Dear Health Committee Chairs:
This is your November 2004 email update on state health policy resources available to you for free on the Internet. We hope you’ll let your new colleagues know about this resource by forwarding a copy of this newsletter to new health leaders and encouraging them to send us their e-mail addresses. New health committee and subcommittee chairs may subscribe by emailing kala.ladenheim@ncsl.org. We also welcome chairs of other committees and subcommittees dealing with health policy, such as finance, human services and insurance.
Looking to 2005
As election fever dies down and you begin to prepare for the upcoming session, we’d like to hear from you. What does your 2005 agenda look like? You’ll be receiving a survey under separate cover, but you can also let us know your thoughts now. We’ll use this information to plan the work we do for you in the upcoming year, so do let us know what issues you would like us to cover.
1) What three issues do you think will be the top priorities for your committee in the upcoming session? Please describe briefly—for example, not “insurance” but “lack of access to affordable insurance for small businesses.”
2) How do you think they are likely to be addressed?
3) What health issues are your top priorities personally, separate from your role as chair?
As editor of the newsletter, I keep an eye out for issues that may not yet be ready for major policy discussions but that bear watching in case they do break out. Send your nominations for issues worth watching. Return the survey and send your priorities to kala.ladenheim@ncsl.org or dick.merritt@ncsl.org.
Mark Your Calendars
See you in Savannah December 7-10 for the upcoming meeting of Health Chairs, to be held in conjunction with the Eighth Annual NCSL Health Conference and NCSL’s Fall Forum in Savannah, Georgia. You should have already received the Chairs meeting agenda. See the health conference agenda at http://www.ncsl.org/programs/health/04confagenda.htm.
Going fast…There are still a very few scholarships available to help defray most of the costs of attending the Chairs meeting and Health Conference. Please contact Dick Merritt within the next few days by phone at (202) 624-8698 or by e-mail at dick.merritt@ncsl.org.
If you missed the June Chairs meeting, which focused on Medicaid, mental health and substance abuse, you can still catch up. Speakers slides and links to some presentations can be found at http://www.ncsl.org/programs/health/forum/chairs/hlthchairmtg04.htm Webcasts from some of the health sessions in the annual meeting, Salt Lake City, can be heard at http://www.ncsl.org/programs/health/kaisernews.htm.
New Health Resources for You:
Influenza
Flu shots are getting major buzz this fall. The unexpected shortfall has pointed up problems in production and distribution and even led to reexamining medical practices: NEJM just published a suggestion that future supplies might be extended by changing how they are administered. NCSL has compiled a list of state laws that may come into play as you deal with the issue, from prohibitions on price-gouging to rules related to emergency Rx distribution http://www.ncsl.org/programs/health/rxemerg.htm#flu. A recent State Health Notes has a cover story on the shortage as well: http://www.statehealthnotes.org/pub/25_431/cover/140384-1.html. All health legislators and their staff can receive State Health Notes online for free. If you don’t know your password or want to subscribe, contact Rachel.Balick@ncsl.org, or call Rachel at 202-624-3585.
An October 31 NY Times article discusses other drug shortages and government’s role in drug supply. http://www.nytimes.com/2004/10/31/weekinreview/31harri.html. The GAO reports on the shortage, Infectious Disease Preparedness: Federal Challenges in Responding to Influenza Outbreaks. GAO-04-1100T, September 28,
2004 (13 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-04-1100T.
Medicare Part D Drug Benefits
The new Medicare drug benefit may be the largest health entitlement expansion since Medicare’s creation. But the complexity of the law has state experts scratching their heads as they sort out the implication for states. How big will the clawback be? What will this do to existing state pharmaceutical cost controls and discounts? NCSL and NGA collaborated on a series of conference calls on the new law. For these and other NCSL resources on Medicare Part D, go to http://www.ncsl.org/programs/health/pharm.htm#new.
Academy Health conducted an invitational meeting on the topic in October. Reports and slides from the meeting http://www.statecoverage.net/medicarepartd/ are a good source of information on this complex issue, according to our own in-house expert, Donna Folkemer (Donna.Folkemer@ncsl.org).
Health Information Technology
The federal department of Health and Human Services is putting both its mouth and money behind health information technology (HIT) development. Last summer’s appointment of David Brailer to head the initiative was widely praised. More recently, a first round of grants included more than 100 grants ($96 million-worth) to hospitals and health systems and five directly to states (Colorado, Indiana, Rhode Island, Tennessee and Utah) to improve their capacity to link medical information and ultimately improve patient care. The announcement is at www.hhs.gov/news/press/2004pres/20041013.html and details of the grants are at www.ahrq.gov/research/hitfact.htm.
Access and Insurance
The Robert Wood Johnson’s Synthesis Project continues its series of round-ups of what is known about a number of health issues with a synthesis on individual coverage, Expanding the Individual Health Insurance Market: Lessons from the State Reforms of the 1990s. http://www.rwjf.org/publications/synthesis/reports_and_briefs/issue4.html.
The Heartland Institute has challenged RWJ’s conclusions. http://www.heartland.org/Article.cfm?artId=15688.
