Dear Health Committee Chairs:
Happy 2005! We hope your legislative session is off to a good start.
This is your February 2005 e-mail 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 e-mailing 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 (hold the 9th-11th), a special session just for you at the annual meeting in Seattle, audioconferences on hot topics, and some in-state consulting available at your request.
Looking ahead
Save the date of April 15th and 16th for Medicaid and Mental Health for Children and the Elderly, to be held just after the 2005 NCSL Spring Forum in Washington, D.C. Some limited travel stipends are available for actual expenses. Please notify Debra Prosnitz via email at debra.prosnitz@ncsl.org if you are interested in receiving the updated program and logistical information next month. Slides from our December 2004 Medicaid and Mental Health meeting are at http://www.ncsl.org/programs/health/mentalh.htm.
'Cover the Uninsured Week' 2005 will be held from April 30 to May 8, 2005. The week is a nationwide effort co-chaired by former Presidents Gerald Ford and Jimmy Carter. It will feature local town hall meetings on the state of health care and proposed Solutions. The Web site will have more information as the project gets rolling, including local activities across the country. http://covertheuninsuredweek.org/.
Access and Insurance
Hospital billing practices have been coming under fire for over a year, with reports of very high charges and aggressive collection measures directed at uninsured patients. A series of lawsuits have further pressured hospitals to make good on community benefit requirements. The American Hospital Association (AHA)and Healthcare Financial Management Association (HFMA) have issued a report for their members on reviewing policies for the un- and under-insured from the “Patient Friendly Billing Project.” http://www.patientfriendlybilling.org/2005report/2005_pfb_report.pdf. The site also has tools, including state policies in this area. http://www.patientfriendlybilling.org/2005report/tools.htm#6.
Health centers and the people they serve are highlighted in a new state-by-state compilation from the National Association of Community Health Centers (NACHC) . Clicking on a state takes you to a choice of two resources with a great deal of state-level detail: “NACHC’s 2004 State Databook, providing state level statistics on vulnerable populations being served by health centers, Medicaid/SCHIP, disparities, and access to care; and NACHC’s State Fact Sheets, providing a brief description of what health centers are, and the most recent state-level data available for health center patients, services provided, staff, patient visits, and costs of care.” http://www.nachc.com/research/ssbysdat.asp.
Do insurance mandates increase the cost of insurance? Whatever your thoughts on the topic, you will like this table of state mandates produced by the Council for Affordable Health Insurance. One feature of the chart is an estimate of the cost of each mandate. Bear in mind that adding multiple mandates doesn’t necessarily increase by the total of their values since many will have overlapping effects. http://www.cahi.org/cahi_contents/resources/pdf/MandatePubDec2004.pdf.
Costs
The Robert Wood Johnson Foundation features an interview with researcher Paul Ginsburg and the results of his latest examination of health cost trends, which appears in the journal, Health Affairs. Increases are still higher than inflation but not quite as bad as in the last few years: total health spending rose 7.4% per privately insured person in 2003, compared to 9.5% in 2002 and 10% in 2001. Rates of inflation fell across all areas. Hospital price trends were a 6.5% increase, down from over 8% in the last two years. Furthermore, the increase in the amount of hospital use fell to 0.9%, compared to much higher rates in the last two years. Premiums and employees’ share of premiums both rose although not as much as in recent years. See more details, and link to abstracts of the article, an interview and a webcast, at http://www.rwjf.org/news/special/slowCosts_2.jhtml.
Health Affairs also features an analysis of Medicaid cost drivers by John Holohan and Arunabh Ghosh. The study found that a spurt of new enrollees as the economy struggled contributed strongly to the growth. The study is at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.52 and a webcxast and related materials can be found at http://www.kff.org/medicaid/kcmu012605pkg.cfm.
Prevention
It’s the time of year for New Years Resolution diets. We may not all be able to emulate Arkansas Governor Huckabee (although he is a great role model!) but here are the latest suggestions from the CDC. This sixth edition of Dietary Guidelines for Americans emphasizes balanced exercise as well as eating less, can be found at a site that also lists information about fitness and wellness http://www.healthierus.gov/dietaryguidelines/.
Where does state policy intersect with nutrition? Many states have been looking to school programs to improve fitness and teach better nutrition (we’ve been tracking state policies on vending machines in schools http://www.ncsl.org/programs/health/vending.htm). Other NCSL resources on nutrition and obesity can be found at http://www.ncsl.org/programs/health/phyactobesity.htm.
According to a study released in January by the Insurance Institute for Highway Safety, more people die from traffic accidents in the 28 states where safety belt laws are only enforced if a driver is stopped for another reason. “Primary safety belt laws would save 700 lives per year”, the Institute estimates, and its press release includes estimates of the likely impact of these changes in states that do not enforce these laws. http://www.iihs.org/news_releases/2005/pr011305.htm.
