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

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 NCSL 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 at 2 p.m. Eastern time. Get details, and register on line at http://www.ncsl.org/programs/health/webcast2.htm.

NCSL’s Fall Forum will be in San Antonio this year, December 5-8. We’ll actually begin programming for Health Chairs on the 5^th with a half-day meeting entitled “Leave No One Behind.” We’ll spend most of the time discussing your ideas and initiatives, especially your plans for 2007 legislative sessions. On the afternoon of the 5^th, you will have a choice of short health programs on a variety of topics including health information technology and substance abuse issues. 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...Addiction...Public Health…Health Information Technology

Access & Medicaid

The 2006 Kaiser/HRET Employer Health Benefits Survey finds that health premiums increased during 2006 at the lowest rate since 2000: 7.7 percent. The bad news? That’s still more than twice the rate of growth for wages (3.8 percent) and general inflation (3.5 percent). The Kaiser Family Foundation, the Center for Studying Health System Change and Health Research and Educational Trust conducted the annual survey of employers to understand changes in premiums, employee contributions and cost-sharing policies, and employers’ views of the effectiveness of various approaches to finding care and managing cots. This year’s study included a look at high deductible health plans and the rate at which health savings accounts are being used with them. http://www.kff.org/insurance/7527/

Individual Coverage

A Commonwealth Fund reports that individual coverage is hard to find (nearly nine of 10 seeking coverage never found a plan they could buy), expensive (with annual premiums costs over $3,000 for more than half of adults with individual coverage, compared to 1/5 of those with employer coverage) and generally less satisfactory than group coverage. http://www.cmwf.org/usr_doc/Collins_squeezedrisinghltcarecosts_953.pdf

Medicaid

Recent Medicaid waivers and plan modifications under new Deficit Reduction Act (DRA) authority are modeled on defined contributions and limited benefit plans, which are increasingly popular for commercial coverage. A policy brief from the George Washington University’s Sara Rosenbaum looks at Defined-Contribution Plans and Limited-Benefit Arrangements: Implications for Medicaid Beneficiaries. The study warns that, despite their budgetary appeal, they can have perverse effects due to obstacles to care and eroded networks, and undermine efforts to measure and assure quality. http://www.gwumc.edu/sphhs/healthpolicy/chsrp/downloads/Rosenbaum_AHIP_FNL_091306.pdf

Retirees

How will retirees pay for their health care? Medicare leaves substantial gaps, even with the new drug benefits, and under-65 retirees aren’t eligible at all. A new paper from the Employee Benefit Research Institute (EBRI), Savings Needed to Fund Health Insurance and Health Care Expenses in Retirement looks at costs, trends and options for current and future retirees. The issue brief can be found at http://www.ebri.org/pdf/briefspdf/EBRI_IB_07-20061.pdf.

WatsonWyatt Worldwide has a report on The Changing Horizon of Retiree Medical Benefits as well. The executive summary is available (may require free registration) at http://www.watsonwyatt.com/research/deliverpdf.asp?catalog=w-926&id=x.pdf.

Children

With SCHIP reauthorization looming and census data showing an up tick in uninsured children for the first time since that program started, it is time for a closer look at which children lack coverage, why, and why it matters. Families USA has prepared a report on behalf of the coalition, Campaign for Children’s Health Care including state profiles. No Shelter from the Storm: America's Uninsured Children points out that a majority of children without insurance are in two-parent working families, while over 60 percent are members of racial or ethnic minorities. http://www.childrenshealthcampaign.org/tools/reports/no-shelter-from-the-storm.html

A companion fact sheet discusses the minority composition of uninsured children in 12 states: CA, FL, GA, HI, IL, NJ, NY, NC, OK, PA, TX, and VA. http://www.childrenshealthcampaign.org/assets/pdf/Uninsured-Minority-Kids-at-Risk.pdf

Quality and Chronic Conditions

The National Committee for Quality Assurance (NCQA) issued its 10th Annual State of Health Care Quality report. The report gives results for care provided to 70 million people served by health plans around the country. It found general improvement in a number of measures, for the seventh year, but also recorded great variation from region to region. The report makes the case for shining the spotlight on things that a state wants to improve. The table below estimates deaths that might have been avoided (37 to 81 thousand) and unnecessary costs ($2.9 to $3.9 billion) if all areas were providing care like the best areas. Link to the report, executive summary, chartpaks and an audioconference at http://www.ncqa.org/Communications/News/SOHC_2006.htm.

