HEALTH INSURANCE

Coverage for Dependents

Beginning in May, New Jersey will increase the age of dependency for health insurance to 30, the oldest in the nation. Under the new law, unmarried adults younger than 30 who do not have dependents and live in New Jersey can receive health insurance through their parents, regardless of whether they are students or reside with their parents. The law does not apply to parents who receive health insurance through the federal government or large companies that self-insure. Most employer-based health insurance terminates dependent coverage at 19, or upon graduation from college. Nationally, 32 percent of people age 19 to 29 are uninsured. “Young people don’t buy insurance because they don’t think they’ll get sick,” Rep. Neil Cohen, sponsor of the bill, told USA Today. Cohen estimates that the “18 to 30” bill will extend coverage to an additional 200,000 young people and increase premium coverage for an adult dependent from $1,200 to $2,000. Critics of the bill argue that the law may have unintended consequences such as making coverage for those who are part of employer groups more expensive, or increasing dependent premiums to unaffordable rates. In recent years, Colorado, Illinois, New Mexico, South Dakota, Texas and Utah have expanded coverage to 24, 25 or 26 years. Connecticut, Kentucky, Massachusetts and New York are considering similar measures.

SUBSTANCE ABUSE

Inhalants Popular with Young Teens

Most youth who started abusing inhalants during the past 12 months were white and from homes with incomes well above the poverty line, according to a new report from the Substance Abuse & Mental Health Services Administration (SAMHSA). Thirty percent of beginners were aged 12 or 13, nearly 40 percent were 14 or 15, and nearly 31 percent were 16 or 17. The most popular categories of inhalants include (in descending order of use) glue, shoe polish, paint thinners and solvents, gasoline, lighter fluid, nitrous oxide, spray paints, correction fluid, degreasers or other cleaning fluids, amyl nitrite and locker room deodorizers. “The problem of inhalant abuse remains particularly serious among 8^th-graders, who may be unaware of the damage inhalants can cause,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. “Inhalants can harm the brain, liver, heart, kidneys and lungs, and abuse of any drug during adolescence may interfere with brain development and increase the risk of addiction.”

Treatment, Not Jail Time

California’s Proposition 36 – which requires that substance abuse be treated primarily as a public health issue rather than a criminal justice issue – has saved the state enormous sums of money, according to a new report from the Drug Policy Alliance, a pro-legalization nonprofit. Passed by more than 60 percent of voters in 2000, Prop. 36 mandated treatment instead of incarceration for most nonviolent drug possession offenders. From Dec. 31, 2000 to June 30, 2005, the number of people incarcerated in state prisons for drug possession has fallen by 32 percent, from 19,736 to 13,457. Each year, some 26,000 people enter Prop. 36 treatment, which costs about $3,300 per person per year. In contrast, the average cost of a year in prison is about $34,150 per person, the Alliance says. Consistent with the view that substance abuse should be treated as a public health issue, Prop. 36 does not permit the courts to incarcerate, even for short periods of time, individuals who suffer a first or second relapse during treatment. “The law says that the focus must be on achieving the goals of recovery, not punishing missteps along the path,” the Alliance says. An official Prop. 35 cost-benefit analysis is forthcoming from UCLA.

CHILDREN’S HEALTH

Obesity

The eating habits of infants and toddlers may contribute to the growing trend of overweight youngsters. The Feeding Infants and Toddler Study, released March 16 by Mathematica Policy Research Inc., found that children as young as four to six months were consuming too many calories and eating inappropriate foods. Researchers, who surveyed 3,000 children nationwide aged four months to two years, found that their eating habits mimic the American adult diet – high in fat and low in nutrition. More than half of toddlers consume too much sodium, and one-forth to one-third of children aged six to 11 months ate no fruits or vegetables on a given day. Half the meals eaten by young children were eaten away from home and consisted of high-calorie foods and sweetened drinks. Mothers who were older, breastfed their babies and had a college education tended to provide more nutritious meals to their children. Hispanic toddlers were more likely to eat more nutritious culturally based foods such as soups, beans, rice and fresh fruits, but they also were more likely to drink fruit-flavored sweetened beverages and to eat a greater number of sweets. Study authors recommend that infants and toddlers obtain the recommended daily nutrients from breast milk and fortified formula, as well as from the consumption of fruits, vegetables, whole grains and milk on a daily basis. In addition, parents and caregivers should model healthy eating behaviors. “It is very important that young children develop eating behaviors and food preferences that support good nutrition throughout their lives,” said Ronette Briefel, a senior fellow at Mathematica and a principal investigator for the study.

QUALITY

Gaps in Care

While disparities in health care are real, nearly every person in the United States is at risk of failing to receive needed care regardless of race, gender, income or insurance status, says a March 15 study in the New England Journal of Medicine. Funded by The Robert Wood Johnson Foundation, the survey was the third installment of an examination of health-care quality in the U.S. Nearly 7,000 adults in 12 metropolitan areas were surveyed over a two-year period. Researchers looked at 439 indicators of quality for 30 acute and chronic conditions such as urinary tract conditions, asthma, high blood pressure and diabetes. They concluded that the disparities in care that exist are relatively small, compared to the gap between what everyone needs and what they are receiving. Women were more likely to receive recommended preventative care than men, blacks fared better than whites overall in chronic disease management, and compared to whites, Hispanics were more likely to receive screening. Younger, wealthier participants were more likely to be screened but also less likely to receive follow-up care than older participants, and adults under 31 years of age were significantly more likely to receive preventative care than those older than 31. Researchers found that insurance had no real effect on quality, and those with annual family incomes of $50,000 had quality scores that were just 3.5 percentage points higher than those with incomes of less than $15,000. “This tells us that the U.S. health-care system is unreliable and cannot guarantee patients – rich or poor, white or black, insured or uninsured – will receive the right care at the right time,” said Elizabeth McGlynn, senior study author.

HEALTH-CARE COSTS

Joint Replacements for Boomers

The number of artificial knee and hip replacements will increase significantly over the next 24 years, as U.S. residents live longer and exercise more, according to a study presented March 24 at the annual meeting of the American Academy of Orthopaedic Surgeons. By 2030 the number of procedures per year for total knee replacement will jump 673 percent to 3.48 million, and the number of primary total hip replacements will increase 174 percent to 572,000 per year. Researchers suggest that the trend is related to the increased number of individuals who have osteoarthritis as a result of exercise or weight gain, as well as improvements in artificial joint technology. "The good news is that there's not much in medicine that's as effective as a joint replacement procedure," said Dr. Joshua Jacobs of the AAOS. On the other hand, the cost impact will be substantial. Artificial joint replacements can cost between $30,000 and $50,000 each, reports the Chicago Tribune. “We’re on a collision course between the demands placed by the Medicare population for services – joint replacement being a major one – and the ability of our society to pay for them,” Jacobs said.