The institute has a wealth of other material on traffic safety and state laws (http://www.iihs.org/safety_facts/safety.htm) including a scorecard on state laws. California, Washington D.C. and Georgia had the best scores on this chart. http://www.iihs.org/safety_facts/state_laws/measure_up.htm.
Quality and Patient Safety
Minnesota has just released its first report on preventable adverse events, as required under a 2003 law. To learn more about the requirements, see the law, and see the report, head over to the Minnesota Patient Safety page, which also has links to other patient safety resources. http://www.health.state.mn.us/patientsafety/.
A well orchestrated legislative campaign related to patient safety improvement and reporting on infections in hospitals from Consumers’ Union is meshing with professional initiatives by the hospital accreditation organization (JCAHO) and federal agencies. The national association dealing with infection control (APIC) is planning a February meeting in Atlanta on mandatory public reporting. Results will be available on line. http://www.infectioncontroltoday.com/hotnews/4bh814629.html. Also--take a look at what they see ahead for 2005. http://www.infectioncontroltoday.com/articles/511feat2.html.
Electronic medical records and fully connected health information are an inspired vision of the future. The hope is that better information flow will improve health and lower costs. The national effort underway has a long time horizon. Standards need to be developed, and there have been mixed signals about whether states should move ahead on their own or wait for a uniform framework. The E-health Initiative’s HRSA-funded project, Connecting Communities for Better Health, includes analyses of state legislation that affect this at http://ccbh.ehealthinitiative.org/communities/community.aspx?Section=288.
Minority Health
The Centers for Disease Control recently released the third in a series of reports on disparities, detailing differences in care and outcome that affect African Americans. http://www.cdc.gov/mmwr. A listing of state officials charged with minority health activity can be found at http://www.cdc.gov/omh/Partnerships/resourcesSMHC.htm.
Long-Term Care
Everything, we mean EVERYTHING you want to know about state long-term care can be found in AARP’s newly released Across the States: Profiles of Long Term Care. The state profiles include information on demographics, LTC need, home and community-based services and resources, nursing facility serves and resources, expenditures and financing, and trends. In addition to 51 profiles, the report has comparative charts and maps. The long (282 page) document is a slow download. Hard copies may also be obtained by contacting AARP directly. http://research.aarp.org/health/d18202_2004_ats.pdf.
Medicare and Medicaid
The 2003 Medicare Modernization Act, provides a pharmaceutical benefit under a new Medicare Part D. NCSL’s Federal Affairs Counsel & Health Policy Director Joy Johnson Wilson has summarized the act and will be providing updates as rules are issued. The summary and links to various fact sheets can be found at http://www.ncsl.org/statefed/health/MMAfnlRule.htm.
Other NCSL resources on the Medicare changes including links to presentations at past NCSL meetings can be found at http://www.ncsl.org/programs/health/rxstatemma2.htm.
The Centers for Medicare and Medicaid Services (CMS) has set up a briefing for state legislators and state legislative staff on the final regulations implementing the Medicare Part D prescription drug program for Monday, February 14, 2005 from 10:00 a.m. - 11:00 a.m. To call, use the toll free number 800-779-6318. The passcode is: Title 1 & 2. Please forward any specific issues or concerns you have regarding the Medicare Part D program to Joy Wilson at joy.wilson@ncsl.org so she can provide a list to the CMS staff.
Here’s some material from the National Health Policy Forum that was used to brief new members of Congress and their staff on Medicare and Medicaid. In addition to excellent presentations, it is a good one-stop shopping point leading to some essential documents on these programs. http://nhpf.ags.com/M&M_E.brief.book/Contents.htm.
State Studies
Massachusetts Division of Health Care Finance & Policy found that the state had spent at least $52 million providing medical assistance or free care for uninsured workers in firms with 50 or more employees. Many of the uninsured could have obtained coverage through their employers. The study may be a good starting point for identifying ways to improve public-private coordination. The page lists other studies as well. http://www.mass.gov/portal/index.jsp?pageID=eohhs2terminal&L=3&L0=Home&L1=Researcher&L2=MassHealth+and+Insurance&sid=Eeohhs2&b=terminalcontent&f=dhcfp_researcher_hpt_health_insurance&csid=Eeohhs2.
That Time of Year
Year-end round-ups are coming out. Summaries of health issues on governors’ State-of-the-States reports can be found at several locations. We will be covering them in the State Health Notes. To log in—and activate your susbscription if you haven’t already done so—go to http://www.statehealthnotes.org/issues/26_437/cover/140425-1.html.
