Dear Health Committee Chairs:
Happy 2005! We hope your legislative session is off to a good start.
This is your January 2005 email update on state health policy resources available to you for free on the Internet. We hope you’ll let your new colleagues know about this resource by forwarding a copy of this newsletter to new health leaders and encouraging them to send us their e-mail addresses. New health committee and subcommittee chairs may subscribe by emailing kala.ladenheim@ncsl.org. We also welcome chairs of other committees and subcommittees dealing with health policy, such as finance, human services and insurance.
We have lots of things planned for state Health Chairs in 2005, including a June policy meeting together with a Medicaid Institute in Washington, a special session just for you at the annual meeting in Seattle, audio-conferences on hot topics that you need to know more about, and some in-state consulting available at your request.
State of the States
The Fiscal Survey of States, just released, gives actual fiscal 2003, preliminary fiscal 2004, and appropriated fiscal 2005 figures. States revenues are slowly recovering from the worst downturn in 60 years, although they are still below historical averages. But, as the latest budget report from the National Governors’ Association and NASBO puts it, “Medicaid spending continues to hound state budgets.” With the end of federal fiscal relief in the Medicaid match (FMAP), states anticipate over 12 percent growth for state funds and 3.9 percent for federal Medicaid funds in FY 2005. http://www.nga.org/cda/files/FSS0412.pdf
Ready or not…for bioterrorism.
The Trust for America’s Health looks at state preparations to deal with bioterrorism threats, and finds much to be concerned about. State and federal funding actually decreased in many states in FY 2004. The report finds Florida and North Carolina the best prepared, with Massachusetts and Alaska meeting only three apiece of 10 key indicators the report uses to gauge state preparedness. The site includes links to comparative state information including public health budgets. http://healthyamericans.org/reports/bioterror04/.
Access for the Uninsured
Continued Erosion of Retiree Coverage
States are slipping towards a coverage gap due to the erosion of retiree benefits. According to a Kaiser Family Foundation / Hewitt Associates survey, the cost of retiree health benefits for large firms grew, on average, 12.7% in 2004. Over three quarters responded by increasing the retirees’ share, and an even greater percentage plan to do the same in 2005. The survey also looks at how the Medicare prescription drug benefit is likely to affect employer-based prescription benefits. For the report and an audioconference, see http://www.kff.org/medicare/med121404pkg.cfm.
Which noncitizens get care, where and how? A recent report describes how states have responded to changing federal law. Covering New Americans: A Review of Federal and State Policies Related to Immigrants' Eligibility and Access to Publicly Funded Health Insurance includes extremely detailed state-by-state information and analysis of the requirements and opportunities for public programs. Be patient—the file loads slowly.
http://www.kff.org/medicaid/7214.cfm
http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=48750
Chronic and Long Term Care
Diabetes. The Agency for Healthcare Research and Quality and Council of State Governments have released Improving the Quality of Diabetes Care: New Tools for States, consisting of a resource guide (152 pages) and workbook (38 pages) for states to use to see how well they are doing and design strategies to improve diabetes care. Diabetes is a grave illness. Proper care can make a huge difference in costs to the health system and to individuals’ quality of life. Racial and ethnic disparities are often great, an indication that real improvement is there for the making. The massive resource guide includes excellent state-level tables on costs and health status—for example, table 2.2 gives state-by-state counts of the number of people on Medicaid with diabetes and their annual Medicaid spending. Table 2.3 estimates total cost of diabetes and proportion of population with the disease, by state. It reports on how well each state is performing on several treatment standards. Finally, it features programs that have been shown to work. If you expect a discussion of diabetes care this year (and if you don’t, why don’t you?) you need this. http://www.ahrq.gov/qual/diabqualoc.htm.
Disease Management
For an overview of the topic, take a look at this presentation by the California HealthCare Foundation. It is a very readable slide show—navigate by clicking through the list on the right. http://www.chcf.org/documents/policy/DiseaseManagementInMedicaid2004.pdf.
Pharmaceuticals
The Congressional Budget Office has just released an excellent report, Medicaid’s Reimbursements to Pharmacies for Prescription Drugs. The 24-page report, released in December 2004, sorts through and clarifies the complex policy decisions states make in this area. http://www.cbo.gov/ftpdocs/60xx/doc6038/12-16-Medicaid.pdf.
If you’ve been holding your breath for the Secretary’s report on drug reimportation, you can sigh now. All 145 pages of the HHS Task Force Report on Drug Importation: Report on Prescription Drug Importation can be downloaded at http://www.os.dhhs.gov/importtaskforce/ . Joy Johnson Wilson summarizes it as follows: “(1) the Administration continues to oppose drug importation; and (2) the Administration does not believe that drug importation would provide significant savings to U.S. consumers.”
State Studies
Maine’s Dirigo Health is the subject of a series of reports available from the National Academy for State Health Policy. In addition to NASHP reports, the page leads to Dirigo’s site including information about the program’s quality and cost as well as access components. http://www.nashp.org/_docdisp_page.cfm?LID=A495E7F2-8D3E-440B-9112C396FC0750D9.
Utah’s Gov. Michael Leavitt has been nominated to be Secretary of the U.S. Department of Health and Human Services. The latest issue of NCSL’s State Health Notes looks at Utah’s one-of-a-kind waiver and asks what it portends for state Medicaid programs in the next few years. “As governor, Leavitt obtained a "Section 1115" demonstration Medicaid waiver that was unique because it paid for an expansion of health-care coverage to some by reducing benefits to others.” http://www.statehealthnotes.org/issues/25_434/fyi/140410-1.html .
