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SUMMARIES OF RECENT
Commonwealth REPORTS
Dec 2004 - April 2005
UPDATE ON TRADE ACT HEALTH COVERAGE TAX CREDITS
Despite a promising start, a federal tax credit program designed to help displaced workers buy health insurance is still experiencing disappointingly low enrollment rates more than a year after its implementation. Based on case studies of MD, MI and NC where enrollment rates among those potentially eligible for the advance-payment option under the Health Coverage Tax Credit program were 11.5%, 7.7%, and 9.5 %, respectively, as of September 2004. While federal and state officials have succeeded in preventing the kind of marketing fraud that marred health insurance tax credits in the early 1990s, insurance premiums available under the tax credit program are apparently too high for most eligible workers to afford even though the credit covers 65% of premium costs. The complexity of enrollment procedures and delays in subsidies for qualified individuals have contributed to low take-up rates.
CLICK HERE for Article
WAYS AND MEANS SIGNALS READINESS TO BASE MEDICARE PAYMENT ON QUALITY PERFORMANCE
Ways and Means Health Subcommittee Chairwoman Nancy L. Johnson, R-Conn., signaled at a House hearing how she aims to reform Medicare payments to physicians, while stressing that her thinking on the matter is still "embryonic." The key elements: Get rid of the "Sustainable Growth Rate" (SGR) system that has lined up physicians for big annual cuts over the next several years and replace it with a system that rewards doctors who perform well on specific measures of quality care.
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HOUSE PANEL APPROVES ASSOCIATION HEALTH PLAN MEASURE
The House Education and Workforce Committee approved a bill that would help small businesses purchase health insurance after narrowly staving off adoption of an amendment aimed at making it more difficult for insurers or companies to discriminate against higher-risk patients. The panel voted along party lines to adopt the bill, which would allow small businesses that band together into association health plans to bypass state laws that mandate coverage for specific treatments and procedures. [EINO: AHP's endanger health care quality for everyone by allowing the marketing of products which meet no specific standards. They are unregulated at every level. Sure buy into them now for years and later when you get sick find out what treatments/ conditions are uncovered.]
CLICK HERE for the Article
MALPRACTICE REFORM MUST INCLUDE STEPS TO PREVENT MEDICAL INJURY
by SC Schoenbaum, and RR Bovbjerg
Focusing solely on capping malpractice awards ignores the largest problem: patient injury. Physicians must use their abilities to make care safer and injuries rarer, by developing, evaluating, and implementing safety improvements. More active work on the part of physicians to improve care and reduce harm is clearly in the best interest of the public and physicians. The current medical liability system works poorly for patients and physicians, the authors say. Because of steep increases in malpractice premiums, physicians tend to practice "defensive medicine," ordering unnecessary medical tests, procedures, and referrals for their patients. Not only are patients exposed to unnecessary physical risk, but health care costs rise even further. Meanwhile, large numbers of Americans continue to suffer preventable medical injuries.
CLICK HERE for the Article
DEMOGRAPHY IS NOT DESTINY, REVISITED
by RB Friedland and L Summer
Planning for the future on the basis of demographic projections alone is a "fool's game." In an update of a seminal 1999 report Georgetown University researchers explain why the country's future will not be determined solely by anticipated changes in the size and age distribution of the population. Even if demographic projections turn out to be correct, economic and public policies can have a far greater impact. Ensuring the productivity of future workers, regardless of age, is the central challenge, the report notes. Public policies need to encourage and facilitate education, basic research, and the application of promising technologies. [EINO: Perhaps the Bush Admin and GOP are assuming that the nation will never climb out of this 'recession' and prductivity will never rise? ]
CLICK HERE for Report
HOUSE, SENATE MEDICAID CUTS COULD ADD TO UNINSURED
The Medicaid spending reductions included in the House and Senate budget resolutions are likely to weaken health care coverage for low-income Americans and increase the ranks of the uninsured. Both proposals would go farther than the Medicaid spending changes in the Bush administration's fiscal 2006 budget that have already drawn opposition from the nation's governors.
