This is the Health Chairs e-bulletin for May 2006.

These are excerpts from the May, 2006 email update on state health policy resources available on the Internet.

In advance of the upcoming NCSL meeting in Nashville, you might want to read a couple of recent interviews in Health Affairs’ Web Exclusives, featuring TennCare advocate Gordon Bonnyman http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w217, and Blues CEO Vicky Gregg http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.558v1 (abstract and new interview available on line; archived articles require subscription to read.)

Resources Online

Access & Medicaid...Quality & Chronic Conditions...Addiction...Workforce...Public Health…

Access

Health Care Costs 101, 2006 Edition from the California Healthcare Foundation is based on federal health expenditure data. The snapshot—and even briefer reference guide—provides concise graphic descriptions of health spending by type and source. http://www.chcf.org/documents/insurance/HealthCareCosts06.pdf

State Health Reform, proposed and enacted, is the subject of several new analyses.

Massachusetts’ ground-breaking measure is complex and time will undoubtedly reveal new aspects. The politics of the reform were striking, with committed reformers across the political spectrum finding enough common ground to pass a law. Some initial analyses, and the language of the act itself, can be found at NCSL’s page on the Massachusetts reform, http://www.ncsl.org/programs/health/massoverview.htm. The conference summary http://www.mass.gov/legis/summary.pdf and a section-by-section summary from the legislature is at http://www.mass.gov/legis/sections.pdf. If you or your staff want to really delve into details, the CMS waiver submission is now available at http://www.mass.gov/?pageID=eohhs2modulechunk&&L=1&L0=Home&sid=Eeohhs2&b=terminalcontent&f=eohhs_cms_waiver_chunk&csid=Eeohhs2

At the other extreme, a 2-page fact sheet from Kaiser is available at http://www.kff.org/uninsured/upload/7494.pdf

The Heritage Foundation worked hard with Massachusetts Governor Romney to find a politically viable compromise, and their analyses reflects their commitment to the project. A thoughtful essay and some useful links to additional documentation can be found at http://www.heritage.org/Research/HealthCare/wm1035.cfm

John McDonough, a former health chair himself, was also one of the co-directors of the Health Chairs project for many years when he was at Brandeis. Now as Executive Director for Health Care for All Massachusetts (HCFAMA), he has been keeping a blog on Massachusetts reform. In addition to lots of inside baseball on the politics and policy from an impassioned front-line point of view, the blog contains no-punches-pulled analyses such as a summary of how the funding works titled, simply, "Health Reform: How Much Does It Cost & How Is It Financed?” http://www.hcfama.org/blog/2006/04/health-reform-how-much-does-it-cost.html

Sources	FY07	FY08	FY09
Federal Safey Net Revenue	605.0	610.5	610.5
Federal Medicaid Match	184.6	242.1	299.6
Hospital Assessment	160.0	160.0	160.0
Payor Assessment	160.0	160.0	160.0
Free Rider Surcharge	50.0	40.0	25.0
Fair Share Assessment	45.0	36.0	22.5
General Fund	125.0	125.0	125.0
Existing Obligations
MCO Supplemental Funding	287.0	180.0	160.0
Free Care Pool/Safety New Fund	610.0	500.0	320.0
SubTotal	897.0	680.0	480.0
New Spending
Children to 300%	18.2	27.4	37.4
Restored MassHealth Benefits	48.0	53.0	58.0
Medicaid Rate Increase	90.0	180.0	270.0
Commonwealth Care Subsidies	160.0	400.0	725.0
Subtotal	336.2	660.0	1090.4
Total Spending	1,233.2	1,340.0	1,570.4
Three Year Balance	+116.4	+33.2	-167.9

HCFAMA also has a guide to the reform for consumers, at http://www.hcfama.org/_uploads/documents/live/HCReformFAQ.pdf

Other states will have to come up with their own combinations since the Massachusetts reform rests on unique foundations that have been built over decades. For a taste of how one state approached assessing where it stood in relation to what happened in Massachusetts, check out Rick Curtis' analysis of what it would cost California to do the same thing. Besides giving a feel for what it would cost California, this is a model for other states that want to try similar analyses. http://www.ihps.org/pubs/2006_Apr_CHCF_MA_Style_Brief_Final.pdf

