These are excerpts from the February, 2007 email update on state health policy resources available on the Internet.
Looking Ahead
And Future. SAVE THE DATE. The annual Health Chairs meeting will be in Washington DC on June 21-22. We plan to meet all day on Thursday and a half-day Friday, and we may schedule some related seminars the night before or the afternoon after that meeting. We’ve nailed down the date earlier than usual so as to reserve space in a different hotel. We won’t solidify the program for a while but it will include sessions on state health reform activity and long term care. Stay tuned for more details. To see last year’s meeting, go to http://www.ncsl.org/programs/health/forum/chairs/0606.htm.
Resources Online
Access & Medicaid... Oral Health...Quality & Chronic Conditions...Disparities and Quality...Long Term Care...Workforce Providers...Addiction...Public Health...Health Info Technology...
Borrowing to Stay Healthy is the provocative title of a new study on debt and health spending. Researchers at the Access Project found much higher levels of credit card debt among people who use credit cards to pay medical bills, raising questions about the use of such high-cost financing in conjunction with HSAs, high-deductible plans and medical credit cards. The authors recommend policies that distinguish medical from other debt and limit entry of health care providers into financial services field.
http://www.accessproject.org/adobe/borrowing_to_stay_healthy.pdf
From all indications, this will be a strong year for discussing access, in both states and nationally. NCSL is tracking state proposals as they surface http://www.ncsl.org/programs/health/h-primary.htm and as they are translated into legislation. http://www.ncsl.org/programs/health/universalhealth2006.htm Stay tuned for more detailed analyses, and do call on us for more information. A web-assisted audioconference series highlighting various approaches under discussion is also in the works.
The New America Foundation (NAF) has released an excellent survey of recent state access reforms. The report, From New England to the Golden Gate Bridge: A Look at Creative Coverage Expansions at the State and Local Levels can be downloaded from http://www.newamerica.net/files/HPStatePaper_0.pdf. This is such a dynamic year we expect this will be out of date before you can read it but we’ll be doing our best to keep you updated as things change.
The Employee Benefits Research Institute (EBRI) issued its Ninth Annual Health Confidence Survey (HCS). According to their press release, they found:
- Public dissatisfaction focuses on costs.
- Sharp growth in poor ratings of the health system: Six in 10 Americans rate the health care system as fair (28 percent) or poor (31 percent), twice the rate at the start of HCS in 1998.
- Health care quality still ranks high, and Americans prefer to use quality rather than cost as their primary consideration when making decisions about care.
- Health costs force trade-offs in other spending, such as decreased retirement savings, as a result of rising health costs.
- Employment-based health benefits rated higher than cash for three-quarters of those with employer coverage.
Of particular interest to Health Chairs will be the survey’s findings on support for a number of policy options, with large majorities strongly or somewhat favoring: tax breaks for coverage (86 percent favor), employer mandates (78 percent), expanded government programs (73 percent) and buy-in to government insurance or public programs (78 percent). http://ebri.org/pdf/notespdf/EBRI_Notes_11-20061.pdf
The American Academy or Family Practitioners (AAFP) leads a coalition of medical specialty associations calling on Congress to enact health reform following 11 principles. “Principles for Reform of the U.S. Health Care System” can be found at
http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20070111reformprinciples.html
America’s Health Insurance Plans (AHIP) has issued a proposal for universal coverage and a statement about state roles as they see it in this reform. Calling their program “We Believe,” their Vision for Reform (start with children and expand from there to universal coverage) is available at http://www.ahipbelieves.com/Portals/0/docs/vision_of_reform.pdf and their Principles for State Reform (maximize public programs, encourage insurance coverage, support health accounts and don’t create new bureaucracies) can be found at http://www.ahipbelieves.com/Portals/0/docs/principles_of_reform.pdf
A broad coalition of insurers, business, providers and consumer advocates calling themselves The Health Coverage Coalition for the Uninsured has put down its marker for health reform. The proposal sounds a lot like what states have been doing with waivers recently: expanding child health coverage to include families, and allowing states to cover all low income adults. Areas of disagreement among original members of the study group included the future role of employment-based insurance. http://www.coalitionfortheuninsured.org/index.html
I recently found a highly personal, opinionated and vivid site listing state coalitions and groups working for universal coverage that looks like a good source of information about projects in the works. Check it at http://americanhealthcarereform.org/html/states.html
The Government Accountability Office (GAO) has issued a new report on early experience with health savings accounts and high deductible health plans. Health Savings Accounts: Early Enrollee Experiences with Accounts and Eligible Health Plans is available at http://www.gao.gov/docdblite/details.php?rptno=GAO-06-1133T.
