HEALTH REFORM: Social Policy After the Economic Crisis

It takes a village to raise a child, but it takes a crisis to rouse a policymaker.

In this time of economic crisis, it seems stimulus goes both ways. As the need to bail out our economy grows larger, policymakers seem freed to think bigger.

And so, when the New America Foundation’s Next Social Contract Initiative hosted panels of experts last Friday to look at social policy after the economic crisis, the focus was not on what we can’t do, but what we must do. Karen Kornbluh, a New America alum who was the principal author of the 2008 Democratic Party platform and a policy adviser to President-elect Barack Obama, provided the keynote to the event (video below).


HEALTH: Baucus Plan Highlights Importance Bipartisanship and Cost of Inaction

This post also appears on the National Journal's Health Care Experts Blog. where you can also see what other health policy analysts have to say.

On Wednesday, Senate Finance Chairman Max Baucus (D-MT) made clear that reforming our health care system is an economic imperative and that comprehensive health care reform should be a priority for Congress. I applaud his leadership, vision, and willingness to work with colleagues, stakeholders and the public to "get it done" in this Congress. He has laid down a key cornerstone in our pathway to a high quality health care system that works well for all Americans.

Senator Baucus emphasized two important messages on Wednesday: 1) The cost of "inaction is much more expensive" than reform, 2) We should approach health reform with a bipartisan attitude and endeavor to persuade "80 Senators" to support the final legislation. I believe the health care reform conversation would be well-served to continue to remember and echo these two points.

As for policy, the Baucus policy plan is extensive, so today I will simply highlight what I view as the most original contributions.

IN THE STATES: Chutes and Ladders, Ballot Edition

Tuesday's election brought a series of health care initiatives to state ballots. Some, like Prop 101, blocking the state of Arizona from enacting universal coverage, are still too close to call. Others, like Michigan's Prop 1 on medical marijuana, aren't our bag (we swear officer). And still others, like measures passed in Montana and Maine, remind us that health reform at the state level can sometimes seem like a game of Chutes and Ladders.

For the more than 30,000 children in Montana without health insurance, the passage of ballot initiative I-155, "The Healthy Montana Kids" plan represents a major step forward. The measure expands the eligibility for Medicaid and SCHIP to uninsured children, whose family income is below 250 percent of the federal poverty level (previously only those in Montana with incomes below 175 percent of FPL were eligible). The plan is expected to cost around $22 million annually and will cover most of the state's uninsured children.

IN THE STATES: Mind the Gap? Fix Health Care

Fall is a season of tweeds, wool sweaters, knit caps and "a neutral palette with pops of purple," that is, if you ask the Gap. If you ask state lawmakers, who are staring at an altogether different kind of gap, the kind in their budgets, the trends are much more austere.

Forced to find savings to compensate for shrinking state revenues, many staet lawmakers are eying cuts in Medicaid, which, on average, accounts for close 17 percent of a state's annual budget. USA Today's Julie Appleby takes a look at the implication of such cuts, focusing on the experiences of four states during this economic downturn:

QUALITY: Gone to Carolina, Where I Know Patients Have a Medical Home

We've mentioned Community Care, North Carolina's innovative Medicaid program for chronic disease management, briefly in the past but today's News and Observer takes a detailed look. Community Care has been shown to save money —and improve the quality of care for Medicaid patients with conditions such as diabetes and asthma. The savings are impressive—$100 million a year, or $2 for every $1 the state spent on the program, which covers 810,000 Medicaid patients in "medical homes" through 14 nonprofit networks around the state.

The patients are monitored closely, so that conditions are kept in check and complications and hospitalizations are minimized. Case managers work with physicians and other providers, hospitals, public health and social service agencies to coordinate comprehensive care and make sure that patients don't fall through the cracks and that transitions—say after a hospital admission—are handled smoothly. Doctors get paid a fee to compensate them for the time-consuming aspects of care coordination and management that are often go not reimbursed.

COVERAGE: Making the Call for Health Reform

If home shopping networks sold health care safety net coverage, they'd probably be telling you to "act now because supplies are limited." State legislatures are especially receptive to this pitch during an economic downturn. Many are struggling to handle growing Medicaid programs during a period of shrinking tax revenue.

We've written about this vicious cycle before, and a new report from the Kaiser Family Foundation provides more insight into why we cannot afford to ignore our struggling health care system any longer, especially in times of economic turmoil. Quick highlights showing the link between health care and the economy:

IN THE STATES: Stains and Strains of the Economic Cycle

What does the ballpoint pen in your pocket have in common with a weak economy?

Both can produce vicious cycles—one in your washer-dryer, the other in state budgets, as decreased tax revenues must be balanced with the costs of thousands of newly-unemployed applicants for Medicaid. And while the forgotten pen may leave you muttering beside a pair of khakis, the fiscal crisis has state lawmakers lobbying hard for federal help, the Associated Press reports.

COVERAGE: A Back-to-School Necessity

Backpack? Of course. Lunchbox? Certainly. Shoes with wheels in the heel? Maybe. But health insurance? Definitely.

That's the message the Robert Wood Johnson Foundation hopes to convey as it kicks off its annual Cover the Uninsured Back-to-School Campaign with a report highlighting the importance of health insurance to children's health.

The study, conducted by researchers at the University of Minnesota, found that children with insurance were three times more likely to have visited a doctor in the past year and highlighted the importance of public programs like Medicaid and SCHIP for ensuring children's access to needed care. For example:

COST: Making Sure the Kids Are All Right

First Focus, a children's advocacy group, this week in its Children's Budget 2008 reported that only one cent of each "new" dollar of federal spending (excluding defense) goes to kids. A lot of the report focused on education, so we asked them how does health spending add up. The answer: not so hot.

The overall share of federal, non-defense spending going to children's programs has dropped by 10 percent over the past five years. Real discretionary spending on children has declined by more than 6 percent since 2004, while at the same time all other non-defense discretionary spending has increased by more than 8 percent, the group reported.

Because so much of spending on children' health is through Medicaid, SCHIP, and other entitlements, not out of the discretionary budget, spending on health programs did grow from 2004–08. However, total spending on children's health amounts to less than 2 percent of the total federal budget, and less than 0.4 percent of the Gross Domestic Product.

COST: What's Love Got to Do With It?

Forget pheromones. A new poll from the Kaiser Family Foundation found that seven percent of adults reported that in the past year they or someone in their household decided to get married in order to get health insurance from a spouse. (We don't even want to think about what their bridal gift registry looks like.)

The Kaiser poll had lots of somber news as health care costs are taking their toll on American families (including the middle class) during the economic downturn. Twenty-eight percent report that they or their families have had a serious problem paying for health care, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent). Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent). That 28 percent figure was true as well for middle class families, making between $30,000 and $75,000.

"Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public's economic concerns," Kaiser Family Foundation President and CEO Drew Altman said.