shnhighlights

Volume 27, Issue 459

January 23, 2006

HEALTH INSURANCE

Helping Small Businesses

More than 1,000 small businesses have submitted applications for Montana’s new health insurance program, according to the Billings Gazette. Funded mostly by an increase in cigarette taxes, the program provides:

refundable income tax credits to small businesses that already provide health insurance but are in danger of ceasing because of rising premiums; and
premium assistance to small businesses that currently don’t provide coverage, but agree to buy it through an insurance pool created by Blue Cross and Blue Shield of Montana.

“Business people across Montana are starving for affordable insurance,” said State Auditor John Morrison, whose office will run the program. “It’s the No. 1 pocketbook issue for small businesses in Montana.” Businesses will be given assistance on a first-come, first served basis, and initial funds are expected to provide coverage for about 900 businesses. The 2005 Legislature passed the “Insure Montana” program as part of HB 667.

Covering Young People

New Hampshire is one of a growing number of states that are considering bills to extend coverage to young adults – the demographic group most likely to be uninsured in the United States, according to the St. Petersburg Times. Children who are covered by their parents’ plans generally are dropped when they turn 19, unless they’re full-time students. But last year, at least 12 states considered or enacted laws broadening coverage of college-age dependents. Insurers generally don’t oppose the bills because young people tend to be low-cost. New Hampshire’s HB 37-FN would require carriers to continually cover full-time dependent students while they are on a medical leave of absence. “Michelle’s law” is named after a student who continued her studies full-time while dying of colon cancer, in order to maintain her health insurance. New York, which already has a law similar to the New Hampshire bill, is considering raising the maximum age for dependents from 23 to 25. Texas allows young people up to age 25 to remain on their parents’ plans regardless of whether they are in college. In California, Gov. Arnold Schwarnzenegger vetoed a bill that would have required insurers to cover dependent children until age 26. The bill could lead to higher premiums and thus decrease the number of employers who offer coverage, he said. For more, visit NCSL.

MEDICAL EFFECTIVENESS

A New Tool

A new program run by the Agency for Healthcare Research and Quality provides a compass to those who are researching the effectiveness of medical procedures. The “Effective Health Care Program” compares alternative treatments for selected health conditions. The program’s first report found that drugs for gastroesophageal reflux disease – which costs about $10 billion a year to treat – are as effective as surgery. Users can go to the program’s Web site to sign up for a LISTSERV that will notify them of new reports and findings.

HEALTH CARE QUALITY

EDs Declare an Emergency

Florida’s emergency departments (EDs) are approaching code-red, says the Florida Hospital Association (FHA). Increased patient volumes, lack of capacity, shortages of specialists willing to work in EDs, medical liability issues and growing numbers of uninsured who use EDs as their primary source of care are among the factors contributing to a crisis in Florida EDs, according to a December 2005 report from the FHA. “We all recognize what problems plague emergency departments,” said Bill Bell, legal counsel for the FHA. “What this report does is lay out the changes that must be made in order to fix that state of emergency care.” The task force makes 45 suggestions to ease the crisis, some of which are modifications to Florida statutes. For example, EMS workers are required to transport patients to EDs, regardless of whether the patient requires emergency care. This requirement results in “delays in treatment and backlogs in hospitals,” said Bell. The FHA thus recommends that EMS be allowed to transport patients to the most appropriate licensed setting for the patients’ needs, and that they be allowed to treat patients not requiring emergency care in the field. The crisis in Florida is echoed in the 2006 National Report Card of the State of Emergency Medicine, an assessment from the American College of Emergency Physicians of the support provided by each of the 50 states for emergency medicine.

Increasing RN-to-Patient Ratios

An increase in the proportion of registered nurses per patient could help save lives, decrease the length of hospitals stays and prevent more medical complications without an increase in cost, according to a study published in the January/February issue of Health Affairs. Researchers examined patient outcomes and health costs relative to the proportion of RNs and the number of nursing care hours per patient. Three approaches to improved nursing care were tested: an increase in the proportion of RNs per patient without changes in nursing care hours; a boost in the number of nursing care hours per patient without changes in the proportion of RNs and licensed practical nurses; and a rise in both the proportion of RNs and the number of nursing care hours per patient. According to the study, the first option would require hospitals to hire 37,000 RNs to replace LPNs at a cost of $811 million – but could provide long-term savings of $1.8 billion. The second and third options also could improve patient care but would increase costs by $5.8 billion and $5.7 billion, respectively, the study finds. The study is available online.

TOBACCO

Smoking Ban

New Jersey has joined the growing list of states to ban smoking in indoor public places. On Jan. 9, the General Assembly overwhelmingly passed A3424 which bans smoking in virtually all of the state’s bars and restaurants – with the exception of the gambling areas of Atlantic City’s 12 casinos. The Assembly’s vote ends a year long battle between public health advocacy groups and lobbyists for the tobacco industry and the casinos, says the New York Times. While supporters of the bill are disappointed with the casino exemption, they say the law is a step in the right direction. “I could stand here and say, ‘It’s half a loaf, it’s three-quarters of a loaf,’ but it’s a start,” said Assemblyman David W. Wolfe in the Times. In addition to restricting where cigarettes can be smoked, the Assembly approved a measure increasing the minimum age required to purchase cigarettes from 18 to 19. The ban makes New Jersey the 10^th state to become “smoke free,” said a spokeswoman for the American Lung Association. California, Connecticut, Delaware, Massachusetts, Maine, New York, Washington, Rhode Island and Vermont already have prohibited smoking in nearly all workplaces, restaurants and bars, and a similar ban passed by the City Council of the District of Columbia is expected to go into effect once the Mayor signs it.

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