Dear Health Committee Chairs:
This is your December 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 sign up by sending 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.
Many of you will be in Savannah next week. We look forward to seeing you there for what promises to be an amazing several days. We’re getting this quick December Chairs Bulletin out to you before seasonal activities take over. We wish you all a joyous holiday season and a warm and hopeful new year.
New Health Resources for You:
State of the States
The United Health Foundation, with the American Public Health Association and Partnership for Prevention has released its annual report, America's Health: State Health Rankings for 2004. Rankings are based on a mix of individual behavior, public policies, environmental factors and outcomes. Overall, top rankings go to Minnesota and New Hampshire, as they have in most years since the survey began. Louisiana, sadly, is on the bottom rung again. Beyond such stereotypes, the report includes much more nuanced information on state health status, including rates of improvement, that provide some hopeful news for almost everyone. http://www.unitedhealthfoundation.org/shr.html
What are the cancer rates in your state? Knowing causes of death, how they compare with other states, and how they differ among groups within your state can guide public health priorities. The Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries (NAACCR) have released their third annual United States Cancer Statistics Report, with information on more than one million cancer cases diagnosed in 2001 among residents of 43 states, six metropolitan areas and the District of Columbia. The race and ethnicity categories include statistics for Hispanics/Latinos. Reports from previous years are also available.
http://apps.nccd.cdc.gov/uscs/index.asp?Year=2001
Access for the Uninsured
In Massachusetts, Governor Romney (R) and Senate President Travaglini (D) agree on an objective of dramatically cutting the state’s uninsured. One driver for the initiative may be a recent report commissioned by the Blue Cross Blue Shield of Massachusetts (BCBSMA)Foundation. In Caring for the Uninsured in Massachusetts: What Does it Cost, Who Pays and What Would Full Coverage Add to Medical Spending, http://www.bcbsmafoundation.org/foundationroot/en_US/documents/roadmapReport.pdf.
Urban Institute researchers estimate the costs and benefits of extending coverage to Massachusetts’ more than 450,000 uninsured. The report is significant, not only because it supports a careful discussion in Massachusetts, but because it provides a model for how this sort of analysis can be done on a state level. The report concludes that covering the uninsured in Massachusetts will actually raise health spending slightly but that the benefits in improved health far outweigh the additional cost. The result might vary in other states, depending on the make-up and health status of the uninsured, the services they are currently receiving, and the cost of care in a particular state.
Nearly two-thirds (64 percent) of uninsured poor adults are ineligible for Medicaid, which is generally not available for childless adults. Can new options be designed to cover the poorest of the poor? Stan Dorn’s new paper for the California HealthCare Foundation maps out hows and whys. Medicaid Coverage for Poor Adults: A Potential Building Block for Bipartisan Health Reform http://www.esresearch.org/Documents/MedicaidAdults.pdf
Surprisingly, the uninsured haven’t been crowding emergency rooms. Maybe that is because they don’t think of them as part of a health care safety net. In fact, about half don’t have ANY place that they think of as a place to get needed care, according to a new study from the Center for Studying Health System Change.
Most Uninsured People Unaware of Health Care Safety Net Providers, Issue Brief No. 90, November 2004. By Jessica H. May, Peter J. Cunningham, Jack Hadley. http://www.hschange.org/CONTENT/718/.
Medical Malpractice
The problem doesn't look like its going away. The Maryland Hospital Association, with support from the Maryland Business Council, has released An Analysis of the Economic Impacts of Maryland's Medical Liability Environment: by economist Anirban Basu. The thorough 74-page report includes an overview of the issue and analysis of differing state environments, historical overview of previous malpractice crises, compares two neighboring states with very different demographics (West Virginia and Pennsylvania) and ends with a useful bibliography. http://www.mdhospitals.org/mha/Health_Policy_Issues/Full.Report.Study.Details.Economic.Impact.Med.Liability.11.16.2004.pdf.
Aging
The Center for Best Practices for Aging and Long-Term Care at the National Governors Association has just issued Measuring the Years: State Aging Trends & Indicators, a terrific look at trends and indicators related to aging. States need good data to estimate future needs of an aging population. The report includes chapters on: demographic shifts; health care concerns including chronic diseases; long term care workforce shortages; housing. transportation, technology and educational resources and needs in the elderly; and the financial impact of uninsured health care costs. In addition to discussions on these and other topics, the report has a wealth of state-level data. The report can be accessed at http://www.nga.org/center/databook04. This report was funded by the Robert Wood Johnson Foundation and prepared by Georgetown University researchers.
Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs A new study by Actuarial Research Corporation for the Kaiser Family Foundation finds that the new program will be most beneficial to seniors with low incomes or very high drug costs, as intended. Three quarters of the people who enroll in the program are expected to pay less for as a result of the programs. In any given year, about one in four may pay somewhat more than they would have without the program. The report, news conference and related links can be found at http://www.kff.org/medicare/med112204pkg.cfm
CMS responded to the report by sending a four page comment to reporters pointing out that many beneficiaries might receive assistance through their employers, or public or charitable funding.
State Studies
Health Economics Program at the Minnesota Department of Health has released three new studies. “Minnesota Health Care Spending in 2002” Link: http://www.health.state.mn.us/divs/hpsc/hep/issbrief/2004-05.pdf.
"Minnesota's Acute Care Hospitals: A Regional Perspective”. Link: http://www.health.state.mn.us/divs/hpsc/hep/issbrief/2004-06.pdf.
"Minnesota Mental Health and Chemical Dependency Treatment Utilization Trends: 1998 – 2002.” Link: http://www.health.state.mn.us/divs/hpsc/hep/issbrief/2004-07.pdf.
Conventional Wisdom
It stands to reason that one reason for being uninsured is that you just don’t see the need. But a study of the long-term uninsured from the Urban Institute confirms what we’ve heard in other studies: “People in fair or poor health were much more likely to be uninsured and for lengthier periods of time (21.3%) than those in good to excellent health (9.3%).”
The study also found a drop from 1999 in long-term uninsurance for children and the elderly, but more poor adults ages 19 to 34 who lacked coverage. 53% of the people who were without coverage at some time during the year leading up to the 2002 survey were uninsured for 12 months or longer. http://www.urban.org/UploadedPDF/311112_DP04-10.pdf.
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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