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

This is your September 2006 email update on state health policy resources available to you for free on the Internet. For those who missed our interesting program in Nashville, you can see material from the Chairs program at http://www.ncsl.org/programs/health/forum/annualmeet06.htm.

Looking Ahead

October Cultural Competence Conference Calls. The Forum’s Critical Health Areas Project (CHAP), a project to build expertise in four selected issue areas for emerging leaders, will offer a series of conference calls dealing with aspects of cultural competence—in chronic care quality, in substance abuse treatment, as it affects access, and as part of providers’ training—each Friday in October.

Shelly Gehshan, formerly of NCSL and now at the National Academy for State Health Policy (NASHP) is offering stipends for legislators who wish to attend a pre-conference session Sunday, October 15, 8 a.m. – 4:40 p.m on juvenile justice. The program, Helping Troubled Youth: Juvenile Justice, Medicaid and Behavioral Health, precedes NASHP’s annual conference in Pittsburgh. For more information, visit NASHP’s meeting site at http://www.nashp.org/_docdisp_page.cfm?LID=6E15691A-FFD6-4EF3-9428FCA5CDB050AA or contact NASHP’s Jen Tabor at (207) 874-6524 or jtabor@nashp.org.

NCSL’s Fall Forum will be in San Antonio this year, December 5-8. We’ll actually begin health programming on the 4^th with activities for the Critical Health Areas Project (CHAP). Chairs and CHAP activities continue on the 5^th, followed by a choice of short health programs on a variety of topics including health information technology and substance abuse. We have set aside a limited number of scholarships to support some of your travel expenses. As usual, we encourage you to seek matching funds from your state so that more of you can receive support. You will receive more information on the meeting shortly, including an RSVP form.

The San Antonio meeting hotel is the Hyatt Regency http://sanantonioregency.hyatt.com/hyatt/hotels/.

Resources Online

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

Access & Medicaid

Children

A number of papers on children’s health and their access to care and insurance were issued this month, including many in conjunction with the Robert Wood Johnson Foundation’s seventh annual Covering Kids & Families Back-to-School Campaign. http://coveringkidsandfamilies.org/.

The project’s central document, prepared by the University of Minnesota State Health Access Data Assistance Center (SHADAC), shows how states compare in their efforts to cover children. http://coveringkidsandfamilies.org/press/docs/2006StateofKidsCoverage.pdf

Adolescents are particularly at risk for not having insurance. The National Institute for Health Care Management (NIHCM) Foundation has released a paper highlighting the health issues and factors that influence health, access and use of available care for this group. Young People's Health Care: A National Imperative suggests policies to stave off a crisis of care for this group and showcases innovative state and local programs. http://www.nihcm.org/finalweb/YoungPeoplesHCFINAL.pdf

Disparities in children’s health are the subject of a paper from the Children’s Defense Fund. Improving Children's Health: Understanding Children's Health Disparities and Promising Approaches to Address Them. http://cdf.convio.net/site/DocServer/CDF_Improving_Children_s_Health_FINAL.pdf?docID=1781

The Association of State and Territorial Health Officers (ASTHO) has just issued a guide with reviews of recent state access efforts. We’ve covered many of these here and in State Health Notes. Link to the report, State Efforts to Expand Health Insurance: Primary Care Resource Guide at http://www.astho.org/pubs/StateHealthCareReform.pdf

Two similar resources that we’ve featured in the past are NCSL’s pages on access (see links to various subjects to the right of this overview page) http://www.ncsl.org/programs/health/h-primary.htm and the RWJ-funded State Coverage Initiative’s State Coverage Matrix http://www.statecoverage.net/matrix.htm

In the RWJ-funded paper, The Role of Medicaid and SCHIP as an Insurance Safety Net, the Urban Institute analyzes census data collected in 2001 and 2005 and again documents the decline in employer-sponsored coverage, just barely overcome by increased public coverage in the case of children. A notable statistic in the paper: “Almost 75 percent of all uninsured children are eligible for Medicaid or SCHIP, compared to only 14 percent of uninsured adults.”

