This is the Health Chairs e-Bulletin for March 2005.

Looking ahead

We hope to see you in DC for the NCSL Spring Forum, April 14-16, and hope you will plan to stay through the 16^th for Medicaid and Mental Health for Children and the Elderly. Some limited travel stipends are available for actual expenses. Please notify Debra Prosnitz via email at debra.prosnitz@ncsl.org if you are interested.

Mark June 9-11 on your calendar now for the annual State Health Chairs policy meeting in Washington DC. We’ll be sending details soon. This annual event gives you a chance to get together with chairs from other states as well as to hear from people shaping the health system at the national level—both in and out of government. This year the meeting will be preceded by a special Medicaid Institute. We will also see you in the other Washington in August, at the annual meeting in Seattle. We are tentatively planning a session for you that will feature Washington’s innovative approaches to long term care.

Access and Insurance

Harvard researchers Nancy C. Turnbull and Nancy M. Kane are the authors of a study of state regulations designed to make individual coverage more available and affordable. Kane concludes that “"The market can serve healthy people who don't need insurance, or sick people who do. But it has a hard time serving both.” Most states have some combination of regulations that require carriers to sell coverage to all applicants regardless of age or health; create high-risk pools for individuals with preexisting conditions; or place limits on the extent to which premiums can vary by age, sex, or health status, according to the report. Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market and a set of six related case studies are available from the Commonwealth fund at http://www.cmwf.org/publications/publications_show.htm?doc_id=259025

Driving home the point that sick people are at a disadvantage when it comes to getting coverage, Georgetown University researcher Karen Pollitz worked with the American Diabetes Association (ADA) to follow 851 people who called ADA for help with insurance problems. According to “Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes,” only 1 in 5 callers could be helped. An overview, with links to the press briefing and full report, can be found at http://www.healthinsuranceinfo.net/newsyoucanuse/08.html

NCSL’s information on state employees’ health coverage has been updated by Richard Cauchi in the Denver office. http://www.ncsl.org/programs/health/stateemploy.htm

Medicare, Medicaid and SCHIP

Eight years in, there’s enough experience to talk about how the Child Health Program is working and what has been learned. Cindy Mann and Robin Rudowitz have done that in Financing Health Coverage: The State Children's Health Insurance Program Experience. This Kaiser Commission on Medicaid and the Uninsured Issue Paper is an excellent introduction for those unfamiliar with the program, and full of useful ideas and experience for those who have been working on it. http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=50856

There’s some radical reform in the wind in Florida and South Carolina. Time will tell how far these will go, but both states have begun to float proposals that would create something like HSAs for their Medicaid recipients. Stay tuned for what is likely to be a vigorous debate. Florida’s proposal is summarized at http://www.empoweredcare.com/ and http://www.fdhc.state.fl.us/Medicaid/deputy_secretary/recent_presentations/proposed_framework_for_modernization_020705.pdf

Reactions to the Governor’s proposal compiled by Florida D’s can be found at http://www.fladems.com/Briefings/Medicaid.php

South Carolina’s proposal also includes changes in long term care. http://www.dhhs.state.sc.us/internet/pdf/South%20Carolina%20Medicaid%20Choice.pdf

The National Academy of State Health Policy issued recommendations for improving Medicaid developed by a group of experts with broad Medicaid experience. The NASHP suggestions have a broader scope than the current budget debate. The project was funded by the David and Lucile Packard Foundation, the Robert Wood Johnson Foundation, AARP, and the Agency for Health Care Research and Quality. The report recommends changes in: eligibility; flexibility for optional groups; coordination with other coverage; financing; and long term care.

Making Medicaid Work for the 21st Century: Improving Health and Long-Term Care Coverage for Low-Income Americans can be downloaded at http://www.nashp.org/Files/Making_Medicaid_Work_for_the_21st_Century.pdf

The Kaiser Family Foundation and the Kaiser Commission on Medicaid and the Uninsured has everything from brief fact-sheets to detailed studies and analyses on Medicaid that can provide data to inform the debate. Find links to their latest on Medicaid including: reports on transitioning people who are dually eligible for Medicaid and Medicare to the new drug benefit; an analysis of spending growth; and reports on optional benefits and services and intergovernmental transfers at http://www.kff.org/medicaid/index.cfm

Costs

The Outlook for National Health Care Spending. The latest estimates of future national health care spending have just been released by CMS. Kaiser has a broadcast of the press conference with links to the report and an article in Health Affairs that summarizes the projections: health care inflation will stabilize around 7% growth a year (still substantially above wage increases) and government payments will rise to about half of all spending, principally as a result of the Medicare drug benefit.

