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These are excerpts from the April-June, 2007 email update on state health policy resources available on the Internet. Meetings Past The annual Health Chairs Forum was held June 21 & 22. Over 30 legislators met at the Kaiser Family Foundation for talks, discussion and networking. Presentation slides are available online and recordings will be added as soon as they are digitized. Although we billed the program as "Access 2007" there was a striking amount of agreement among the speakers that we had to change how we provide care as well, improving quality and including such things as chronic care management and disease prevention. For more information please visit http://www.ncsl.org/programs/health/forum/chairs/0607.htm. Looking Ahead This year’s Annual Meeting will be August 5-9th in Boston MA. http://www.ncsl.org/annualmeeting/agenda/showmain.cfm A simple search with "health" will show health sessions in the program. For agendas, registration and travel information please visit http://www.ncsl.org/annualmeeting/agenda/index.cfm. We'll have our annual CHAP/Chairs tea on Tuesday August 7 from 5-6:30 as an adjunct to a mini-plenary on access reform. This will give you an opportunity to explore issues in more depth with some of the speakers from this panel. As usual there are lots of other health related programs before, during and after. We'll have pre-conference programs on prisoner re-entry and health; health information technology and health care quality; mental health; and child health. The health committee program will include a lot of content as well--for example, a Monday program on disparities. Let us know if you would like to attend any of these. 50 State Comparison on Health System Performance In June, The Commonwealth Fund released “Aiming Higher: Results From A State Scorecard on Health System Performance.” It’s an ambitious try for a single yardstick to measure health care performance, and although there are lots of places one may find to quibble, this study is a good starting point. Researchers evaluated each state on 32 indicators related to: healthcare outcomes, quality, access, efficiency and equity. They conclude (surprise) that there is large variation across states and all states have areas for improvement. One provocative tool invites states to race to the top. For eleven indicators, it shows each state how many lives and dollars could be saved if the state matched the highest-performing state in each area. The report and associated state assessments can be accessed via http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=494551
Access State Children’s Health Insurance Program (SCHIP) reauthorization is front and center on the state-federal health agenda. Although the program is small compared to Medicaid and Medicare, its flexibility has made it a critical part of many state coverage experiments. The Kaiser Family Foundation has organized a number of documents and resources on SCHIP on a page dedicated to New Resources Related to Children's Coverage and the Reauthorization of SCHIP http://www.kff.org/medicaid/kcmu020907pkg.cfm, including customizable state children’s health fact sheets http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=children. As part of its RWJ-funded Critical Health Areas Project (CHAP), NCSL has just updated its “Frequently Asked Questions” (FAQ) on SCHIP http://www.ncsl.org/programs/health/forum/SCHIPFAQ.htm. Other NCSL resources on SCHIP and expanded child health coverage can be found at http://www.ncsl.org/programs/health/kidsins.htm. Jeanne Lambrew has prepared a review of the program for the Commonwealth Fund, including its history and future policy options, The State Children's Health Insurance Program: Past, Present, and Future. The study is written for a Federal Congressional audience, but will likely be of interest to states as well. http://www.cmwf.org/usr_doc/991_Lambrew_SCHIP_past_present_future.pdf A two-pager on SCHIP from the National Health Policy Forum can be downloaded at http://www.nhpf.org/pdfs_basics/Basics_SCHIP.pdf. The Alliance for Health Reform conducted a briefing on outreach and other efforts to enroll eligible children in SCHIP. They point out that “by some estimates, almost three-fourths of America’s nine million uninsured children are eligible for either State Children’s Health Insurance Program (SCHIP) or Medicaid.” The session and related resources can be found at http://allhealth.org/briefing_detail.asp?bi=98. A new Government Accountability Office (GAO) report addresses State Experiences in Implementing SCHIP and Considerations for Reauthorization http://www.gao.gov/new.items/d07447t.pdf. It includes a chart showing which states under- or over-spent their allotments each year. If you attended last June’s Health Chairs meeting you will remember Len Nichol’s moral argument for health care. You can read a version of it in the current Health Affairs at http://www.newamerica.net/publications/articles/2007/the_moral_case_for_covering_children_4960. From all indications, this will be a strong year for discussing access, in both states and nationally. NCSL is tracking state proposals as they surface http://www.ncsl.org/programs/health/h-primary.htm and as they are translated into legislation http://www.ncsl.org/programs/health/universalhealth2007.htm Stay tuned for more detailed analyses, and do request information from NCSL. Recordings of NCSL’s web-assisted audioconference