The paper may be found at http://www.rwjf.org/files/publications/other/UrbanHealthInsuranceBrief.pdf

Rural Health

A new study from the University of North Carolina’s Sheps Center asks how well premium assistance programs for low income families work in rural areas. The authors conclude that states can (and sometimes do) design the program to be more accessible for rural residents, for example by allowing individuals to purchase coverage directly rather than providing assistance only to employer plans. http://www.shepscenter.unc.edu/research_programs/rural_program/WP85.pdf

Medicaid

Coverage isn’t enough: you need a place to take your insurance card. A new study by the Center for Studying Health System Change finds that, while roughly the same proportion of physicians continue to have some Medicaid patients, a shrinking share of these physicians are caring for ever-growing numbers of people on Medicaid. Medicaid Patients Increasingly Concentrated Among Physicians http://www.hschange.org/CONTENT/866/

According to the August 24 issue of the New England Journal of Medicine, West Virginia’s recent state plan amendment calling for patients to sign personal responsibility agreements “asks physicians to violate all three fundamental principlesenumerated in the Physician Charter on Medical Professionalism:the primacy of patient welfare, the principle of patient autonomy,and the principle of social justice.” Read the entire article, “Personal Responsibility and Physician Responsibility—West Virginia's Medicaid Plan” for free at http://content.nejm.org/cgi/content/full/355/8/756?query=TOC

Other articles in the issue also deal with the reform. http://content.nejm.org/cgi/content/full/355/8/753?query=TOC

The State Coverage Initiative has updated an issue brief published this spring about critical success factors in consumer-directed models in Medicaid. http://www.statecoverage.net/pdf/issuebrief806.pdf

Comprehensive Reform

We’ve been reading about Massachusetts’ and Vermont’s reforms. Those of you who made it to Nashville heard about Tennessee’s changes and we’ve posted slides from the session at http://www.ncsl.org/programs/health/forum/annualmeet06.htm

Other legislators are actively working on comprehensive reforms as well. California’s legislature sent a single payer measure to the Governor at the end of August, although he says he will veto it. Here’s SB 840: http://info.sen.ca.gov/pub/bill/sen/sb_0801-0850/sb_840_bill_20060824_amended_asm.html, a favorable analysis of a similar measure by the Lewin Group in 2005 http://www.healthcareforall.org/studies.html and a critical response published by the Pacific Research Institute http://www.pacificresearch.org/pub/sab/health/2006/deadly-solution.html

A Wisconsin group has been working on a version of pay-or-play for at least a year. http://www.wisconsinhealthproject.org/plan/understand.htm.

Quality and Chronic Conditions

The Institute of Medicine recently released its latest report in the Quality Chasm series, Preventing Medication Errors. The report estimates that each year at least 1.5 million people are harmed by medication errors at a cost of about $3.5 billion annually and calls on all facets of the health care system to implement changes. http://www.nap.edu/catalog/11623.html

State Legislation Relating to Disclosure of Hospital and Health Charges is a key element in informed consumerism and in value-based purchasing. The issue is tracked and explained on a newly updated NCSL page, http://www.ncsl.org/programs/health/Transparency.htm

Who better than CMS—Medicare and Medicaid—to take the lead in requiring accountability from the institutions it pays for the care of vulnerable Americans? According to the newly released report from the Deloitte Center for Health Solutions, Paying for Performance: A Call for Quality Health Care,

“Medicare, as the predominant payer in the health care industry, has taken a major, if not the lead, role to promote the P4P movement…and
“P4P seems to be part of a ‘value-based purchasing’ agenda that was promoted in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and further endorsed during congressional debates in 2005. ... this Point of View provides background on the P4P movement, gives a status report, and, most importantly, outlines strategies health care organizations can pursue in preparing to meet the clinical and operational challenges of a trend that has become cutting edge.” http://www.deloitte.com/dtt/cda/doc/content/us_chs_p4p_032806.pdf

Consumer Reports’ September issue includes a nursing home guide with information by state, including state oversight activities. Read the report at http://www.consumerreports.org/cro/health-fitness/nursing-home-guide/0608_nursing-home-guide.htm

Compulsory managed care for people with disabilities in Medicaid is a relatively new and still relatively uncommon phenomenon. The George Washington University has analyzed state experience with these programs to come up with recommendations about program design, contracting and operations to benefit enrollees in Managed Care and Medi-Cal Beneficiaries with Disabilities: Assessing Current State Practice in a Changing Federal Policy Environment. http://www.gwumc.edu/sphhs/healthpolicy/chsrp/disabilities_publications.html