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1365

Download the article at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.74

Links to CMS data on past and projected health spending, including the data underlying this report, can be found at http://www.cms.hhs.gov/statistics/nhe/default.asp . The page includes links to state health trends, but only for 1980-1998. The national trend data, current to 2003, do show the share of spending done by states in aggregate in various categories.

The California Healthcare Foundation presents a user-friendly synthesis of these and related data in its annual update on cost, Health Care Costs 101, 2005 Edition. The Foundation also presents California’s state specific data from CMS, although as noted above, they are only available through 1988. It is a nice report that other states may want to adapt to display their own data. http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=109369&subTopic=CL498&subsection=reports

Federal policies

NCSL analyzes and responds to federal policies on behalf of the states. While Medicare and Medicaid dominate the budget discussion, the federal-state office analyzes issues as diverse as bioterrorism, e-health and privacy, AIDS and tobacco. You will find NCSL’s analysis of the federal budget and its impact on state health programs, and a preview of other legislation before Congress at http://www.ncsl.org/statefed/health/fedhealthissues.htm

The NGA is meeting in Washington and negotiating on Medicaid this week. They recently released a policy statement on Medicaid. http://www.nga.org/nga/legislativeUpdate/1,1169,C_ISSUE_BRIEF%5eD_8023,00.html

Prevention and Public Health

The U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Environmental Health Sciences has announced a June 1-2, 2005 conference on youth obesity. The conference announcement can be accessed at: http://www-apps.niehs.nih.gov/odconfer/oe2005/flyer.pdf

CDC's National Center for Health Statistics has released preliminary information on rates and causes of death for 2003. The report is based on more than 2.4 million death certificates issued in 2003, about 93% of death certificates issued that year. A final report will be issued in September. In addition to national rates and trends, some tables include state-level statistics: Table 3, page 19 has state age-adjusted death rates. In the section on infant mortality Table I, page 33 lists state infant mortality rates.

Quality and Patient Safety

The Agency for Healthcare Research and Quality (AHRQ) has just released two reports that track progress in 2004—or its lack—in improving quality National Healthcare Quality Report (NHQR) and reducing disparities National Healthcare Disparities Report (NHDR) . The reports (the second in an annual series that began in 2003) give a mixed result, with improvement in 67 areas but deterioration in 30. The gap between what is desirable and what we are achieving remains large. The disparities report shows more losses than gains. The quality report documents improvements in preventing unecessary hospitalizations due to uncontrolled diabetes and fewer elderly patients getting inappropriate medications, but also document a long way to go in reducing disparities in care and results among various groups. The reports are slow to download, so you may want to navigate using the index, or download the whole document and look at it locally. Maps show how states are performing on various quality measures. http://www.qualitytools.ahrq.gov/qualityreport and the sources of the measures are documented. Probably because of differences in how the data were collected and analyzed, there are no tables of comparative state data for the whole report.

Whether you are looking for comparative quality information, or information about the projects that make these comparisons, the collection of links that The Massachusetts Health Data Consortium has organized gives a great starting point. Some state-level projects in Wisconsin, Massachusetts, Rhode Island and Texas are featured in the middle of this page of annotated links. http://www.mahealthdata.org/data/library/10-outcomes.html

The CDC just released consensus guidelines relating to reporting hospital infections. Many states are considering legislation on this topic. The guidance may be downloaded from http://www.cdc.gov/ncidod/hip/PublicReportingGuide.pdf

Medical Malpractice

Here's some information on the "sorry works" movement. They promote apologizing as an alternative to torts. http://www.sorryworks.net/index.phtml.

Minority Health

Disparities in care and results begin young, according to this report in February’s issue of Pediatrics. http://pediatrics.aappublications.org/cgi/content/full/115/2/e183.

Disability Services

The Institute for Community Inclusion (ICI) at UMass Boston presents data from state mental retardation/developmental disabilities agencies, the Rehabilitation Services Administration, the Social Security Administration, and the U.S. Department of Labor in the form of customizable charts at http://www.statedata.info/ You can compare data on persons with disabilities and programs to serve them at a state, national or population level. Trends in your choice of variables are graphed from 1990 to the most recent year available. You can compare pairs of states, or state with national experience. According to the site, “the goal of this project is to provide a clear account of current day and employment services for individuals with developmental disabilities and to identify individual, program, and policy factors that influence individual outcomes on a state and national level. Studies collect data from state and private agencies and also analyze public data from Social Security and the Census.”