The Cost of the Uninsured in California is the subject of an admirably concise and well documented study by the New America Foundation. Authors Len Nichols and Pete Harbage estimate that the insured pay a 10% increase in premiums to cover the cost of the uninsured. See their analysis at http://www.newamerica.net/files/HealthIBNo3.pdf
Good news for Medicaid in two recent reports. The National Governors’ Association (NGA) Center for Best Practices finds that most states preserved or modestly expanded coverage for pregnant women and children in 2005. The report includes a number of useful tables showing which states have various provisions such as presumptive eligibility and expanded coverage for adults with children. http://www.nga.org/Files/pdf/0609MCHUPDATE.PDF
Medicaid inflation is way down as revenues rise, according to the sixth annual Medicaid budget survey from Kaiser and Health Management Associates. The annual growth of 2.8 percent for SFY 2006 was the lowest in 10 years, and 2006 was the fourth consecutive year of budget deceleration. It might have been lower yet if states had not been financing part of the new Medicare drug benefit through the provision sometimes called “clawback”. Looking ahead, although five states say they planned restrictions on eligibility, more than half said they expected expansions or improvements and many indicated they were looking to use the new flexibility allowed by the Deficit Reduction Act (DRA) to reshape their programs. Read more about Low Medicaid Spending Growth amid Rebounding State Revenues: Results From a 50-State Medicaid Budget Survey State Fiscal Years 2006 and 2007 at http://www.kff.org/medicaid/kcmu101006pkg.cfm
Kaiser also found that states were holding ground on Medicaid and SCHIP in 2006. A 50-state survey shows that one-third of states (17) increased access to health coverage in 2006 and no state cut income eligibility in Medicaid and SCHIP for the first time in four years. Resuming the Path to Health Coverage for Children and Parents: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2006 and related materials can be found at http://www.kff.org/medicaid/7608a.cfm.
New Medicare prescription drug benefits have gone a long way to help people who need this support but states are still playing a big role for ineligible groups. NCSL’s Dick Cauchi sent us this heads up: “The ever-useful National Pharmaceutical Council (NPC) Rx book for '06 is available now.” Pharmaceutical Benefits Under State Medical Assistance Programs, 2005-2006. To download the entire document or browse by section, go to http://www.npcnow.org/resources/PharmBenefitsMedicaid.asp
The report has sections on the Medicaid program, state characteristics, pharmacy program characteristics, state pharmacy program profiles (see chart below), state profiles, and useful appendices including state and federal Medicaid contacts, Medicaid program statistics, Medicaid rebate law, federal upper limits for multiple source products, and a glossary.
Medicare drug benefits have been a mixed blessing for states. NHPF reports on an August meeting that looked at how the program was affecting states. A report from the Forum session "Complexity, Coordination and Compromise: States and the Medicare Drug Benefit" is at http://www.nhpf.org/pdfs_other/MMAMtgRpt(08-04-06).pdf
Children
A fact sheet on children in vulnerable families released by the Urban Institute highlights the various ways the most vulnerable can be at risk: “child maltreatment, domestic violence, children's disabilities, substance abuse, and parental mental illness”. The report has a number of interesting bullet points on rates and trends. For example,
- “The number of children receiving services under the Individuals with Disabilities Education Act (IDEA) has increased substantially in recent years. The number of infants and toddlers getting help grew from 165,000 in 1994 to 231,000 by 2000. In the 1992-93 school year, 455,000 preschoolers received services under IDEA, whereas 600,000 children obtained assistance in 2000-01. For those age 6 through 21, the number receiving services rose from 4,500,000 in the 1991-92 school year to 5,800,000 by 2000-01.”
Download the three-page overview at http://www.urban.org/publications/901016.html and link from there to more detailed reports.
An issue brief on the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program has been posted by the National Health Policy Forum (NHPF). The brief reviews the past and present of the program, from its importance for prevention services to its essential role for children with special needs, highlighting concerns about the implications of new flexibility in the Deficit Reduction Act (DRA). EPSDT: Medicaid's Critical but Controversial Benefits Program for Children can be downloaded from http://www.nhpf.org/pdfs_ib/IB819_EPSDT_11-20-06.pdf
The National Academy for State Health Policy (NASHP) is tracking state efforts to cover all kids, with links to a wealth of material on SCHIP at http://www.chipcentral.org/ This page links to fact sheets, a map with links to state actions, and the report of a March meeting convened to discuss barriers and opportunities, Seven Steps toward State Success in Covering Children. http://www.nashp.org/_catdisp_page.cfm?LID=1AD25874-1E26-402D-A9975255D880316A
Oral Health
The Center for Health Care Strategies issued a report in August on effective state strategies to improve oral health, Catalyzing improvements in oral health care: best practices from the state action for oral health access initiative. The report features RWJ-funded demonstrations in Arizona, Oregon, Pennsylvania, Rhode Island, South Carolina, and Vermont. States took actions to:
- Develop state financing and purchasing strategies;
- Broaden the provider network;
- Expand the dental safety net;
- Create a dental home; and
- Enhance consumer and provider education.