A study of quality in New Jersey hospitals also finds improvements. The third state Hospital Performance Report found improvements in treatment of pneumonia, congestive heart failure and heart attack in 2005. http://web.doh.state.nj.us/hpr/

Mental Illness

A Department of Justice report finds mental illness pervasive among inmates, a fact well known by correction officials. The report recommends more screening to identify persons with mental illnesses cycling through these facilities. http://www.ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf

Long Term Care

The National Center for Assisted Living (NCAL) 2006 Assisted Living State Regulatory Review is a set of state profiles that summarize state laws and regulations in 20 categories, including such things as rules on medication assessment, staffing, and special Alzheimer’s’ unit requirements. The volume includes agency contact information. The report was issue in March (sorry, we missed it.) http://www.ncal.org/about/statsum.htm

AARP has just released a paper on state policies around personal care workforce, Paying for Quality Care: State and Local Strategies for Improving Wages and Benefits for Personal Care Assistants. The report finds little federal direction, problematic rate setting, and a variety of state approaches that seem specific to the varying state circumstances. The report includes a tabulation of state responses to the survey. http://www.aarp.org/research/health/carequality/2006_18_care.html

Providers and Workforce

Charitable Care and Community Benefits were the subject of a Senate Finance Committee hearing that inquired into whether hospitals provide enough care to justify their not-for-profit status. Hospital responses to the committee queries may be found at http://www.senate.gov/~finance/press/Gpress/2005/prg091206summary.pdf and the hearing is available at http://www.senate.gov/~finance/sitepages/hearing091306.htm. A September NCSL issue brief on the same issue, Collecting from the Uninsured: Hospital Billing Practices is available to legislators and staff at http://www.ncsl.org/legis/lbriefs/2006/06LBAugSep_CollectingfromUninsured.pdf.

Certificate of need (sometimes called CoN) is examined in a new report from California’s legislative research bureau. Hospital Planning: What Happened to California’s Certificate of Need Program? gives an overview of the program’s history and compares California’s experience with other states. http://www.library.ca.gov/crb/06/09/06-009.pdf

If you want to learn more about CoN, check out the American Health Planning Association’s web site. AHPA is the association for these state programs and, as you’d expect from planners, has a clear site with links to various resources including state CoN programs http://www.ahpanet.org/websites_copn.html. According to AHPA, “Health services policymakers have used certificate of need (CON) regulation to help shape the health care system for more than three decades. The rationale for imposing market entry controls is that regulation, grounded in community-based planning, will result in more appropriate allocation and distribution of health care resources and, thereby, help assure access to care, maintain or improve quality, and help control health care capital spending.”

Is health care spending bad per se? According to a recent BusinessWeek article, employment growth in the health care sector propped up a faltering economy in the early 2000’s. See the article (and read comments that point out that the same could be said of any part of the economy that is non-cyclical—that is, doesn’t grow and shrink according to economic cycles) at http://www.businessweek.com/magazine/content/06_39/b4002001.htm

Addiction

The Substance Abuse and Mental Health Administration (SAMHSA) has released the National Survey on Drug Use & Health (formerly called the National Household Survey on Drug Abuse (NHSDA)). Among the highlights is the good news that a four-year decline in current illicit drug use among youths aged 12 to 17 continued, with rates falling to 9.9 percent in 2005. http://www.oas.samhsa.gov/nsduh.htm

In particular, the report includes State Estimates of Substance Use from the 2003-2004 National Surveys on Drug Use and Health http://www.oas.samhsa.gov/2k4State/toc.htm with a number of maps and tables, including individual state data tables http://www.oas.samhsa.gov/statesList.htm.

