This is the Health Chairs e-Bulletin for September 2005.
Looking Back
On March 31-April 3, 2005, The Agency for Healthcare Research and Quality (AHRQ) and the National Conference of State Legislatures (NCSL) sponsored “Introduction to State Health Policy: A Seminar for New State Legislators” in Chicago, Illinois. The sessions are now available on line. They may be particularly interesting to legislators who are new to health policy issues or to new staff. http://www.hsrnet.net/ahrq/newleg/
Resources on Line
Access and Costs
Managed Care is a topic that has been knocked out of the spotlight recently, but most of us still have our own care managed by plans. What to do when there is a disagreement about what is needed? The Kaiser Family Foundation and Consumers Union have teamed up to produce A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, including state-by-state profiles of such things as dispute resolution and external review. http://www.kff.org/consumerguide/7350.cfm
Related NCSL research includes our page on Managed Care State Laws for Ombudsman, Report Cards and Provider Profiles http://www.ncsl.org/programs/health/hmorep2.htm, and one on Managed Care Insurer Liability at http://www.ncsl.org/programs/health/liable.htm
How are Americans dealing with the rising costs of medical care? The Kaiser Family Foundation has just released results of a survey on the issue. It will be featured in three articles in USA Today. For links to the articles, the report and charts, see http://www.kff.org/newsmedia/pomr090105pkg.cfm
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New Federal statistics on coverage and the uninsured are now available from three very different sources. The Census Bureau has just released its analysis of 2004 coverage. Uninsured remain at15.7% of the population, unchanged from last year. Employment based coverage continues to decline, with increased Medicaid coverage filling the gap. http://www.census.gov/prod/2005pubs/p60-229.pdf
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From AHRQ, three statistical briefs with estimates of the uninsured in 2004 are available. They estimated that 16.8 % of the non-institutionalized population under 65 is uninsured. Data are available from http://www.meps.ahrq.gov/papers/st83/stat83.pdf.
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Employer Coverage in 2005 is summarized by region in a new report from the US Department of Labor’s Bureau of Labor Statistics. http://www.bls.gov/ncs/ebs/sp/ebsm0003.pdf
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Medicaid
NCSL principles for Medicaid reform, the result of a year of task force meetings, were adopted at the annual meeting in Seattle this month. http://www.ncsl.org/statefed/health/MArefPrinc.htm
The National Governors Association (NGA) has just released a set of recommendations on Short-Run Medicaid Reform that can be included in the revenue and spending reconciliation bills. http://www.nga.org/Files/pdf/0508MEDICAIDREFORM.PDF
Some of the most innovative state activities have been in the area of home and community-based services. Kaiser has updated its compilation of data on these programs. A valuable resource with state information on such things as policies and options adopted, people served, waiting lists and expenditures, http://www.kff.org/medicaid/7345.cfm
A related project is Cash and Counseling experiments, which give persons with disabilities much greater control over how they obtain needed care. A report by Mathematica, The Effect of Cash and Counseling on Medicaid and Medicare Costs: Findings for Adults in Three States is available from HHS at http://aspe.hhs.gov/daltcp/reports/3stcost.pdf
Other recent reports on this topic, the result of a ten-year project, can be found at http://aspe.hhs.gov/_/topic/subtopic.cfm?subtopic=Cash%20and%20Counseling%20Demonstration
Mental Health and Substance Abuse
State Profiles of Mental Health and Substance Abuse Services in Medicaid are available at the SAMHSA web site, with detailed information on state policies related to behavioral health in Medicaid and SCHIP, as of mid 2003. http://www.mentalhealth.samhsa.gov/publications/allpubs/State_Med/default.asp
Two New NCSL Resources on Children’s Mental Health. Children and Mental Health Parity explains various ways in which states define mental health parity, presents benefits and potential drawbacks of mental health parity implementation, and discusses how parity could affect children’s mental health care. Balancing Budgets and Health Services: Children’s Mental Health in an Era of Budget Cuts provides an overview of how state budget cuts have affected children’s mental health care and reviews implications for the current system about future financing decisions. These are available at: http://www.ncsl.org/programs/health/mentalh.htm
Women and Children
The Annie E. Casey Foundation has released its annual Kids Count data book, including state-level data and ranking on a number of health and other indicators of wellbeing. You can look at one state, compare states, map and graph trends.