The dialogue points up how hard it can be to reach sweeping conclusions based on states with varied programs and histories.
One reason incremental coverage discussions turn into glass-half-empty glass-half-full debates may be because the uninsured are so varied. The Economic and Social Research Institute (ESRI) released a book of fact sheets that “set out key data and crucial policy design questions for eight groups of uninsured who could potentially become the subject of incremental health reform: employees of small business; workers who lose their jobs; workers who are offered but decline employer coverage; low-income parents; low-income, childless adults; the near-elderly; young adults; children; and immigrants.” Towards Incremental Progress: Key Facts About Groups of Uninsured. http://www.esresearch.org/newsletter/facts_uninsured.pdf.
ESRI also authored a recent Kaiser report on public coverage for a group that is often the last to be covered. Medicaid and Other Public Programs for Low-Income Childless Adults: An Overview of Coverage in Eight States. http://www.kff.org/medicaid/7143.cfm.
A new report from State Coverage Initiatives examines how states have used reinsurance to support and expand insurance coverage. Deborah Chollet writes about historical experiences and recent innovations in The Role of Reinsurance in State Efforts to Expand Coverage at http://www.statecoverage.net/pdf/issuebrief1004.pdf.
Budgets and Medicaid
The Kaiser Commission on Medicaid and the Uninsured has issued two more in their series of reports on how states budget constraints are affecting Medicaid. Although public health insurance took up most of the slack as employer coverage fell in the early 2000s, states continue to face challenging budgets. Some states are moving to restore lost coverage, even as others are seeking better ways to manage spending on services for the elderly and disabled. The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004 and 2005 http://www.kff.org/medicaid/7190.cfm.
Beneath the Surface: Barriers Threaten to Slow Progress on Expanding Health Coverage of Children and Families http://www.kff.org/medicaid/7191.cfm.
The National Association of State Budget Officers (NASBO) released its report on 2003 state expenditures. “The data show that in fiscal 2003, Medicaid accounted for 21.4 percent of all state spending, closing in on K-12 education spending, which was 21.7 percent.” http://www.nasbo.org/Publications/PDFs/2003ExpendReport.pdf.
Results of an NCSL survey that may be especially interesting to legislatures that only meet once per biennium show how legislatures control federal funds, including interim authority over unanticipated funds. Find Legislative Oversight of Federal Funds at http://www.ncsl.org/programs/fiscal/ositefedfund.htm.
Chronic Conditions
People with low incomes and high medical needs pose a double challenge to health policy. The size and severity of this problem, and the disparate impact of some current policy trends on this vulnerable group, is documented in "Rising Health Care Costs, Medical Debt and Chronic Conditions." By Ha T. Tu, Center for Studying Health System Change. Issue Brief; No. 88 (The Center, Washington, DC) September 2004. 5 p. Full Text at: www.hschange.com/CONTENT/706/706.pdf.
More care doesn’t mean better care for people with chronic conditions, according to a newly released study from the Robert Wood Johnson Foundation. The October 7 web exclusive in Health Affairs http://content.healthaffairs.org/webexclusives/index.dtl?year=2004 includes an interview with Dr. John Wennberg—the leader who has spent thirty years documenting that different areas treat patients very differently, with little apparent difference in outcomes. RWJ also provides links to webcasts and related material on improving care for people with chronic conditions at http://www.rwjf.org/news/special/wennbergInterview_1.jhtml.
An update of the Chronic Care Chartbook, with data on a number of conditions and their impact on people and policies has been posted at http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.
Conventional Wisdom Strikes Again
Just exactly who is it crowding those emergency departments? New research based on nearly 50,000 adults interviewed between 2000 and 2001, presented at a meeting of the American College of Emergency Physicians finds that it isn’t the uninsured.
“…83 percent of emergency department visits were made by people who reported having a usual source of health care other than an emergency department, 85 percent reported having medical insurance, and 79 percent reported having incomes exceeding the poverty threshold. Individuals without health insurance were no more likely to have had an emergency visit than those with private health insurance, and individuals without a usual source of care were 25 percent less likely to have had an emergency visit than those with a private physician.“
So, who is using the ED? The researchers found they were especially likely to be used by people in poor health. http://acep.org/1,34130,0.html.
Is the managed care backlash over? A Health Affairs web exclusive showcases a study that found most individuals were willing to accept specific managed care practices that restrict access in preference to greater cost sharing. Not surprisingly, people with very low incomes were especially willing to accept such restrictions. Managed care may also be viewed more favorably when it is chosen from a menu of insurance options rather than being the only choice. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.516
And an October 31 NY Times article suggests that Kaiser Permanente, with its salaried medical groups insulated from the business side, is once again serving as a model for how to provide high quality care within a budget.
Collected Resources Online
The New York Academy of Medicine (NYAM) periodically publishes a list of “grey literature” reports on health issues that are published outside of journals and major publishing houses. The list, a compilation of the sort of issue briefs and policy reports we refer you to in this bulletin, can be found at http://www.nyam.org/library/glrv6n3.shtml.
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, Group Director
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
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