Figure 3.1 Alcohol Use in Past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Public Health

Obesity

Several new reports highlight the problem, and NCSL is tracking state responses.

As part of the Healthy People 2010 objectives, the Centers for Disease Control and Prevention (CDC) set a goal to reduce the prevalence of obesity among adults in the United States by 15 percent. Instead, rates of obesity continue to rise according to a recent Morbidity and Mortality Weekly Report. http://www.cdc.gov/mmwr/preview/mmwrhtml/tab

Overweight and Physical Activity among Children: A Portrait of States and the Nation 2005 presents the results of the National Survey of Children’s Health. This chartbook from the Health Resources and Services Administration includes tables and findings for the nation and each state on such things as rates of childhood obesity, body mass index and levels of exercise. In addition to analyses according to income, race and ethnicity, the book charts the relationship of parental behavior and child health outcomes. http://mchb.hrsa.gov/overweight/

A new Institute of Medicine (IOM) report finds that one third of American children and youth are either obese or at risk of becoming obese. The IOM makes four recommendations: formation of high-level coordinating task forces; evaluate current programs and initiate culturally relevant alternatives; monitor results and trends while funding research; and release the results. http://www.iom.edu/Object.File/Master/36/987/11722_govt_factsheet.pdf

For more on national efforts, call NCSL staff Joy Johnson Wilson, Health Policy Director at 202-624-8689 or Rachel Morgan RN, BSN, Senior Health Policy Specialist at 202-624-3569.

From NCSL, Childhood Obesity: Legislative Policy Approaches and the Evidence Base to Date reports state legislative policy options for childhood obesity prevention and current scientific evidence about the effectiveness of each option. http://www.ncsl.org/bookstore/productdetail.htm?prodid=0166610&catsel=xhlt%3BHealth

The Legislative Role in Healthy Community Design analyzes state legislation from 2004 through the first half of the 2006 session that encourages physical activity and access to healthy food through changes in the built environment, land use planning and zoning. http://www.ncsl.org/bookstore/productdetail.htm?prodid=0143580004&catsel=xenv%3BEnvironmental%20Protection

NCSL staff following state activities on obesity in Denver include Amy Winterfeld, Leslie Robbins, and Doug Shinkle at 303-364-7700.

Disparities

Who you are and where you live both affect your longevity, according to a new report that documents disparities across eight groups defined by race and geography. Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. The authors found a gap of over 35 years in longevity between the longest-lived group and the one with the highest death rates, with differences persisting over decades. http://www.globalhealth.harvard.edu/Murrayetal-EightAmericas-PLoSMedicine2006_000.pdf.pdf

Health Information Technology

The eHealth Initiative released its Third Annual Survey of Health Information Exchange at the State, Regional and Community Levels. The report follows 165 initiatives located in 49 states, the District of Columbia and Puerto Rico. The press release is http://www.ehealthinitiative.org/news/2006HIEReport.mspx and the entire report may be found at http://toolkits.ehealthinitiative.org/assets/Documents/eHI2006HIESurveyReportFinal09.25.06.pdf.

You can track legislation related to HIT state by state at the eHI site, http://ccbh.ehealthinitiative.org/communities/community.aspx?Section=288.

You can also track HIT efforts at the state level and below, whether private or public, using the Health Information Management System Society HIMSS) “dashboard” including a clickable map that lets you drill down to substate levels at http://www.hitdashboard.com/.

State by State

NSCL** tracks—or has tracked all kinds of legislation, in health and in other matters. Check out our legislative tracking resources on the web at http://www.ncsl.org/programs/lis/lrl/50statetracking.htm.

Is there any issue you’d like to see tracked but can’t find there? Let us know!

Two other tracking resources we use a lot—and think you will too-are the Kaiser Family Foundation’s State Health Facts at http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi and the coverage matrix from the Robert Wood Johnson Foundation’s State Coverage Initiative http://www.statecoverage.net/matrix.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

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