This is the Health Chairs e-Bulletin for October 2005
Looking Back
You can depend on Uwe Reinhardt to be entertaining and provocative as well as profound in his critique of the US health system, and he didn’t disappoint this year. If you missed Seattle and still want to see if he said anything to inspire you or get your blood pressure up (I call it a ‘cardiovascular moment’) you can dial up either audio or video at:
Audio: http://www.tvw.org/MediaPlayer/Archived/WME.cfm?EVNum=2005080077C&TYPE=A
Video: http://www.tvw.org/MediaPlayer/Archived/WME.cfm?EVNum=2005080077C&TYPE=V
Resources on Line
Katrina-related links
A number of dimensions of preparedness, need and response have been exposed by the storm. Here are some resources that may be of interest to states responding to the storm, absorbing people displaced by the storm, or seeking to learn from the Gulf states’ experience.
NCSL has posted a resource guide on Katrina for legislators at http://www.ncsl.org/programs/press/2005/katrina.htm.
Other state associations also have collected important information. The Association of Public Human Services Agencies (APHSA) (Medicaid and Welfare program directors) lists policies and resources affecting states at http://www.aphsa.org/katrina/disasterpolicy9-13-05.asp.
In response to the total loss of health information for Katrina evacuees, a remarkable public-private effort has put together a system that allows people and providers to recreate their prescription information from the existing electronic trails. Check it out at http://www.katrinahealth.org/.
According to NCSL Federal Health Affairs director, Joy Wilson, the Administration, through Secretary Leavitt, has established an 1115 waiver demonstration project by which states can provide expedited Medicaid and SCHIP benefits to evacuees. Texas has received a Medicaid waiver for the evacuees that is expected to serve as a template for other states. http://www.hhs.gov/news/press/2005pres/20050915b.html. Here are some waivers for their caregivers: http://www.hhs.gov/katrina/ssawaiver.html.
A discussion is unfolding on how Disaster Relief Medicaid can be used to cover costs for some of the evacuees. The Alliance for Health Reform convened a September 12 meeting, Safeguarding the Health of Katrina's Victims, available as a webcast at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1507.
Resources for advocates are found on the National Health Law Program (NHeLP) Katrina page.http://www.healthlaw.org/library.cfm?fa=detail&id=82840&appView=folder.
The Agency for Healthcare Research and Quality (AHRQ) offers tools and resources for emergency responders to use at http://www.ahrq.gov/path/katrina.htm.
Doctors and other health professionals helping children process the storm and its aftermath may turn to resources from the American Academy of Pediatrics at http://www.aap.org/new/disasterresources.htm.
The National Library of Medicine has collected some toxicology and environment-related links at http://sis.nlm.nih.gov/enviro/hurricane.html.
Access and Costs
Three on Individual Coverage
Dueling estimates
The CBO says few uninsured workers would buy individual coverage, even with proposed subsidies http://www.cbo.gov/ftpdocs/66xx/doc6620/08-24-HealthInsurance.pdf A pair of former CMS (HCFA) actuaries and analysts dispute this estimate. http://www.realtor.org/GAPublic.nsf/files/CritiqueofCBO.pdf/$FILE/CritiqueofCBO.pdf.
NCSL Forum for State Health Policy Leadership has issued a State Health Lawmakers Digest on individual coverage. The digest features interviews with Janet Trautwein and Mila Kofman, abstracts of journal articles, and describes state, federal and private efforts to make individual coverage more available http://www.ncsl.org/programs/health/forum/shld/54.htm.
And don’t forget to check the Kaiser State Health Facts on costs and budgets for state-by-state and comparative data http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&welcome=1&category=Health+Costs+%26+Budgets.
Trends in Employer Coverage
A terrific overview of state activities to address the erosion of employer-based coverage can be found in Current Strategies to Expand Dependent Health Coverage, released by the Economic and Social Research Institute (ESRI). This brief (24 page) overview is full of information on what states have tried and what was learned. The erosion of coverage is especially harmful to children, according researchers at the UC Berkeley Center for Labor Research and Education and Working Partnerships USA in Kids at Risk. Declining Employer-Based Health Coverage in California and the United States: A Crisis for Working Families. The two new papers were commissioned by the California Endowment’s project, Cover California’s Kids. Both the documents and more can be read at http://www.covercaliforniaskids.org/links.php.