CLICK HERE for the report
CAGE THE "CLAWBACK," GOVERNORS URGE
A mechanism within the 2003 Medicare overhaul law that aims to ease the cost burden on states for providing drug coverage to people enrolled simultaneously in Medicare and Medicaid follows a flawed formula that undermines its purpose, according to the National Governors Association. Under the "clawback" mechanism, Medicare picks up the costs of drug coverage for those "dually eligible" for both Medicare and Medicaid, but states repay 90 % of those costs next year through clawback payments.
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WITH INDIVIDUAL COVERAGE, AFFORDABILITY IS ALWAYS THE ISSUE
The individual health insurance market has long been a troubled one. Such coverage usually bought by people lacking access to employer-based or other group policies is often prohibitively expensive and benefits are limited. Many people with preexisting medical conditions cannot buy any kind of individual coverage at all. This new study assesses the effectiveness of state regulations that attempt to make individual policies more accessible and affordable. Depending on the state 30% of applicants may be rejected and waiting times to have pre-existing conditions covered in policy might extend to 2 years.
CLICK HERE for Article (Acrobat)
GRANTEE SPOTLIGHT: STEPHEN SHIELDS
The terms "long-term care" and "nursing home" typically bring to mind visions of unwelcoming, regimented institutions. But a growing movement, known within the industry as culture change, is looking to change that perception by transforming how residents are treated and served. Proponents of culture change believe long-term care residents can and should drive their own lives, and recommend replacing institutional units with households of small groups of residents and staff. Recently we spoke with Stephen Shields one of the pioneers of the movement and the president and CEO of the Meadowlark Hills retirement community in Manhattan, Kansas.
CLICK HERE for Article (Acrobat)
TRADE ACT TAX CREDITS: UPDATE
Despite its promising start, a federal tax credit program designed to help displaced workers purchase health insurance is still experiencing disappointingly low enrollment rates more than a year after the program's implementation. While federal and state officials have succeeded in preventing the kind of marketing fraud that marred health insurance tax credits in the early 1990s, health plan premiums are apparently too high for most eligible workers to afford even though the credit covers 65 % of premium costs.
CLICK HERE for Article (Acrobat)
RISK-ADJUST MEDICARE ADVANTAGE PLANS, SAVE $1.5 BILLION
For years, the Medicare program's payments to managed care plans have been higher per enrollee than the costs of beneficiaries in traditional, fee-for-service Medicare a direct result of managed care plans' "favorable selection" of the healthiest, and least costly, beneficiaries. Recent legislative changes have raised private plan payments even further, to entice more private plans into the market. But a new study questions whether the federal government can fiscally justify and sustain private plan overpayments amid strong pressure to reduce the federal budget deficit.
CLICK HERE for Article (Acrobat)
MAINE: STRIVING FOR SUSTAINABLE HEALTH CARE
When Governor John Baldacci signed the Dirigo Health Reform Act into law in June 2003, he cited the urgent need to address a health care situation he characterized as "not sustainable." As a percentage of state income, Maine is among the highest spenders on health care in the nation, and some 130,000 of its residents out of a population of only 1.3 million go without health insurance. The Dirigo plan is seeking to contain costs (with a high-deductible plan and encouraging timely treatments) while at the same time ensure universal coverage and improve the quality of care. [Additional public funds will be spent on private insurance products.]
CLICK HERE for Article (Acrobat)
TRANSFORMING THE U.S. HEALTH CARE SYSTEM
The United States spends more than any other nation on health care well over twice the per capita average among industrialized nations. Yet while the U.S. health care system excels in some areas, on many measures of quality it delivers poor-to-middling results. What Americans want and what our high spending should buy is the best health care in the world. Work by The Commonwealth Fund and others suggests a 10-point strategy for transformational change. We must agree on our shared values and goals. Today, we tolerate a system that compromises the health of our workforce, strains our economy, and deprives many Americans of a healthy and secure retirement. We must identify what we want as a society and hope to achieve over time. [Commonwealth's Pres. Karen Davis GETS IT RIGHT !! She puts agreeing on shared values first - that's exactly the program at Project EINO. Let's all agree on having an all-inclusive system of health care -a right of all Americans and then (her number 2) let's organize the system according to patient needs. ABSOLUTELY and EXACTLY. ]
CLICK HERE for the Commonwealth Article (Acrobat).