Critics from left and right have logged in with their explanations of why it won’t work. Unions and long-time single payer proponents Woolhandler and Himmelstein decry it as “Massachusetts Health Reform Bill: A False Promise of Universal Coverage.” http://www.commondreams.org/views06/0406-35.htm And, to quote McDonough’s blog again, “On the right, the Cato Institute, the Washington Times, the Wall Street Journal and others are firing away at Romney's big government, anti-libertarian agenda.” Cato swats down straw men at http://www.cato.org/pub_display.php?pub_id=6341

New York’s proposed pay or play plan, called “Fair Share for Health Care,” is the subject of a new critique from the Employment Policies Institute. The study finds employer mandates to be an inefficient and counterproductive way to expand access. http://www.epionline.org/study_detail.cfm?sid=97. Maryland’s Fair Share law, a much more narrowly targeted measure often alluded to as a “Wall-Mart” bill, was enacted earlier this year. Related policies are described at http://www.ncsl.org/programs/health/fairsharenews.htm More state pay-or-play bills can be found at http://www.ncsl.org/programs/health/payorplay2006.htm

The Uninsured are the subject of several studies released in the run-up to Cover the Uninsured Week, May 1-7. The Coverage Gap: A State-by-State Report on Access to Care deals with differences in access and the effect of the disparities on health status and includes a both trend data and state comparisons. http://covertheuninsured.org/media/research/CoverageGap0406.pdf

The Commonwealth Fund has released a new report based on its survey of coverage. Gaps in Health Insurance: An All-American Problem finds growing problems in middle income families. http://www.cmwf.org/publications/publications_show.htm?doc_id=367876

The Kaiser Family Foundation has webcast the opening of festivities and provides a wealth of links on who is uninsured and why at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1724

A webcast of an April 24 Hill briefing on making insurance more affordable for small businesses gives a peek at the debate going on in Washington this week. You can even listen to it as a podcast, if you want at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1717

NCSL has updated its information on state employee health benefits http://www.ncsl.org/programs/health/stateemploy.htm

Medicaid and Medicare

Kaiser offers new brief on who is covered by Medicaid, including a number of maps and tables in an amazingly condensed 7 pages. http://www.kff.org/medicaid/upload/7496.pdf

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Kaiser also has released another in a series of tracking polls on implementing the Medicare drug benefit. This one finds seniors generally pleased with the results so far but many are not aware of the upcoming deadline for enrollment. http://www.kff.org/kaiserpolls/pomr042506pkg.cfm

An upcoming briefing will look at women in Medicaid. Learn more or see the archived webcast after 5 p.m. ET on Thursday, May 11 at
http://www.kaisernetwork.org/healthcast/kff/11may06

The Foundation has updated the statehealthfacts.org website with state-by-state data on “how many, and what share, of beneficiaries have drug coverage from various sources.” This site has lots of other new items and is always worth visiting! http://www.statehealthfacts.org/r/whatsnew.html .

SCHIP allotment. According to Rachel Morgan, “On Friday April 21, 2006, CMS began distributing special grant funds authorized in the Deficit Reduction Act of 2005 (DRA) to provide additional SCHIP allotments to states in order to eliminate FY 2006 funding shortfalls...The funds apply to services furnished on or after October 1, 2005.” The table of additional shortfall allotments for FY 2006 and redistribution of the unexpended SCHIP allotments for FY 2003 (10 pg. PDF), were published in the Federal Register: http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-3833.pdf

Quality and Chronic Conditions

Pay for Performance is the topic of an upcoming (May 16) free webcast from the Agency for Healthcare Research and Quality (AHRQ). You may want to forward the notice to your Medicaid agency or tune in if you are thinking of asking your providers to prove their worth. Even if you don’t tune in you may want to look at their Decision Guide for Purchasers. http://www.academyhealth.org/ahrq/p4pwebconference/

A new GAO piece on federal long term care insurance has findings about enrollment, claims patterns, underwriting patterns, and benefit packages that may be useful to states as they look at long term care insurance after the federal deficit reduction act of 2005 (DRA.) http://www.gao.gov/new.items/d06401.pdf