StateLine has the full text of the speeches, at http://www.stateline.org/stateline/?pa=issue&sa=showIssue&id=422881.
Summaries and links to speeches can also be found at Kaiser Foundation http://www.kaisernetwork.org/static/quick_results-3_new.cfm. Just search for “state of the state” + speeches.
State Coverage Initiative’s report, State of the States: Finding Alternate Routes gives a round-up of cost concerns and state access activities in 2004 and a look forward to 2005. http://www.statecoverage.net/pdf/stateofstates2005.pdf.
Challenging Conventional Wisdom
Half of personal bankruptcies are a result of illness, and most who file are middle class and insured. People who declare bankruptcy because of medical debt are no more likely to be uninsured than other bankrupts at the time of filing—just under 1/3—but are likelier (38%) to have experienced a spell without coverage in the previous two years, according to a Health Affairs web exclusive study of medical bankruptcy. http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1.
More Numbers
Every 10 years, in accordance with the Constitution, everyone in the U.S. is counted. In order to get details needed for public and private planning, 10% of households are asked to prepare a census “long form”. Now the two components are about to be separated as the Department of Commerce rolls out a new survey, the American Community Survey. To be answered on a rolling basis by 250,000 households a month, the survey is designed to provide more up-to-date data on changing demographics and social factors.
According to the Census press release, “Roughly 2.5 percent of the nation’s 124 million households — about 1-in-40 households — will participate in the survey each year. By comparison, 1-in-6 households received the Census 2000 long form” once in 10 years. The new method will allow the census to provide estimates for smaller geographical units, based on multi-year averages, after it has been fielded for several years. State-level data can be accessed now at http://www.census.gov/acs/www/.
You may also want to check out the American FactFinder, which combines several sources of census and economic data. Check out your own zip code! http://factfinder.census.gov/home/saff/main.html?_lang=en.
Subscription Opportunities
In addition to this monthly Chairs Bulletin, you may want to get more information in your inbox on specific issues. Our health policy listserv (healthpolicy-l@ncsl.org) is open to legislators and staff. It is used to publicize meetings, documents, news and opportunities for state legislators. Legislators and staff also use it to ask other states for information about their plans and experiences. There is also an NCSL listserve for federal and state Medicaid issues (Medicaid-l@ncsl.org ). To subscribe to either of these, contact Kathy Helm (Kathy.helm@ncsl.org).
There are a number of resources out there that will notify you of new publications and activities, or provide periodic news summaries. The trick is to find a level of notice that won’t be overwhelming. The Kaiser Family Foundation (www.kff.org) has a number of different opportunities to subscribe for notification, and tends to send very comprehensive compilations. You can also receive notification of KFF webcasts.
Daily industry newsletters include AHA’s NewsNow (ahawashdc@aha.org) and Modern Healthcare’s Daily Dose (modernhealthcare.com). For a broad business perspective, my current favorite is HealthLeaders News, a daily newsletter with a business and industry spin, excellent coverage of state news, and links to the full text of cited articles. Subscribe at www.healthleaders.com.
Many policy research centers offer newsletters that highlight research that they conduct or sponsor. Examples include the Urban Institute (www.urban.org), the Agency for Healthcare Research and Quality (www.ahrq.gov), and Academy Health’s RWJ-funded State Coverage Initiatives (www.statecoverage.net).
Many organizations that conduct policy research in a particular area will notify you when new items of interest are available. We’ve listed an unscientific sampling below to give you an idea of how varied these can be. Let us know your interest and we’ll try to find you ones that match.
- The Association of State and Territorial Health Officials (ASTHO) distributes Primary Care and Prevention Network News. This monthly includes a much wider range of topics than the title suggest. To subscribe, send an e-mail to newsletter@astho.org requesting this newsletter. See past issues at http://www.astho.org/newsletter/newsletters/8/index.html.
- iHealthBeat is a free, daily news digest from the California HealthCare Foundation reporting on the Internet's impact on health care. Subscribe at www.ihealthbeat.org.
- The weekly newsletter Health Policy Matters gives a market-oriented point of view. It is available from the Galen Institute by sending a request to galen@galen.org.
- Ensuring Solutions to Alcohol Problems at The George Washington University Medical Center in Washington seeks to increase access to treatment for individuals with alcohol problems. Email them at info@ensuringsolutions.org to request the newsletter with updates and resources.
- MCH Alert is a bulletin on maternal and child health from Georgetown University. To receive it, send an e-mail message to MCHAlert-request@list.ncemch.org with SUBSCRIBE in the subject line.
- And for more gnawing child health concerns, you can subscribe to a bulletin on children’s dental health with an e-mail to mambrose@cdhp.org.
Tell us about your favorite on-line resources, 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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