DISCOUNT MEDICAL CARDS: INNOVATION OR ILLUSION?
Double-digit premium increases have made health insurance unaffordable for many Americans. As an alternative to insurance coverage, some consumers are turning to discount medical cards, which allow the purchaser to obtain services at reduced fees from participating doctors, hospitals, and other providers. But discount medical cards have come under increasing scrutiny by regulators and law enforcement officials as a result of mounting consumer-reported problems. While some cards provide a measure of value, other cards were found to have serious drawbacks, including: high-pressure sales tactics; misleading or inaccurate promotion; exaggerated claims of savings; difficulty finding participating doctors; and providers who failed to give cardholders promised discounts.
CLICK HERE for the Commonwealth Article
CREATING A STATE MINORITY HEALTH POLICY REPORT CARD
by AL Trivedi
The first-ever "report card" on states' performances in addressing minority health care disparities. Looking at all 50 states, the report card evaluates insurance coverage rates, proportion of minority physicians, presence or absence of a minority health office, and mortality data for various populations. The study found that "high- and low-performing states tended to cluster geographically." Indeed, location was the only factor that consistently correlated with performance.
CLICK HERE for the Commonwealth report
INSURING THE HEALTHY OR INSURING THE SICK?
by NC Turnbull and NM Kane
The effectiveness of state regulations that attempt to make individual policies more accessible and affordable is assessed. Most states have some combination of regulations that require carriers to sell coverage to all applicants regardless of age or health; create high-risk pools for individuals with preexisting conditions; or place limits on the extent to which premiums can vary by age, sex, or health status. Stricter regulation has made an important difference, but affordability is still a major problem. In states that have adopted more stringent regulation, the individual market offers comprehensive polices that are available to all, and premiums are more affordable for higher-risk people. Older or sicker adults face a range of problems in states with weaker regulations.
CLICK HERE for the Commonwealth Article
INTERNATIONAL SURVEY: PATIENTS CONCERNED ABOUT THEIR PRIMARY CARE
An effective primary care system is essential to keeping overall health costs down and helping people lead healthy, productive lives. Serious shortfalls in the delivery of safe, timely, and patient-centered primary care are a big problem both in the United States and abroad. Access to care is related to costs, and particularly to a nation's insurance system. Given often high uninsured rates and cost-sharing in the US, Americans were the most likely to report not seeing a doctor when sick, not getting recommended tests or follow-up care, or going without prescription medications because of high costs.
CLICK HERE for the Commonwealth Article
A WORKFORCE DIVIDED: HALF OF LOW-WAGE EARNERS LACK COVERAGE
Most workers without access to employer-based coverage are uninsured, offering clear evidence that job-based health coverage is crucial to the health and economic well-being of Americans. But what if your employer does not offer coverage, or you cannot afford your share of the premium? And what if your modest income disqualifies you for public coverage? Millions of workers find themselves in this quandary and scrambling for ways to pay for needed health care. Not only were the problems of low-income workers 107% worse than well-paid workers, but mid-range paid workers also fared 86% worse than well-paid workers, using three determinants for health and health-related financial risk.
CLICK HERE for the Commonwealth Article
EFFORTS TO IMPROVE HEALTH CARE SAFETY RATE 'C+'
The Institute of Medicine's 1999 landmark report on medical errors struck a nerve with medical professionals, the media, elected officials, and the American public. Now that five years have passed, has anything changed? One of the nation's leading medical safety experts says that efforts to address the problem have so far done little to improve protections for patients.
PRIVATE PLANS COSTING MEDICARE MORE
Federal payments to private health plans that insure Medicare beneficiaries will average 7.8 % more in 2005 than costs in the traditional, fee-for-service Medicare program. This amounts to an extra $546 for each of the 5 million enrollees in Medicare Advantage private plans, for a total of more than $2.72 billion.
CLICK HERE for the Commonwealth Article
MEDICARE'S WAITING PERIOD IS HARD ON DISABLED
Unlike older Americans, who typically become eligible for Medicare upon turning 65, the nearly 6 million adults with severe or permanent disabilities must wait two years after receiving disability insurance benefits before their Medicare coverage takes effect. And the wait can have a devastating impact on their health and lives.
CLICK HERE for Article (Acrobat)
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