The Henry J. Kaiser Family Foundation and the Hospital Research and Education Trust (HRET) collaborate on an annual survey on trends in employer-based coverage including changes in premiums, offer and take-up rates, and new benefit designs. A webcast of the release of the latest report includes presentations of highlights and links to the report. http://www.kaisernetwork.org/healthcast/kff/14sep05.
Kaiser offers a number of modules on health policy topics for those who want to learn an issue in greater depth. The tutorial on counting the uninsured explains why different surveys yield different estimates: http://cme.kff.org/Key=9226.Pr.D.C.FVqfsJ. To get under the surface of rising costs and learn what options are being considered, check out their issue module on costs http://cme.kff.org/Key=9226.Pr.F.C.FPK7dw. Rx costs merit their own module: http://cme.kff.org/Key=9226.Pr.G.C.FPhYWv. See other tutorials at http://www.kaiseredu.org/tutorials_index.asp.
The California Healthcare Foundation has issued an interesting report that considers how the cost of care is shared between individuals and insurers in different ways according to their health status and health needs. The Price of Illness: Cost Sharing and Health Plan Benefits, http://www.chcf.org/documents/insurance/ThePriceofIllnessConsumerCostSharing.pdf.
The Government Accountability Office (GAO) has issued a report on hospital and physician prices for the federal employee health benefit plan. The report provides a window on prices across the country. One finding: Wisconsin is home to some of the highest physician prices. http://www.gao.gov/new.items/d05856.pdf.
Medicaid
On September 1, the Medicaid Commission sent its first report to HHS Secretary Leavitt. The report can be downloaded at http://www.cms.hhs.gov/faca/mc/090105rpt.pdf. According to NCSL’s Joy Johnson Wilson, who was a non-voting member, the Commission made the following recommendations:
- Prescription Drug Reimbursement Reform. Permit states to establish prices based on the Average Manufacturers Price (AMP) rather than the Average Wholesale Price (AWP).
- Extend the Medicaid Drug Rebate Program to Medicaid Managed Care Organizations.
- Change the Start Date of Penalty Period for Persons Transferring Assets for Medicaid Eligibility.
- Increase the "Look-Back" Period from Three to Five Years.
- Permit Tiered Co-Payments for Prescription Drugs.
- Change Provider Tax Law to Require States to Tax All Managed Care Organizations in the Same Way. Under current law, states can impose provider taxes on Medicaid-Only managed care organizations without imposing the same tax on other managed care organizations operating in the state.
The Health Policy Institute (HPI) of the Joint Center for Political and Economic Studies has launched Place Matters: Addressing the Root Causes of Health Disparities, a broad initiative to address the social and economic conditions that increase the incidence of diseases among minorities. Partners with the Joint Center on the initiative include the National Association of Counties, the International City/County Management Association, the National Association of County Health Officials, and the Center for the Advancement of Health. At its launch, HPI released a study of the consequences of proposals to limit Medicaid. Medicaid Responsiveness, Health Coverage, and Economic Resilience: A Preliminary Analysis by Stan Dorn, Barbara Markham Smith and Bowen Garrett. The paper bases an argument against Medicaid caps on a strong relationship between unemployment rates and Medicaid spending. http://www.jointcenter.org/publications1/PublicationsDetail.php?recordID=127.
Aging
The President's Council on Bioethics has released a report that will resonate with anyone who has cared for an aging friend or family member. Taking Care: Ethical Caregiving in our Aging Society discusses the ethics of caregiving, and points out the dangers on both sides—the risk of not caring for the elderly against the risk of sacrificing the young to subsidize their care. The report recommends further study, a process that should be followed with profound interest http://www.bioethics.gov/reports/taking_care/index.html.
Public Health
The National Health Policy Forum has issued a pair of outstanding background papers that will interest states concerned about public health policy.
