HEALTH INSURANCE

Turning to the State

Unions in Illinois are using a report from the Department of Healthcare and Family Services to try to build support for “pay-or-play” legislation. Released Oct. 7, the report found that 363,506 Illinois workers from 3,270 companies obtained medical care from Medicaid and other state health programs between August 2005 and March 2006 at a cost to taxpayers of $335.7 million. Topping the list of employers were Wal-Mart, McDonald’s, Burger King, Target, Jewel, Manpower and Kelly Services. “The myth is that public health insurance has expanded because of individuals and families who have no employment,” Sen. Jeffrey Schoenberg told the Chicago Tribune. “The reality is that enrollment is increasing because employers in retail and hospitality and other service sectors are failing to provide health insurance coverage to their employees.” Schoenberg sponsored legislation that became law in 2005. The law (Article 5 of Public Act 094-0242) requires hospitals to report whether a person receiving uncompensated care is employed and, if so, the identity of the employer. The state must then prepare an annual report for the General Assembly that tabulates information on employers with more than 100 employees and 25 or more workers enrolled in public health programs. Businesses say they’re doing their best to remain competitive while providing benefits. “A lot of these folks are part-time workers and aren’t eligible for benefit packages,” David Vite, president and CEO of the Illinois Retail Merchants Association, told the Tribune.

END-OF-LIFE CARE

Cost Differentials

While everybody dies, not every death costs the same, according to a new report from the Dartmouth Atlas of Health Care. For example, the last six months of life in Miami, Florida, can cost over $23,000, with a high likelihood of dying in an intensive care unit. In Portland, Oregon, on the other hand, people are more likely to die in their homes, with the aid of a hospice program, at a cost closer to $14,000. Part of the difference in costs comes from variations in the number of hospitals and beds available to patients. More hospital beds mean more patients seeing more doctors and specialists over a longer period, increasing the overall tab. Another factor is the culture surrounding the end of life in a particular state or region. Oregon, for example, has long had the “Physician’s Order for Life Sustaining Treatment” (POLST) form. The POLST form clearly spells a patient’s wishes for end-of-life care, including when he or she does and does not want life-sustaining treatment. (POLST exists or is in development in 13 others states.) The form ensures that all levels of medical care—from emergency technicians to nursing home attendants—follow the wishes of the patient. Overall, states in the Pacific Northwest and the Mountain regions averaged the fewest physician visits and days spent in a hospital during the last six months of life. The Southeast averaged the most days spent in a hospital for that period, whereas the Mid-Atlantic averaged the most days spent in an intensive care unit.

HEALTH-CARE FRAUD

Investigating Discount Plans

In an effort to protect consumers from fraud, California has begun licensing discount health-care firms, the San Francisco Chronicle reports. Such firms may provide discounts of up to 80 percent on the care provided by loose networks of dentists and other health professionals, in exchange for monthly fees. But state officials say some of the plans have failed to provide the promised discounts. Discount health programs are not insurance, so they often fall between a state’s regulatory cracks. The state issued its initial license Oct. 10 to First Dental Health, which has a network of more than 75,000 dentists statewide, after verifying the company’s rates and comparing them with national standards. Licensing non-dental medical plans will be more difficult because health insurers negotiate significant discounts from the full fees charged by physicians and hospitals.

SUBSTANCE ABUSE

Strategies for States

States that want to attack their drug and alcohol addiction problems might consider reviewing their laws to determine which ones are outdated. For example, many states used model language from the 1971 Uniform Alcoholism and Intoxication Treatment Act to decriminalize public intoxication and establish publicly funded treatment and prevention programs. In doing so, many states heavily emphasized initial detoxification. While that service remains important, research now shows that detoxification that is not immediately followed by intensive treatment usually does little or nothing to help maintain sobriety. That’s just one of the recommendations from a recent report by experts convened by Join Together, a community-oriented program of the Boston University School of Public Health, funded by The Robert Wood Johnson Foundation and others. The report recommends that states take the lead in implementing effective substance use disorder policies because states “pay dearly” for failures in treatment and prevention.