Dear Health Committee Chairs:
These are excerpts from the October 2007 email update on state health policy resources available on the Internet.
Access
Healthy San Francisco, the city’s new universal health care program, which reached its first enrollment goal early, expanded to twenty additional clinics in mid-September. With the hopes of providing medical homes to all 82,000 uninsured San Francisco residents, these plans do not require proof of citizenship or employment, and possession of a preexisting condition is not grounds for being denied program entry. Included services are primary care, with a focus on prevention, emergency care, mental health services, substance abuse services, radiology, and prescriptions. To get more information on the Healthy San Francisco plan visit http://www.healthysanfrancisco.org/.
A report published by the Department of Veteran’s Affairs’ (VA) Office of Inspector General (OIG) found that 27% of injured veterans had to wait at least 30 days for an appointment, despite the VA’s policy that patients be scheduled within 30 days of their request. OIG said that the VA falsely reported to Congress that 95% of appointments were scheduled within 30 days or less. A Government Accountability Office (GAO) report found that 46% of soldiers returning from Iraq and Afghanistan who qualify for personalized medical care do not receive it. The GAO report cites staff shortages as the primary reason for the lack of care. “Warrior transition units” had staff vacancy rates of 47% according to the GAO report. To view the OIG report please visit http://www.va.gov/oig/52/reports/2007/VAOIG-07-00616-199.pdf. The GAO report can be accessed at http://www.gao.gov/new.items/d071256t.pdf.
Disparities
The Center for Health Care Strategies (CHCS) recently produced an issue brief, “From Policy to Action: Addressing Racial and Ethnic Disparities at the Ground Level.” This paper outlines strategies that states and managed care organizations are utilizing to address health care inequalities. http://www.chcs.org/usr_doc/From_Policy_to_Action.pdf
Costs
Analysts at CMS determined that residents of the Northeast spent the most on health care in 2004. Residents of Washington D.C. spent the most on health care per capita at $8,295, followed by Massachusetts, Maine and New York. Utah’s residents spent the least at $3,972. The national per capita average is $5,283, which has increased, on average, 6.3% annually from 1998 to 2004. http://www.cms.hhs.gov/NationalHealthExpendData/downloads/res-us.pdf
A study released in late September by Avalere Health, a Washington, D.C. based health research and advising group, determined that Medicare stand-alone drug plan premiums will increase 8.7% to $40 per month. A spokesperson for Avalere health was quoted as saying “Plans that are popular are raising their prices because they understand that seniors are not interested in switching.” A representative from CMS said that the agency would work to place beneficiaries in appropriate plans. Because premiums for Medicare prescription drug plans will exceed the cost limit in many regional markets, Humana and UnitedHealth will lose over 1 million dual eligibles. To learn more about Avalere Health’s research projects please visit http://www.avalerehealth.net/.
Providers and Workforce
A recent survey conducted by the National Council of Churches, an association of 35 Christian faith groups representing over 100,000 congregations, reported that 70% of churches provide some type of health care activities. The churches provided counseling for mental health or substance abuse problems, screening tests, vaccinations, sponsorship of health clinics and health care education programs to members of their congregation, members of their community, or both. This survey, which was funded in part by the Robert Wood Johnson Foundation, found that 51% of churches provided financial assistance for medical bills. http://www.ncccusa.org/pdfs/healthsurveyfinal.pdf
The Alliance for Health Reform held an informative briefing on employer-sponsored insurance (ESI) on September 21st. For those of you who missed the presentations, materials are available online at http://www.allhealth.org/briefing_detail.asp?bi=113.
Oral Health
The Kaiser Family Foundation (KFF) released a fact sheet on dental care for low-income children and the role of Medicaid and SCHIP. KFF states that the most common disease affecting children is tooth decay and children who receive preventative dental care have oral health costs that are 40% lower than children who do not receive these treatments. It is estimated that over 20 million children are without dental coverage. Medicaid and SCHIP cover approximately 34 million low-income children. This fact sheet can be viewed by visiting http://www.kff.org/medicaid/upload/7681.pdf.