Substance Abuse

SAMHSA's National Survey on Drug Use & Health [formerly called the National Household Survey on Drug Abuse (NHSDA)] was released on Valentine’s Day. This is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse in the general U.S. civilian non institutionalized population, age 12 and older. The survey, which has been conducted annually since 1991, can help states track trends, identify problems and set priorities for spending. See how you’re doing, and how your state stacks up against national trends, at http://www.oas.samhsa.gov/nhsda.htm#NHSDAinfo

Join together to stop substance abuse in your community. That’s the message of Join Together Online (JTO), a Boston University advocacy tool aimed at substance abuse and gun violence. If you are looking for groups to work with on issues such as abuse of illegal substances, alcohol and tobacco use by children, you’ll like their state pages with lists of local advocacy groups. Each state page also includes news items and links to local news outlets and national and state legislators. http://www.jointogether.org/sa/action/state/

Budgets and Spending

Here’s the latest State Fiscal Brief, from the Rockefeller Institute, with a report on 2004 tax revenues. Things are actually starting to look up a bit; this was the first year of net increases after two years of decreases. But the center of the country was lagging behind the coasts. http://stateandlocalgateway.rockinst.org/fiscal_pub/state_fb/SFB72.pdf

Federal public health spending varies a great deal state by state, according to a publication newly released by the Robert Wood Johnson Foundation, Shortchanging America's Health: A State-by-State Look at How Federal Public Health Dollars are Spent (Hearne SA, Elliott K, Juliano C and Segal LM, February 2005). However, the funding is not enough to address state public health needs, and bears little relationship to the state of a state’s health. The report from RWJ includes state-by-state listings of health indicators and CDC, bioterrorism and HRSA program spending per capita. http://www.rwjf.org/research/files/TFAH%20-%20StateHealthSpending05.pdf

State Studies

Recent reports on access and coverage have been release by a couple of states:

Connecticut: Office of Health Care Access 2004 Household Survey. (January 2005) http://www.ct.gov/ohca/lib/ohca/publications/snapshotfinal.pdf
Oregon: The 2004 Oregon Population Survey (OPS) (January 17, 2005) http://egov.oregon.gov/DAS/OHPPR/RSCH/docs/OPS-healthinsurance2004.pdf

The Massachusetts Health Data Consortium points its readers to information on health status in Massachusetts http://masschip.state.ma.us/ , as well as some other geographically organized sources of health data such as the safety net monitoring project, metropolitan area risk trends from CDC, selections from the Dartmouth Atlas of Healthcare—the project that has documented regional variation in use, and other resources. http://www.mahealthdata.org/data/locator/geographic.html#para2

Challenging Conventional Wisdom

The NIHCM Foundation recently issued a brief by Elliott Fisher that describes the disconnect between quantity and quality of care. http://www.nihcm.org/ExpertV7.pdf

Are most of the uninsured just caught between coverages? The latest look at duration of uninsurance from Urban Institute uses 2002 data to find that “lack of health insurance coverage is both a short-term and long-term problem among the uninsured.” More than half the uninsured experienced 12 or more months without coverage. People in poor health are far more likely (21.3%) to be uninsured a year or more than those in good, very good or excellent health (9.3%). The report has state-level breakouts for 13 states. In Texas, 65% of the uninsured lacked coverage for a year or more, while Massachusetts had the lowest proportion of long-term uninsured, 33%.

http://www.urban.org/UploadedPDF/311112_DP04-10.pdf

Webcasts

If you wanted to make it to Academy Health’s National Health Policy Conference but just couldn’t get out of town, all is not lost. Many of the sessions were webcast, and slides and links for other are available on line. Webcasts and transcripts for select sessions are available on kaisernetwork.org, a free service of the Kaiser Family Foundation. Browse the agenda, and look at or listen to some of the archived material by going to the agenda and following any interesting links. Webcasts that may bring you some unfamiliar voices include a keynote by Dr. Brailer, who is leading the nation along the health information highway, and a session with Glenna Crooks on creating covenants—bringing back relationship-based health. http://www.academyhealth.org/nhpc/agenda.htm

More good things

And if all this hasn’t been enough, you could always stop by the New York Academy of Medicine’s Grey Literature Report which lists the latest items in their library from various health and medical research and think tanks. http://www.nyam.org/library/glrv7n1.shtml

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