Among the new indicators: Low-birthweight babies; Infant mortality; Teen deaths from all causes; Teen births, by Age Group. The pages also allow you to look at some county-level data. http://www.aecf.org/kidscount/sld/compare.jsp?c=6
The National Governors’ Association also released its annual MCH Update, with tables on Medicaid and SCHIP eligibility and coverage. http://preview.nga.org/Files/pdf/0508MCHUPDATE.PDF
HRSA has issued Women’s Health USA 2005 with national data, graphs and tables on a wide variety of health indicators. http://mchb.hrsa.gov/whusa_05/_pdf/whusa2005_preface.pdf
Health Care Providers
Health Centers. The National Association of Community Health Centers released a report documenting trends in service and financing for health centers. The report focuses on the importance of Medicaid financing and the role centers play in serving a growing number of persons without coverage. The Safety Net on the Edge is available at http://www.nachc.com/research/Files/SNreport2005.pdf
Hospitals and the uninsured. A new study of trends in hospital care looks at where people without coverage are getting treated. Among the findings: fewer public hospitals providing care for the underserved; not enough providers in poorer suburbs; and a rising number of suburban emergency room visits by the uninsured. http://www.rwjf.org/research/researchdetail.jsp?id=2114
Hospital Cost Trends and Drivers are the subject of a new and amply illustrated report prepared for the American Hospital Association by the Lewin Group. They estimate that, of the growth in spending from 1998 to 2003, 52% was due to rising costs of goods and services; 43% due to higher demand for care; and 5% due to higher intensity of care. http://www.aha.org/aha/press_room-info/content/CostCaring.pdf
A new round of site visits to look at cost trends in 12 communities, from the Center for Studying Health Systems Change, is the subject of a webcast. http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1500
Family caregiving by older and younger family members is the subject of two different briefs received this month. An Urban Institute paper, part of a series on productive aging, deals with caregiving by older (over-55) persons http://www.urban.org/UploadedPDF/311203_Perspectives3.pdf. From the Commonwealth Fund, a report on caregivers under 65 identifies problems that they face in maintaining employment and obtaining health care coverage for themselves while caring for others. The report proposes some policy remedies http://www.cmwf.org/usr_doc/working-age_caregivers_roles.pdf
From the States
California Insurance Commissioner John Garamendi has issued a report, Priced Out, critiquing spiraling insurance costs in California. This report, which is frankly written in support of his values, recommends a universal coverage solution. http://www.insurance.ca.gov/PRS/PRS2005/priced-out-health-care-in-california.pdf
A new report from UCLA documents rising numbers of uninsured in the state. The numbers give a mixed picture of rising rates of offer, declining eligibility, and increased take-up when eligible. http://www.healthpolicy.ucla.edu/pubs/files/SHIC03_RT_081505.pdf
Oregon has just published hospital quality indicators for 2004, with information on volume and outcome for various procedures. States are continuing to experiment with the best way to make this information available so that people will use it. http://egov.oregon.gov/DAS/OHPPR/RSCH/hospitalqualityrates.shtml
Pennsylvania is seeing rising numbers of uninsured workers at higher income levels in the Philadelphia and Southeastern Pennsylvania area, according to a study using the Philadelphia Health Management Corporation’s Community Health Data Base http://www.phmc.org/chdb/uploads/datareports/2004%20IBC%20Report%20-%20Uninsured%20Adults%20in%20SEPA1.pdf
More on South Carolina’s Medicaid reform proposal, with an article from NCSPA and links to news items and additional analyses at CBPP and the state. http://www.ncpa.org/newdpd/dpdarticle.php?article_id=2126
Getting the 411
StateHealthFacts, the Kaiser Family Foundation site that offers hundreds of different categories of health-related information state by state, has added new facts. This is the first—and often the only—place I look when I want comparative state data, so I’ve actually installed a permanent link to this on my browser toolbar. It will organize the information for you by rank as well as by number, and you can compare all 50 states or look at a state’s profile. The new or updated data include: Dual Eligibles, including enrollment category, spending by service type (including prescription drugs) and total spending for dual eligibles for 2003; Medicare spending for 2001; enrollment in Medicare Advantage contracts, employment-based insurance premiums for 2003, by family size and state; health care employment rates in 2004; 2004 Ryan White Care Act Funding data; and syringe exchange programs in 2002. All the new information can be reached through http://statehealthfacts.org/cgi-bin/healthfacts.cgi?action=whatsnew
Kaiser also has updated a separate site that links to Medicaid benefit information for each state. http://www.kff.org/medicaid/benefits/index.jsp
Several months worth of past Chairs e-bulletins are archived at http://www.ncsl.org/programs/health/forum/chairs/ebull/index.htm
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, Director Emeritus
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
 NCSL Home Page
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