http://www.chcs.org/usr%5Fdoc/SAOHA%5FReport.pdf
Disabilities
Despite the efforts of state Medicaid programs to offer coverage to people with disabilities who are in the workforce, the number of people covered in such programs remains low. A recent report from researchers at Mathematica examines what the federal government and states have done and what has been learned from these demonstrations. How Does the Medicaid Buy-In Program Relate to Other Federal Efforts to Improve Access to Health Coverage for Adults with Disabilities?http://www.mathematica-mpr.com/publications/PDFs/buyinprogram.pdf
The 2006 Disability and Health State Chartbook is a new reference book available from the CDC about people with disabilities. It has information about the people with disabilities state by state and how their health compares with the health of people without disabilities. On-line at http://www.cdc.gov/ncbddd/dh/chartbook. A clickable map with state-by-state profiles can be found at http://www.cdc.gov/ncbddd/dh/chartbook/states.htm.
Care management for the chronically ill in California is the subject of several new reports. From the California Health Care Foundation, Chronic Disease in California: Facts and Figures “highlights key trends and statistics, with a focus on disease prevalence, service utilization, spending, and Medicare beneficiaries.” http://www.chcf.org/documents/chronicdisease/ChronicDiseaseFactsFigures06.pdf
Innovative provider-based models for managing and improving chronic diseases are explored in the second report, Challenging the Status Quo in Chronic Disease Care: Seven Case Studies http://www.chcf.org/documents/chronicdisease/ChallengingStatusQuoCaseStudies.pdf.
The National Health Policy Forum announces the availability of a new site visit report LA Story: Improving Care Management for the Chronically Ill and Chronically Underserved http://www.nhpf.org/pdfs_sv/SV_LosAngeles06.pdf.
The Agency for Health Care Research and Quality (AHRQ) has released its fourth annual report on health care quality and the companion report on health care disparities. Both can be accessed at the AHRQ site http://www.ahrq.gov/qual/nhqr06/nhqr06.htm.
Quality continues to improve overall, but slowly and quite unevenly. Chronic care in the community and hospital-based acute care improved most rapidly. Detailed tables, including many with state-level data are included in appendices at http://www.ahrq.gov/qual/nhqr06/index.html.
Disparities continue high, with Blacks, Hispanics and poor people experiencing poorer quality on many measures when compared with non-Hispanic Whites. Poor people fared worse on every measure. Not only was care for the poor worse but disparities actually widened for this group.
States have been addressing disparities through their Medicaid managed care programs. Learn how in the Center for Health Care Strategies’ Reducing Racial and Ethnic Disparities: Quality Improvement in Medicaid Managed Care Toolkit http://www.chcs.org/publications3960/publications_show.htm?doc_id=440684.
Two updated fact sheets on long-term care financing are available from the Georgetown University Long-Term Care Financing Project. Here’s how the project describes them:
National Spending on Long-Term Care, by Harriet L. Komisar and Lee Shirey Thompson, looks at total spending for nursing home and home care services nationwide,
in total and by major payers. http://ltc.georgetown.edu/pdfs/whopays2006.pdf
Medicaid and Long-Term Care, by Laura Summer, describes Medicaid's role in financing long-term care, with a particular focus on home and community-based services
and how states' provision of these services may be affected by the policy changes in the Deficit Reduction Act of 2005.
http://ltc.georgetown.edu/pdfs/medicaid2006.pdf
Donna Folkemer’s latest research is available on the NCSL site. Learn more about Long-Term Care Reform: Legislative Efforts To Shift Care To The Community, with case studies of Iowa, Wisconsin, North Dakota and Louisiana and highlights on several types of state activity at http://www.ncsl.org/programs/health/forum/longtermcarereform.htm or download the PDF at http://hcbs.org/moreInfo.php/nb/doc/1760/. Mental Health
The Forum welcomes a new staff member, Sarah Steverman, who will be working on a variety of mental health and disability issues out of the DC office. NCSL has just issued a paper by her predecessor, Michelle Herman. A Difficult Passage: Helping Youth with Mental Health Needs Transition into Adulthood can be found at http://www.ncsl.org/programs/health/forum/youthmentalneeds.htm
A background paper explaining Medicare coverage for mental health is now available from NHPF at http://www.nhpf.org/pdfs_bp/BP_Mcare&MentalHlth_11-27-06.pdf.