Caring for "Ryan White": The Fundamentals of HIV/AIDS Treatment Policy describes the epidemic and policy responses, with particular focus on the various federal programs that fund care for persons living with HIV and AIDS. Medicaid and the various titles of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act move funds to people in need through a number of different federal-state or federal-local partnerships. The paper is available at http://www.nhpf.org/pdfs_bp/BP_RyanWhite_08-22-05.pdf. Legislators in states that are interested in pay-for-performance, estimating how much it will cost to offer a service, or want to evaluate benefit mandates or covered services will do well to look at Clinical Preventive Services: When is the Juice Worth the Squeeze? The report includes a discussion of how researchers have estimated impacts and costs; public and private policies related to coverage for preventive services; and reasons other than coverage for services not being used. http://www.nhpf.org/pdfs_ib/IB80_ClinicalPrevServices_08-24-05.pdf.
Prisoners have special health needs and problems, and their care is often disconnected from the rest of the system. But they are ultimately part of our communities, and their health reflects and affects everyone else. The Forum, In Need of Correction: The Prison Cycle of Health Care American Public Health Association and Community Voices Initiative http://cme.kff.org/Key=9275.Cm6.D.D.K3KW5L This forum on correctional health issues highlighted research that appears in the October 2005 issue of the American Journal of Public Health.
Health Information Technology
Newer uses for electronic technology to improve health have taken the limelight lately; nonetheless, NCSL has updated its web page tracking state legislation related to telemedicine http://www.ncsl.org/programs/health/teleleg.htm.
From the States
Kentucky’s Health is the subject of a series in the Louisville Courier-Journal. This series of articles compares Kentucky with other states, analyzes causes and considers options including addressing personal factors such as smoking and obesity. The series, with interactive maps and videos, can be found at http://www.courier-journal.com/apps/pbcs.dll/article?AID=/99999999/NEWS01/50714007&theme=HEALTHCRISIS&template=theme.
Massachusetts Public Policy Institute has released a sophisticated and comprehensive analysis of the new 1115 waiver in Massachusetts. It includes analysis of the connections between the waiver and state mental hospital financing, the uncompensated care pool, safety net providers, DSH, and IGTs as well as thoughtful discussion of the most coverage model for the uninsured. Donna Folkemer (donna.folkemer@ncsl.org) thinks many of the upcoming 1115 waivers will be driven by complex interactions among the factors discussed in this piece http://www.statecoverage.net/statereports/ma48.pdf.
The Minnesota Department of Health continues to produce terrific documents: a chart book of state markets http://www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html; and three new reports from its health economics program: Minnesota’s hospital cost drivers and trends in insurance http://www.health.state.mn.us/divs/hpsc/hep/publications/privatemarkets/2005-02.pdf; distribution of beds by specialty http://www.health.state.mn.us/divs/hpsc/hep/issbrief/2005-02.pdf; and health care capital expenditures http://www.health.state.mn.us/divs/hpsc/hep/issbrief/2005-02.pdf.
How much is it costing us to wait until people show up at the hospital? The Connecticut Office of Health Care Access used AHRQ methods to estimate the impact of hospitalizations that might have been avoided if ambulatory care had been given instead: 50,000 ACSC hospitalizations with nearly 300,000 total patient days and associated total charges of almost $900 million. Roughly half the hospitalizations were for older, Medicare-funded patients http://www.ct.gov/ohca/lib/ohca/publications/acsc_databook00-04.pdf.
A Demographic Profile of All CT ACSC Discharges, FYs 2000-2004
The California Healthcare Foundation has set up a page to track several health referenda in that state (one related to parental notification and two for prescription drug assistance or discounts.) Declaring the page a “no-spin zone” they promise to present all the sides of the debate including information on spending by proponents and opponents. The pages include the ads, analyses of whether they are accurate, and information about who is buying and seeing them http://www.healthvote.org/. They have also released a very in-depth Health Care Market Report with lots of comparative data on hospitals and health plans http://www.chcf.org/documents/hospitals/CAHealthCareMarketRep2005.pdf
Wisconsin has released a report on its health workforce, including priorities, shortages, and effective programs. http://www.dwd.state.wi.us/healthcare/pdf/healthcare_annual_report2005.pdf.
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…
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
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
 NCSL Home Page
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