Quality and Chronic Conditions
According to a story in the Wall Street Journal, a loophole in the federal Breast and Cervical Cancer Prevention and Treatment Act allows the states to opt to provide Medicaid coverage only for women diagnosed by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Act was initially enacted to provide Medicaid coverage to women under age 65 who have been diagnosed with breast or cervical cancer, even if they would not qualify for Medicaid under standard eligibility rules. Currently 21 states do not cover treatment costs for women who are diagnosed outside of the NBCCEDP. For more information on the Breast and Cervical Cancer Prevention and Treatment Act please visit http://www.cdc.gov/cancer/nbccedp/legislation/law106-354.htm
Women Screened Through the NBCCEDP, by Year
1/2001 to 12/2005
National Aggregate
Long Term Care
A study conducted by the Department of Community Health at Brown University, funded by the Commonwealth Fund, found that black U.S. residents receive poorer quality nursing home care than whites. Half of the facilities with the largest disparities were found in Indiana, Michigan, Ohio and Wisconsin. The study also concluded that blacks were three times more likely to live in a nursing home with a large proportion of Medicaid beneficiaries. Lower Medicaid reimbursement rates for nursing home services might be a cause of some of the quality of care issues. This report can be viewed at http://www.commonwealthfund.org/usr_doc/Smith_separateunequalnursinghomes_1057_itl.pdf?section=4039
Mental Health
A study released earlier this month by the National Institute of Mental Health (NIMH) concluded that adult mental disorders account for 1.3 billion missed days of work each year in the U.S. The leading cause of missing work is chronic back or neck pain, followed by depression. http://www.nimh.nih.gov/science-news/2007/mental-disorders-account-for-large-percentage-of-adult-role-disability.shtml
A researcher at Harvard Medical School’s Hurricane Katrina Community Advisory Group released a report indicating that 21% of respondents reported symptoms of post-traumatic stress disorder and 6% had suicidal thoughts. These numbers have increased from those obtained by a survey conducted 6 months after the hurricane. The author suggests that optimism directly after Katrina insulated Gulf Coast residents from suicidal thoughts, but that the hopefulness has since faded. http://www.who.int/bulletin/volumes/84/12/06-033019.pdf
Public Health
The August 3rd issue of the Morbidity and Mortality Weekly Report produced by the CDC indicated that the percentage of U.S. women who breast-feed is at an all time high of 74 percent. Although the numbers are below the goals of Healthy People 2010, CDC researchers are optimistic about their progress. The report can be viewed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5630a2.htm.
The CDC’s National Center for Health Statistics found that life expectancy has reached a record high of 77.9 years for 2005. Life expectancy, which is the number of years a person born in 2005 will live to be on average, varied by race. Life expectancy for blacks increased to 73.2 years and for whites it was relatively unchanged at 78.3 years. For more information on this report please visit http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm
Health Information Technology
The Agency for Healthcare Research and Quality (AHRQ) has an invaluable HIT website. Multiple outcomes from the Privacy and Security Solutions for Interoperable Health Information Exchange Project, which was produced for AHRQ by RTI International, can be found on this page as well as a tool kit for those conducting assessments of local or state-wide HIT systems. http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5554&mode=2&holderDisplayURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/communities/k_o/knowledge_library/features_archive/features/outcomes_from_the_privacy_and_security_solutions_for_interoperable_health_information_exchange_project.html
State by State
Nevada Governor Jim Gibbons asked the Mexican consulate to research a program where Mexico would pay for health care costs of Mexican nationals residing in Nevada. A pilot of the program is being tested in New York under the name “Windows of Health.” Arizona Governor Janet Napolitano is closely monitoring the Nevada/Mexico discussions to see if a similar option would be feasible in her state.
Counter Conventional Wisdom
Approximately 20% of adults receive annual physicals despite contradictory recommendations regarding the practice. A study published in the Archives of Internal Medicine by a RAND researcher and University of Pittsburg Medical School assistant professor, Ateev Mehrotra, claims that many patients did not receive important tests or received unnecessary tests, or failed to receive preventive services during their annual physical. Interestingly, Mehrotra found that adults in the Northeast were 60% more likely to receive an annual physical. http://archinte.ama-assn.org/cgi/content/abstract/167/17/1876
Interesting Tidbit
Oregon State University scientists tested 10 American cities for remnants of drugs in the wastewater. Results could aid law enforcement agencies in tracking the spread of drugs across the country. Drugs such as cocaine and ecstasy peaked on the weekends while drugs such as methamphetamine and prescriptions were constant through out the week. The most common ingredient excreted was caffeine. To view this story please visit http://www.msnbc.msn.com/id/20380094/.
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.
Kelly Wilkicki, Intern
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8662 fx: 202-737-1069
Kelly.Wilkicki@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
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