HIGHLIGHTS

Volume 27, Issue 476 October 2, 2006

ACCESS

Cover Tennessee

Tennessee Gov. Phil Bredesen on Sept. 18 released details of the state’s new children’s health insurance and drug assistance programs. Cover Kids and CoverRX, both of which will begin in January 2007, are part of the governor’s Cover Tennessee initiative. Cover Kids will be available to children younger than age 19 who have been uninsured for at least three months and to pregnant women who meet certain eligibility criteria. Eligible residents will pay income-based premiums, with no premiums for enrollees with annual incomes of less than 250 percent of the federal poverty level. Those enrollees will pay $5 for prescription generic drugs, $20 for prescription brand-name drugs, $15 for physicians' visits, $50 for emergency department visits and $100 for hospital admissions. There will be no co-pay for laboratory work, x-rays or ambulance services if the care is medically necessary. Officials hope to enroll 75,000 of the state's 130,000 uninsured children in CoverKids over the next three years. CoverRX will provide prescription drug coverage to state residents who are uninsured or do not have drug coverage under their insurance plans. Participants will contribute income-based copays, with individuals with annual incomes of up to 250 percent of the poverty level paying no more than $10 for generic medications and $15 for brand-name drugs. Coverage will be limited to five prescriptions—not including insulin, diabetes supplies and some mental health medications—at one time. The program will offer coverage for about 250 medications.

***Premium* *Increases Slow***

For the first time in six years, the rise in employer-sponsored health insurance premiums has slowed. In 2006, premiums increased an average 7.7 percent, compared with increases of 9.2 percent in 2005 and 13.9 percent in 2003, according to a report released Sept. 26 by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust. Researchers surveyed 3,159 employers between January and May of 2006. They found that in 2006, premiums increased at more than twice the rate of employee wages and overall inflation. Since 2000, workers' contributions rose 84 percent, while their incomes increased 20 percent and inflation rose 18 percent. In 2006, about 4 percent of employees were enrolled in high-deductible plans linked to health savings accounts or health reimbursement arrangements. Despite the slowdown in premium hikes, “We are still losing the race between premiums and workers' earnings, and if that trend persists, employer-based coverage will continue to decline as fewer employers and workers can afford the cost of coverage,” report co-author Jon Gabel told the Kansas City Star. The full survey is available online.

PUBLIC HEALTH

Testing Guidelines

States may want to adopt or modify new guidelines on HIV testing from the Centers for Disease Control and Prevention. Published in the Sept. 22 Morbidity and Mortality Weekly Report, the guidelines urge that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped. The CDC estimates that about 25 percent of HIV-positive people in the U.S. do not know their HIV status, and many physicians believe that routine testing could lead to earlier diagnosis and earlier treatment, the New York Times reports. Many states currently require that individuals participate in a 20-minute counseling session before undergoing an HIV test. In addition, people in some states must sign a separate informed-consent form, which details the risks and benefits of the test. The revised guidelines say providers do not have to require written consent forms or undergo counseling, but physicians must allow patients to opt out of the test. It also is “essential” that physicians provide HIV-infected patients with links to clinical care, counseling, support and prevention services. Some advocacy groups oppose removing the pretest counseling requirements, fearing that providers will not give patients information that can enable them to avoid putting themselves and others at risk. The AIDS Project Los Angeles questions who will pay for increased testing costs. “This mandate would require at least an additional $6 billion, yet the federal government has cut domestic funding for care, treatment and services over the past five years,” Craig Thompson, executive director of APLA, told the National Journal. “Conducting millions of HIV tests without appropriating the money for follow-up care is an empty promise.”

***Infant* *Mortality/Life Expectancy Rates***

Among almost two dozen industrialized nations, the United States has the highest infant mortality rate and lowest life expectancy rate for residents older than age 60, according to a report posted Sept. 20 on the Web site of the journal Health Affairs. Researchers for the Commonwealth Fund’s Commission on a High Performance Health System examined 37 indicators of health outcomes, quality, access, equity and efficiency developed by the Institute of Medicine, the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, the National Committee for Quality Assurance and other experts. Overall, the U.S. scored an average 66 out of a possible 100 on the health indicators and did not score highest on any of the indicators, according to the report. The report also found that one-third of U.S. patients reported a medical, medication or laboratory error within the past two years; only 17 percent of U.S. physicians use electronic health records, which can prevent medical errors; and, about 115 per 100,000 deaths in the U.S. are preventable with proper health care, compared with 75 in France and 81 in Japan.

INJURY PREVENTION

***Suicides* *Outnumber Homicides***

Suicides account for three times as many violent deaths as homicides in Connecticut, says a study released Sept. 20 by the Injury Prevention Center at Connecticut Children's Medical Center. The study examined 108 homicides and 296 suicides in 2004, comparing the race, ethnic background and gender of those who died violent deaths. The study showed that there were three times as many suicides in 2004 as homicides. Suicide victims were overwhelmingly male, white and most likely died of gunshot wounds and strangulation. The study found that black men, age 20 to 24, were eight times more likely than any other group to die as the result of homicide. Report authors hope the results will encourage the creation of statewide violence and suicide prevention efforts. Connecticut spent $7.6 million in 2004 treating victims of gun violence, 80 percent of whom were Medicaid recipients or uninsured.