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Volume 27, Issue 463 |
March 20, 2006 |
HEALTH INSURANCE
The number of state health insurance mandates rose from 1,825 in 2005, to 1,843 as of March 2006, according to a new report from the Council for Affordable Health Insurance (CAHI), a non-profit group that promotes free-market solutions to health-care problems. While mandates make coverage more comprehensive, they also make it more expensive – increasing the cost of basic health coverage from just under 20 percent to more than 50 percent depending on the state, CAHI says. The group notes that some states are curbing the number of new mandates; currently, 28 states require that the cost of a new mandate be assessed before implementation, and at least five states allow the sale of basic-benefit packages that do not comply with all existing mandates.
PHYSICIAN-ASSISTED SUICIDE
Few terminally ill Oregonians choose physician-assisted suicide in accordance with the state’s Death with Dignity Act, according to the Eighth Annual Report on Oregon’s Death with Dignity Act, from the state Department of Human Services. First passed as a voter referendum in 1994, the act allows terminally ill Oregonians to get prescriptions from their physicians for lethal, self-administered medications. Thirty-eight Oregonians died using physician-assisted suicide in 2005 – that’s one more than did in 2004. About one in 800 deaths that occurred in Oregon in 2005 were assisted suicides. Compared to all Oregonians who died in 2005, those who chose physician-assisted suicide were more likely to be divorced or never married, have more formal years of education, and have amyotrophic lateral sclerosis, HIV/AIDS or cancer. The rates of physician-assisted suicide decreased with age, although more than 65 percent of users were aged 65 or older. Physicians reported that patients who asked for prescriptions frequently listed three reasons for the request: a decreasing ability to participate in activities that made life enjoyable, loss of dignity and loss of autonomy.
MEDICAID
A new study in the journal Health Affairs casts doubt upon the efficacy of efforts to pay for Medicaid expansions by reducing services to existing beneficiaries. In 2002, Utah became the first state to reduce Medicaid benefits and increase cost sharing for existing beneficiaries in order to pay for an expansion of coverage to previously ineligible adults. After obtaining a waiver, Utah limited benefits and raised cost sharing for very poor parents receiving Temporary Assistance for Needy Families (TANF), including those with incomes below 54 percent of the federal poverty level. The state used the savings to create the Primary Care Network (PCN) for adults with incomes below 150 percent of poverty who were previously ineligible for Medicaid. The PCN covers primary care only – specialty and inpatient hospitalization are excluded. Researchers who surveyed both groups in 2004 found that the PCN “filled an important void – but the need for coverage exceeded what the program’s financing could support.” Expansion enrollees were predominantly poor and most suffered from chronic conditions or disabilities or both. Parents whose coverage was reduced to finance the expansion were extremely poor, were in poor health and faced major financial challenges. Both groups were likely to miss or delay care because of cost or lack of coverage.
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