You can read more on this topic in the archives of the Managed Care for People with Disabilities Purchasing Institute convened by the Center for Health Care Strategies, http://www.chcs.org/publications3960/publications_show.htm?doc_id=392805

Providers and Workforce

In a new report entitled The Emergency Care Workforce in the U.S. the Center for Health Workforce Studies at the University at Albany, State University of New York examines the make-up, distribution, supply and shortages of the various personnel who make up the emergency medical care workforce. The report also points to a number of issues that may impact the future demand for these emergency care workers, including terrorist threats and the aging of the baby boomers. http://www.albany.edu/news/pdf_files/EmergencyCare Workforce in the US 08-2006A.pdf

Public Health

More Katrina

Hurricane Katrina and its aftermath devastated health care in New Orleans, in part because it ripped the bandage off a festering dysfunctional system, according to the latest anniversary piece, a study from the Kaiser Commission on Medicaid and the Uninsured, Health Care in New Orleans Before and After Hurricane Katrina published on the Health Affairs website. This and related materials including interviews with survivors, a short film, and a survey on the response to Katrina are all available from Kaiser at http://www.kff.org/uninsured/kcmu082906oth.cfm

The Legislative Role in Healthy Community Design: Learn how state legislatures can encourage physical activity and access to healthy foods in this new publication from NCSL. Legislators and staff may download for free. http://www.ncsl.org/programs/pubs/summaries/0143580004-sum.htm

Disparities

The Commonwealth Fund continues to document disparities in coverage and the impact on access for racial and ethnic minorities. In Health Care Disconnect: Gaps in Coverage and Care for Minority Adults, which presents findings from the Fund’s biennial survey, the authors note that

“Uninsured rates for Hispanic and African American adults are one-and-a-half to three times greater than the rate for white adults. Nearly two-thirds (62%) of working-age Hispanics and one-third (33%) of African Americans were uninsured at some point during 2005, compared with 20 percent of working-age whites.”

Links to a webcast, issue brief and chartpacks as well as the report may be found at http://www.cmwf.org/publications/publications_show.htm?doc_id=386220&#doc386220

NCSL's "2006 Prescription Drug State Legislation" has been updated through mid-August. This year states have considered more than 460 bills and passed more than 60 laws and resolutions in 34 states. Topics include Medicare Part D wrap around programs and fixes, Medicaid cost containment, Discount and Subsidy Programs, Pharmacy Benefit Manager regulation, Prescription Drug Reuse/Recycling, Electronic Monitoring and Internet Prescribing, and Marketing and Advertising. Highlights include a first-in-the-nation law establishing privacy of pharmacy records to limit marketing, a new discount plan for under-65 adults in New Mexico, and a focus on the donation of unused pharmaceutical drugs in Florida, Arkansas, Georgia, Louisiana, Maryland, Nebraska, Oklahoma and Tennessee. The online edition (61 print pages) is located at http://www.ncsl.org/programs/health/drugbill06.htm

Reinventing Health Care

At this June’s Heath Chairs meeting, you heard dynamic speakers call for rethinking the health system altogether. Two new publications offer comprehensive visions of change.

The RWJ-funded Council on Health Care Economics and Policy holds an annual meeting in Princeton to look at health policy issues. Reinventing Health Care Delivery in the 21st Century was the theme of this year’s meeting. Papers and presentations may be found at http://council.brandeis.edu/ While you’re there you may also want to look at previous conferences, including one on the crumbling retiree health system and one that asks, “How will states pay for health care?”.

The Commonwealth Fund’s Commission on a High Performance Health System has issued Framework for a High Performance Health System for the United States. The Commission’s vision includes universal access, improved resource allocation, higher efficiency and better quality, with features such as transparency, improved integration of services, health information technology and a workforce that is rewarded for innovation. http://www.cmwf.org/publications/publications_show.htm?doc_id=387153

State by State

Florida State Health Committee Chair Representative Holly Benson convened a brainstorming session on access in Pensacola. The results of this “Idearaiser” are on line at http://www.floridahealthcounts.com/.

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

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