ACCESS

Cover the Uninsured Week

May 1-7, 2006 marks the fourth annual Cover the Uninsured Week, a non-partisan, nationwide effort to urge U.S. leaders to make health coverage for Americans their top priority. The initiative is sponsored by The Robert Wood Johnson Foundation and major business organizations, with events planned in 50 states and the District of Columbia. Representatives from diverse communities will come to Washington, D.C. to highlight the dire situation of the nearly 46 million Americans—including 8 million children—who lack health coverage, as well as to discuss plans being tested in various states and communities to try to expand coverage. “While community and state leaders are doing what they can to help those living without health insurance, this is a national problem that demands national solutions,” said Risa Lavizzo-Mourey, president and CEO of The Robert Wood Johnson Foundation. Forums held around the nation will feature high-profile business leaders talking about how rising health-care costs are affecting their business, their ability to provide health insurance for employees and the need for national solutions. The campaign also will work to help the uninsured connect to public health insurance programs. Hundreds of Cover the Uninsured Week enrollment events will be held at hospitals, medical centers, malls, community centers and places of worship.

MEDICAID

Proof of Citizenship

Starting July 1, individuals seeking Medicaid coverage will be required to show proof of U.S. citizenship, such as a birth certificate, passport or another form of identification. The requirement was included in the Deficit Reduction Act of 2005, which President George W. Bush signed into law earlier this year. Under the new federal law, undocumented immigrants can receive only emergency care through Medicaid. The intent of the new federal law is to prevent undocumented immigrants from gaining access to "tax payer-funded care" available only to U.S. citizens and legal residents who become eligible for Medicaid after a five-year waiting period. Some health-care specialists are concerned that the new citizenship requirements will make it difficult for many Medicaid beneficiaries, including those who are mentally disabled or homeless, to get care, reports the Boston Globe. The Center on Budget and Policy Priorities earlier this year issued a report saying the law will affect almost 50 million people and will "almost certainly create significant enrollment barriers for millions of low-income citizens who meet all Medicaid eligibility requirements." Another concern is that states have not been notified about how the law will be enforced, according to the Globe.  The Center for Medicare & Medicaid Services is currently writing regulations for states.

EMERGENCY CARE

Most Visitors to EDs Have Health Coverage

Most people in emergency departments (EDs) have health insurance and regular primary-care physicians, says a March 29 report issued by the American College of Emergency Room Physicians. According to the study, which surveyed 32,699 households in the United States in 2001, respondents without health insurance accounted for only 15 percent of ED visits.  About 84 percent of respondents who visited EDs four or more times annually had health insurance, and 81 percent had access to primary care through a physician or clinic. About half of respondents who visited EDs four or more times per year were enrolled in public health insurance programs, and one-third had private coverage.  The study estimates that about 45 million U.S. adults made a total of 80 million visits to EDs between July 2000 and June 2001. The authors suggest that expanding health insurance alone would not do much to ameliorate the problem of ED overcrowding, which is due in large part to the inability of patients to obtain appointments with their physicians and the lack of inpatient bed capacity.

TOBACCO

Master Settlement Payments Drop

Tobacco companies and states attorneys general are locking horns over a new ruling that could decrease yearly payments to states by billions of dollars. A report from an independent arbiter released March 28 sided with tobacco companies by agreeing that cigarette makers are losing money and should be allowed to reduce their payments to states.  The landmark 1998 Master Settlement Agreement directed tobacco companies to make annual payments to 46 states totaling $246 billion – about $41.6 billion have been paid so far – and barred states from suing the manufacturers to recover the public health-related expenses associated with smoking. The arbiter found that the terms of the legal settlement contributed significantly to a decline in major cigarette makers’ market share, which has dropped from 99.6 percent in 1997 to 92 percent in 2003. RJ Reynolds, Philip Morris USA and Lorillard Tobacco Company have sought to cut a total of $1.2 billion from the $6.5 billion payment which is due April 17. The companies argue that the provision in the original settlement agreement allows them to reduce payments if they collectively lose market share to those outside the agreement, such as cut-rate cigarette makers. Oregon stands to lose $14 million while Connecticut could lose $100 million.

MENTAL HEALTH

The Cost of Parity

Health plans that cover mental health and substance abuse on par with other conditions may not be any more expensive, according to a March 30 study in the New England Journal of Medicine. Beginning in 2001, the Federal Employees Health Benefits Program offered mental health and substance abuse benefits to the same extent that they offered other benefits. Researchers compared claims from seven FEHBP plans with a matched set of plans that did not provide parity. They concluded that (when coupled with management of care) parity of insurance for behavioral health care can improve insurance protection without increasing total costs. The proportion of participants in FEHBP plans who used mental health services increased by 1.35 percentage points to 2.75 percentage points in the two years after parity was initiated. However, use of mental health services also increased among participants in private health plans. In addition, the study found that, although spending for mental health services increased among participants in FEHBP health plans, the increase was similar to that of participants in private plans and “was not attributable to the requirement for parity,” the New York Times reports. Researchers attributed the increased spending for mental health services to inflation and increased use of services. The study also found that out-of-pocket spending for mental health services for participants in all but one of the FEHBP health plans decreased after parity was implemented. “The big winners, in terms of reduced out-of-pocket spending, were the sickest patients, including those who needed hospital care,” study author Richard Frank told the Times. Researchers made two important qualifications to the study: the "HMO-like care management ... appeared to be an important element in controlling spending" and "a reduction in co-payments and other out-of-pocket charges to patients means that insurance premiums might increase slightly,” Frank told the Baltimore Sun.