State Reform

Next week the U.S. Census Bureau will release its updated estimate of the number of uninsured people—now officially at 47 million. David Colby at the Robert Wood Johnson Foundation helpfully assembled some accessible foundation-backed papers and issue briefs on who the uninsured are, what being uninsured means, what the federal environment for change looks like now, and how the states have or have not stepped up. Here's the link to the series "The State of Research on the Uninsured: Putting Census Estimates in Perspective" and we're providing a few of the summaries and abstracts below. We'll post a similar brief guide to some of our own issue briefs and papers on the uninsured before the Census numbers come out.

Even Leslie Clement, Idaho's Medicaid Administrator, admitted that Idaho isn't usually regarded as a hotbed of social innovation, but the AARP was impressed enough with the state's achievements on keeping people out of nursing homes to make Clement one of the featured speakers at a recent luncheon and discussion on long-term care entitled "A Balancing Act: State Long-Term Care Reform." With good reason.

Most of us don't' want to end up in nursing homes. Too often, we don't have an alternative. Many states, Idaho among them, have been exploring ways to provide more home and community-based care. It's cheaper. And people prefer it.

Idaho isn't among the top five or six states in terms of how much of its Medicaid long-term care budget gets spent on home and community based care, but it's still among the better performers and it's moving fast.

Clement said one innovation is to not have a waiting list. Think about it. Nursing homes are an entitlement if you qualify under Medicaid. Home and community-based alternatives are not. If you need help (and you qualify financially for Medicaid) but you are on a waiting list for community services, you end up by default in an institutional setting. That is not successful diversion, Clement pointed out.

Even in a time of very tight state budgets, New Jersey's governor and legislature are taking major steps toward covering all of the state's residents, according to the Philadelpia Inquirer. This week the state Senate and Assembly both passed a measure (S-1557) that would require all children to be covered and would also cover some low-income parents. They provided $8.9 million in new funds to expand FamilyCare, (the state's health insurance program for low-income children and some adults), and moved to allow insurance premiums offered on the individual market to vary based on age to make plans more affordable for younger adults and help bring them into the health insurance pool.

The typical medical student begins residency $139,000 in debt. On Scrubs, J.D. and Turk stole fruit cups and toilet paper from Sacred Heart Hospital to help cover their expenses, but the Michigan State Medical Society has a few other ideas to help medical students cope with the rising costs of education and enable them to go into fields like primary care, instead of more lucrative specialties like dermatology.

Their ideas—presented as a resolution at the American Medical Association's annual meeting—were reported in a well-researched piece in the Detroit Free Press this week. The resolution noted the average doctor in his or her first year of residency could expect to pay nearly half of his or her after-tax income repaying school loans. This burden was especially difficult for primary care doctors who earn about 30 percent less than the average base-year salary for all physicians in 2006 according to the Association of American Medical Colleges.

About a month ago we wrote about the health care reform plan passed by the Connecticut legislature. The plan took an unusual form: it would have allowed municipalities, small businesses, and nonprofits to join the state employee health pool and in doing so, save money by utilizing the buying power of the larger risk pool. We say “would have,” because Governor Jodi Rell, vetoed it on Friday, saying its potential costs were too unpredictable. According to the Courant:

Alabama 's Republican Gov. Bob Riley has signed a law that will expand the tax deductions small businesses can take for employee health care costs. Supporters say the goal is to keep people covered—and take enough strain off small businesses that they can create more jobs.

The measure, described in the Alabama Press-Register, would allow owners of businesses with 25 or fewer employees to deduct from their state income taxes 150 percent of their costs for employee health insurance premiums, up from 100 percent. Additionally, small business workers who make $50,000 or less annually can deduct 150 percent of their health insurance costs.

Riley said the new law will encourage firms to hire more workers, which will help the state's overall economy. Alabama has about a 15 percent uninsured rate, just below the national 16 percent rate.

The state seems to have put the uninsured on its radar screen. Earlier this spring, we wrote about a public-private sector initiative to cover all 5,000 uninsured kids in the city of Birmingham.

It’s no surprise that citizens of a town heavily influenced by its German roots joke that its major food groups are “beer, brats and butter with a little cheese thrown in for good measure.” But at first glance, this characteristic makes it surprising that New Ulm, Minnesota, has been chosen by Allina Hospitals and Clinics for one part of its $100 million initiative to promote community health and clinical research, according to a piece in the Star Tribune by Josephine Marcotty. “The Heart of New Ulm” seeks to find out if it is possible to completely eliminate heart attacks in a community. (Yes, completely eliminate heart attacks.) So why is New Ulm, with all its brats and butter, the perfect place for this innovative experiment?

The results are in!

While there are still kinks to be worked out, the Massachusetts health care reform legislation seems to be achieving many of its goals, according to a study published this week in Health Affairs. The report focuses on a few key successes and a few remaining challenges facing the new program:

We've seen bloggers' careers ruined by focusing only on all things Massachusetts. We write frequently on the health reform efforts of the Bay State, but it's important not to lose sight of the myriad state initiatives occurring across our country. So today we look at Vermont, whose health reform efforts are featured in the latest Annals of Internal Medicine (subscription).

If there's a recipe for health reform, two major ingredients have to be bipartisan compromise and a comprehensive approach that addresses the interrelated issues of cost, coverage, and quality. Both ingredients were in the mix in May 2006 when Vermont enacted its latest reform efforts.

Earlier in May we updated you on the passage of Florida's "bare bones" health policies that Republican Gov. Charlie Crist hopes will make a dent in the state's high uninsurance rate (almost one in five under age 65). Today the New York Times updates what's going on in Florida, along with a useful summary of some other state action—and inaction.

Here's a bit of key information about the new Florida policies:

His [Crist's] initiative, which both houses of the Republican-controlled Legislature approved unanimously, enables insurers to create bare-bones policies that the governor hopes will sell for no more than $150 a month. That is about 60 percent less than the average cost of a policy for a single person in Florida, according to state insurance regulators.

The policies would be available to any Floridian 19 to 64 who has been uninsured for at least six months and who is not eligible for public insurance. In a critical provision, insurers would be prohibited from rejecting applicants based on age or health status.