Health Care Reform News Around the Nation for the Week of April 28

Across Kentucky, about 23% of adults ages 18 to 64 were uninsured during the beginning of this year, according to the Kentucky Health Issues Poll, the Northern Kentucky Enquirer reports. In addition, 31% of adults in the state had been uninsured at some point in the previous 12 months.

For the poll, researchers surveyed 1,632 adults in Kentucky in January and February. The poll found that about 4.3% of adults were covered by Medicaid. Northern Kentucky had the highest percentage of Medicaid beneficiaries at 8.8% and the lowest percentage of uninsured residents at 11.1%. The poll found that residents who were younger, lower-income and less educated were more likely to be uninsured than older, wealthier and college-educated adults.

The poll also found that 91% of Kentucky residents favored access to affordable, quality health care for all Americans. In addition, 72% said they would pay higher taxes or give the federal government a larger role in providing care to accomplish this (O'Farrell, Northern Kentucky Enquirer, 4/22).

In the 2009 fiscal year state budget, the Maryland General Assembly included several million dollars for initiatives that will expand dental care to more children enrolled in Medicaid, the Washington Post reports.

In what is planned to be the first of three annual installments, lawmakers approved $7 million in new funds -- to be matched by $7 million in federal funding -- to increase Medicaid payments to dentists. The increases are intended to ultimately provide as much as $42 million in state and federal funds to bring the state's Medicaid dental care payment rates up to the regional median.

The budget also includes $1.4 million to increase the ability of local health clinics to provide dental care, particularly in underserved areas. Another $700,000 is dedicated to school-based dental programs, including a mobile dental services program.

Lawmakers also approved legislation during the last session that will allow dental hygienists working in public health settings to provide preventive care to patients in the facilities where they work, as well as in schools and other settings. The measure is scheduled to take effect on Oct. 1. The law will allow services to be provided without the authorization or supervision of a dentist, which state law currently requires (Otto, Washington Post, 4/20).

Michigan Senate Health Policy Committee Chair Tom George (R) on Thursday recommended that lawmakers take action on three provisions intended to manage Michigan's individual insurance market, including some proposed by Blue Cross Blue Shield of Michigan, the Detroit Free Press reports (Anstett, Detroit Free Press, 4/25).

BCBS estimates that the individual health insurance market could grow to 25% of all policies sold in the state in the next seven years. BCBS, the state's insurer of last resort, has recommended creating a high-risk insurance pool that would spread the risk of covering people with medical problems among other insurers (Anstett, Detroit Free Press, 4/24). BCBS claims the pool would limit for-profit companies from "cherry-picking" the healthiest patients and leaving it to cover the sickest residents.

Representatives from several consumer advocacy groups appeared before the state health committee on Wednesday and said a high-risk insurance pool would increase insurance premiums for the self-insured and make coverage unaffordable for those who need it most (Rogers, Detroit News, 4/24).

On Thursday, George said only policies that have the most support and will provide the greatest benefit to the consumer should be adopted. He said that the state should implement stronger protections for consumers purchasing coverage and that BCBS should be allowed to increase rates more easily, as commercial insurers are able to do. In addition, he recommended a three-year study to research the state individual insurance market.

State Senate Majority Leader Mike Bishop (D) on Thursday met with representatives of BCBS, private insurers and Michigan's HMO organization, Aetna, to "broker a compromise" over the various proposals. Representatives from BCBS and Aetna's Michigan division confirmed the meeting but declined to provide details of their discussion with Bishop (Detroit Free Press, 4/25).

Minnesota Gov. Tim Pawlenty (R) on Monday said that legislation being considered by lawmakers to overhaul the state's health care system could lead to higher costs by further expanding eligibility for state health programs, the Minneapolis Star Tribune reports. Pawlenty met with members of a legislative conference committee that is working to resolve differences in the state House and Senate versions of the legislation.

Under both bills, health clinics in the state could qualify for higher reimbursement by establishing themselves as "health care homes" that provide comprehensive and coordinated care, particularly for residents with chronic health conditions.

Pawlenty has criticized the cost and scope of both measures, saying lawmakers first should focus on lowering the cost of care for insured residents before expanding state health programs as a way to achieve universal coverage. The governor requested that lawmakers simplify the health care home concept and that lawmakers identify ways to fund the changes proposed by the legislation without using the state's Health Care Access Fund. The legislation would cost an estimated $40 million to $60 million annually.

Pawlenty is seeking to bridge a projected budget shortfall by extracting $250 million from the Health Care Access Fund -- a fund that helps pay for the state's subsidized health care program MinnesotaCare -- to finance state-funded health care programs that usually are financed through state tax revenue. Democrats oppose the move (Wolfe/Lopez, Minneapolis Star Tribune, 4/21).

The Missouri Senate on Wednesday endorsed legislation that would expand health coverage to up to 200,000 low-income state residents, the AP/Kansas City Star reports.

The Insure Missouri bill would expand health coverage to workers with incomes below 200% of the federal poverty level, and beneficiaries would have to contribute $1,000 annually into their savings accounts for use toward deductibles. The state would subsidize insurance premiums.

The legislation, which was proposed by Republican House leaders, was based on a failed proposal of the same name by Gov. Matt Blunt (R). The Senate will hold a second vote on the legislation before it moves to the state House (AP/Kansas City Star, 4/23).