Families provide a great deal of the long term care in this country. NCSL has just released Family Caregiver Support: State Facts at a Glance, by Donna Folkemer and others. Services offered through state programs and state legislative initiatives to shape family caregiver programs are detailed for each state and the District of Columbia. The publication is available at no cost for legislators or staff. Order on line or download at http://www.ncsl.org/bookstore/freedownload.cfm?prodid=0166605

The Assuring Better Child Health and Development (ABCD) Program is a Commonwealth-funded project to address early child development services for low-income children and their families. Three new reports from the project give details of the experience garnered in these states, with practical details for states that may wish to emulate these efforts. The latest reports focus on:

Improving the Delivery of Health Care that Supports Young Children’s Healthy Mental Development http://www.nashp.org/Files/CW14_final_website.pdf
State efforts to partner with pediatricians http://www.nashp.org/Files/CW13_final_website.pdf
Evaluating community-based child health promotion http://www.nashp.org/Files/GNL_62_final_for_web.pdf

Other information about the ABCD program, which has been working with states on this issues since 2000, can be found at its project office, the National Academy for State Health Policy (NASHP.) Check out the link on that page to the “ABCD reading room.”

http://www.nashp.org/_catdisp_page.cfm?LID=2A78988D-5310-11D6-BCF000A0CC558925

NCSL resources on early education and child development are at http://www.ncsl.org/programs/cyf/cc.htm

Addiction

State Estimates of Substance Use from the 2003–2004 National Surveys on Drug Use and Health are now available at the federal substance abuse and mental health services administration (SAMHSA) web site. In addition to detailed information about the use of various illicit and legal substances, from marijuana and cocaine to tobacco and alcohol, the study examines the prevalence of severe psychological distress. According to the report, “Estimates of past month use of any illicit drug in 2003-2004 ranged from a low of 5.8 percent in Mississippi to a high of 11.8 percent in Alaska for all persons aged 12 or older.

Among youths, the percentage of past month use decreased from 11.4 percent in 2002-2003 to 10.9 percent in 2003-2004. …Four States showed decreases from 2002-2003 to 2003-2004 in the percentage that used an illicit drug in the past month: the District of Columbia, Florida, Nevada, and Washington. Six States showed decreases among youths: Illinois, Nebraska, North Carolina, South Dakota, Vermont, and Virginia.”

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http://www.oas.samhsa.gov/2k4state/pdf/2k4state.pdf

Underage Drinking in the United States: A Status Report, 2005 produced by the Center on Alcohol Marketing and Youth at Georgetown University, focuses on an area that will worry many lawmakers. The report is designed to improve knowledge about the scope and impact of the problem. http://www.pewtrusts.org/pdf/CAMY_StatusReport2005Final.pdf.

Providers and Workforce

The Oklahoma Governor’s Council for Workforce and Economic Development released an 84-page study of the future of the state’s healthcare workforce that highlighted emerging shortages of nurses and other professionals. The report points out that health care is the state’s second largest industry.

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http://staging.okcommerce.gov/test1/dmdocuments/Health_Care_Cluster_Report_041006.pdf

The AHA has released its sixth annual chartbook of hospital and health system trends, TrendWatch Chartbook. There are five sections: overall health care market trends, organizational trends, utilization and volume, trends in hospital financing, and workforce. http://www.ahapolicyforum.org/ahapolicyforum/trendwatch/chartbook2006.html

Public Health

Disparities

Yours truly is one of the authors in a series of articles on health disparities and policy just published in the Journal of Health Politics, Policy and Law. The study is based on old data and states have acted a lot since it was written, but you may enjoy the quotes from some of your colleagues. http://www.cmwf.org/publications/publications_show.htm?doc_id=368671

For more recent information on state legislative action in this area, visit NCSL’s pages on health disparities and click on laws in the categories listed on the right hand column. http://www.ncsl.org/programs/health/rdncslweb.htm

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…(and fill out and fax back the Chairs meeting RSVP below if you haven’t done so yet)

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