category=STATE&storyID=554428&BCCode=&newsdate=1/17/2007

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