If you don’t already have a password to log on, follow the directions at this link—SHN is free to all legislators and staff. The Chairs’ meeting in Salt Lake City last summer featured this program. A recent report by Utah’s Dept. of Health researchers is available at http://health.utah.gov/hda/report/SCIJune04-PCN-RoundTable.pdf. Leighton Ku of the Center on Budget and Policy Priorities critiqued the department’s studies and concludes that copayments in Utah lowered the use of needed services and drugs. http://www.cbpp.org/11-2-04health.htm.
Challenging Conventional Wisdom
Electronic data entry doesn’t automatically prevent prescription errors, since the data entry may also be error prone. The United States Pharmacopeia (USP) MEDMARXSM program found that despite the hype, nearly 20 percent of hospital and health system medication errors reported to them in 2003 involved computerization or automation. Facilities with computerized prescriber order entry (CPOE) had fewer harmful errors. http://www.onlinepressroom.net/uspharm/.
Classics
We thought we’d start off the new year—and the new session—with links to some of our favorite sites.
State Health Facts, brought to you by the Henry J Kaiser Family Foundation, is a great starting point for background information and interstate comparisons. It is very easy to use and contains a wealth of state data. You can look at information by state or nationally, and tailor comparisons using maps or tables. Information can be sorted by state name, rank or region. Public Insurance is Kaiser’s strong suite, and that shows in strong details for Medicaid, Medicare and SCHIP, but this site also has a wealth of information on demographics, health status, health costs, insurance, http://www.statehealthfacts.org/.
While you are on the Kaiser site, you may also want to check out their latest reports (http://http://www.kff.org/), see what new webcasts are available at http://kaisernetwork.org/ and explore the background material they’ve created for policy students at http://www.kaiseredu.org/.
The State Coverage Matrix is a deceptively simple table of state policies related to access. Click on any of the cells in the table, and you go to a page that describes the program and links to related sites, including state and national reports on the program. Click on a header and you’ll get a description of the category and a table with thumbnail sketches for each state in the category. And of course, clicking on the state will take you to links for all of its access programs. This site is part of the Robert Wood Johnson Foundation’s State Coverage Initiative at AcademyHealth. http://www.statecoverage.net/matrix.htm.
Lots of other resources are available on this site including a database of state reports, and publications on coverage from AcademyHealth.
For information on long term care in the community, see the site for Real Choice Systems Change (RCSC) grantees, http://www.hcbs.org/. The site brings together the federal government, states, and persons with all types of disabilities of all ages to expand access to high quality, cost-effective, consumer-directed home and community-based services and supports. It has promising practices, practical tools, good state data, recent federal announcements and research abstracts.
http://www.cdc.gov/nchs/hus.htm.
Health, United States is an annual report on national trends in health statistics including highlights, a chartbook, and trend tables with statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, drug utilization, and other health topics. Trend tables can be downloaded as spreadsheet files for data manipulation or graphical analysis. The Preface describes changes and additions to the current report. Major findings are presented in the Current and previous editions are available through this Web site, starting with Health, United States, 1993
Measuring Disparities: State data collection How do you define a minority? What is collected by whom and why, and what definitions are used, is in need of sorting out. One step in that direction is this compilation of current state laws. http://www.omhrc.gov/omh/sidebar/datastats13.htm. Assessment of State Laws, Regulations and Practices Affecting the Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans.
Distribution of Health Spending Who spends what proportion of health costs? This 2001 update of a classic study is not new, but it's important for a lot of policy making. http://www.cop.ufl.edu/departments/PHCA/modellinglab/PAfootewebsite/concentration.pdf.
The Centers for Medicare & Medicaid Services (CMS) is the federal agency concerned with these two public insurance programs. http://www.cms.hhs.gov/researchers/default.asp takes you to a variety of federal data resources related to Medicaid and Medicare. http://www.cms.hhs.gov/researchers/statsdata.asp lists available data. Note the dates. It still takes a couple of years to reconcile and clean up data for the national compilation. The Kaiser site listed above also summarizes much of their data and may be easier to use.
Prescription drugs continue as one of the most active health policy issues for 2005. This page highlights state actions and Medicare part D and what it likely will mean for the states. http://www.ncsl.org/programs/health/pharm.htm. Other NCSL roundups on state pharmacy assistance programs, http://www.ncsl.org/programs/health/drugaid.htm, drug reimportation http://www.ncsl.org/statefed/health/importnews.htm and bulk purchasing http://www.ncsl.org/programs/health/bulkrx.htm .
For information on disability law, look at this Iowa site: http://disability.law.uiowa.edu/. It includes a map of state rules and resources on state work incentive initiatives. http://www.uiowa.edu/~lhpdc/work/map.html
If you are researching chronic illness, start at CDC’s National Center for Chronic Disease Prevention and Health Promotion. http://www.cdc.gov/nccdphp/ Don’t miss the state profiles http://www.cdc.gov/nccdphp/states/index.htm.
Workforce resources from the Federal government are found at http://bhpr.hrsa.gov/ , with state health workforce profiles, http://bhpr.hrsa.gov/healthworkforce/reports/profiles/. Another good place to start when looking to future needs is Center for California Health Workforce Studies (CCHWS) http://futurehealth.ucsf.edu/cchws.html.
To be continued…
We’ll bring you more favorites and more breaking news next month. Tell us what your favorite bookmark is, and what issues you want to see us cover with an e-mail to kala.ladenheim@ncsl.org.
Have any questions you'd like answered? A topic for which you’d like us to gather resources? Do you have a report of your own you'd like to share with your peers? Drop us a line…
Dick Merritt, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8698 fx: 202-737-1069
dick.merritt@ncsl.org
Kala Ladenheim, Ph. D. Program Manager
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
kala.ladenheim@ncsl.org
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