After the hurricane wiped out its major hospitals, New Orleans has the opportunity to rethink its charity-care system. But what is happening in the interim? Can the city meet its own needs? The GAO reports on Hurricane Katrina: Status of Hospital Inpatient and Emergency Departments in the Greater New Orleans Area. http://www.gao.gov/docdblite/details.php?rptno=GAO-06-1003
They say that tobacco is more addictive in Heroin. Tobacco use clearly harms both smokers and people around them. Therefore it is not surprising that a growing number of states are including coverage for tobacco dependence treatment in their Medicaid programs. The federal Centers for Disease Control and Prevention (CDC) has released a survey showing which state Medicaid programs cover services – including gum, nasal spray, the patch, and group or individual counseling – and what they cover. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5544a2.htm?s_cid=mm5544a2_e
Healthy People 2010
Progress of 19 states towards goals of reducing pregnancy and birth related risks is documented in a new report from CDC. The good news is that most of the states have met their goals for two of the eight perinatal indicators measured in this study: smoking cessation during pregnancy and abstinence from alcohol during the last 3 months of pregnancy. Nearly half are on track for target rates of breastfeeding in the early postpartum period and infant back sleep position. However, so far no states have made their goals for rates of intended pregnancy, multivitamin use before pregnancy, absence of physical abuse before pregnancy, or abstinence from smoking during pregnancy.
Monitoring Progress Toward Achieving Maternal and Infant Healthy People 2010 Objectives --- 19 States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000—2003 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5509a1.htm?s_cid=ss5509a1_e
Get Smart is the name of the CDC’s campaign to reduce inappropriate use of antibiotics. If it’s a cold, tough it out; they won’t help and may cause other problems. To see what states are doing to support the campaign, check the list of partners in their program for appropriate antibiotic use by clicking on the map or list at http://www.cdc.gov/drugresistance/community/partners.htm#list
For a round up of state activity in this important area, see the recent report, Profiles of Progress: State Health IT Initiatives from the National Association of State Chief Information Officers (NASCIO) at http://www.nascio.org/publications/documents/NASCIO-ProfilesOfProgress.pdf.
There is so much going on related to HIT that it is hard to keep up. If you or a staff person want to be part of our NCSL activities, let me (kala.ladenheim@ncsl.org) know and we’ll add you to our list of HIT Champions—NCSL Project HITCh (http://www.hitchampions.org/ ). Stay tuned as we add material. Meanwhile you may want to visit NGA’s web site to sign up for information about the State Alliance for eHealth, at www.nga.org/center/ehealth; NCSL is one of the participating groups, and we’ll draw on members of our HITCh group for participation in activities related to the project.
State by State
NSCL tracks—or has tracked all kinds of legislation, in health and in other matters. Check out our legislative tracking resources on the web at http://www.ncsl.org/programs/lis/lrl/50statetracking.htm
Counter Conventional Wisdom
What is the economic impact of health care spending? Some advocates have pointed to the multiplier effects of Medicaid dollars flowing into communities. Economists from time to time take note that spending for healthcare seems immune to the ups and downs of economic cycles. But there may be a darker side to the macroeconomies of health. Running on Empty: [describes] Healthcare as the Engine of the Economy according to Brian Klepper and Alain Enthoven writing for HealthLeaders Media. http://www.healthleadersmedia.com/view_feature.cfm?content_id=84346
By the way, this is a good source of daily news briefs on the industry and policy changes, as well as the occasional longer essay like the one above. You can subscribe for daily or weekly round-ups at http://www.healthleadersmedia.com/
The good news is that hospital performance measures are correlated with outcomes. The bad news? The effects are tiny. That’s the finding of a new study published in JAMA. The authors conclude that we are on the right track but need to continue to improve how we measure and report on quality. The California Healthcare Foundation’s iHealth Beat gives a good overview of the article, Study: Hospital Quality Rankings Have Little Effect on Mortality Rates at http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=128101
Is there any issue you’d like to see tracked but can’t find there? Let us know!
Several months worth of past Chairs e-bulletins are archived at: http://www.ncsl.org/programs/health/forum/chairs/ebull/index.htm
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.
Kala Ladenheim, Ph. D. Program Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
kala.ladenheim@ncsl.org
Donna Folkemer, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8171 fx: 202-737-1069
Donna.Folkemer@ncsl.org
 Health Chairs Project
|