series, ACCESS 2007 highlighting various approaches can be found at http://www.ncsl.org/programs/health/webcast2.htm and in the February and March webcast archives. Disparities and Quality State Quality Reports of various kinds may be accessed through the National Association of Health Data Organizations (NAHDO)’s site, at http://www.nahdo.org/qwglist.aspx?cat=state%20quality%20reports. NAHDO is one of my secret weapons. This organization is made up of the entities in the states that collect and analyze health data. Members share information about resources and work together to come up with consistent approaches to measuring and interpreting the data they gather. Providers and Workforce Monday June 11, 2007 the Supreme Court ruled that home care workers are exempt from federal minimum wage and overtime laws. Supporters of the ruling argue that as agencies provide an increasing amount of care there is a growing need to reduce costs. Opponents feel that this ruling will further worsen the developing shortage of home health care workers. This ruling reinforces 1974 amendments to the Fair Labor Standards Act, which exempted babysitters and companions for the elderly and those with illnesses. Details of the ruling can be found at http://www.supremecourtus.gov/opinions/06pdf/06-593.pdf. Oral Health The Washington Post published a story discussing the growing trend of U.S. residents who receive dental care in Mexico. According to this article, some border cities have begun organizing bus tours for dental work and prescription drug procurement. A study conducted by the University of Texas discovered that 86 percent of El Paso, Texas residents receive medical care or prescription drugs from Mexico. A similar study conducted in New Mexico found that 37 percent of uninsured residents also cross the border for medical care. The significantly lower costs (approximately 1/5th of U.S. prices) and lack of dental insurance among 45 percent of U.S. residents are believed to be fueling this migration. http://www.washingtonpost.com/wp-dyn/content/article/2007/06/17/AR2007061701297.html. Quality and Chronic Conditions The March 9 Morbidity and Mortality Weekly Report includes an article on “Racial/Ethnic Disparities in Diagnoses of HIV/AIDS - 33 States, 2001-2005.” They examined cases from name-based reporting centers by year of diagnosis, transmission category, and age and racial/ethnic classification. Blacks accounted for 51 percent of new diagnoses and 62 percent occurred in people aged 25-44. The report can be viewed at: http://www.cdc.gov/mmwr/PDF/wk/mm5609.pdf. A compendium of state HIV/AIDS testing laws has been updated by the National HIV/AIDS Clinicians' Consultation Center at the University of California San Francisco. It includes comparison charts of a variety of features such as restrictions or mandates for testing, informed consent, counseling, and provider training, as well as the actual statutory language. http://www.ucsf.edu/hivcntr/PDFs/WEB2007State%20Laws.pdf Long Term Care The Alliance for Health Reform has issued a brief on long term care partnerships, which encourage the purchase of private long term care insurance. “In participating states, a person buying a long-term care policy who then uses up its benefits can apply for Medicaid. If accepted, the person can receive Medicaid-covered long-term care services while at the same time protecting some or all of the financial assets that would otherwise have made them ineligible for Medicaid.” These policies currently exist in California, Connecticut, Indiana and New York, with 22 other states said considering the program.
Mental Health The Department of Veterans Affairs (VA) revealed plans to hire suicide prevention counselors at all of its 153 medical centers. This announcement comes only weeks after the VA decided to add 100 additional workers to its clinics for readjustment counseling upon their return from combat. To read about actions states have taken independently and prior to these VA initiatives please see, “States Seeking To Fill The Gap in Mental Health Services For Returning Veterans,” published in Vol. 28 of State Health Notes. http://www.ncsl.org/programs/health/shn/2007/sn493b.htm Pandemic flu preparation information has been updated on the NCSL site, with links to new guidelines, business continuity planning, medical resources and other projects at http://www.ncsl.org/statefed/health/New.htm. Are your organ donation laws up to date? The National Conference of Commissioners on Uniform State Laws (NCCUSL) has new model language http://www.anatomicalgiftact.org/DesktopDefault.aspx?tabindex=1&tabid=63. Science, beliefs and practices have all changed since most states passed laws on this issue. An April 4 Washington Post article features the move to adopt the Revised Uniform Anatomical Gift Act, and the controversy surrounding it. http://www.washingtonpost.com/wp-dyn/content/article/2007/04/03/AR2007040302062.html?hpid=topnews Counter Conventional Wisdom People may get care in too many different places for pay for performance to work, according to the authors of an article in the March 15, 2007 New England Journal of Medicine Volume 356:1130-1139. “Care Patterns in Medicare and Their Implications for Pay for Performance” http://content.nejm.org/cgi/content/full/356/11/1130?query=TOC.
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. Kala Ladenheim, Ph. D. Program Director Donna Folkemer, Group Director
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