Health Care Reform News Around the Nation for the Week of June 2
Last month, the Arkansas Advocates for Children and Families announced plans to launch a statewide three-year effort to increase enrollment in ARKids First by about 22,000 children, the Arkansas Democrat-Gazette reports. ARKids First is the state's version of the State Children's Health Insurance Program.
According to the group, as many as 70,000 children, or 11% of all children statewide, are uninsured, and about 44,000 of the state's children are eligible but not enrolled in the program.
The enrollment initiative is part of the Finish Line Project, which will provide Arkansas with $675,000 over three years and will generate about $264,000 in matching federal funds, according to AACF Director Rich Huddleston. The project will be funded by grants from the David and Lucile Packard Foundation.
In addition, the group plans to work with lawmakers and the state Department of Human Services to increase income eligibility requirements for ARKids to children in families with incomes up to 300% of the federal poverty level from 200% of the poverty level (Park, Arkansas Democrat-Gazette, 5/25).
The Wisconsin Association of Health Plans on Tuesday announced that 17 member companies will begin offering policyholders estimates of out-of-pocket health care costs before undergoing a test or procedure, the Milwaukee Journal Sentinel reports. The group of insurers includes 13 of the 20 largest insurers in the state.
Patients will be required to provide detailed information about procedures to receive an accurate estimate, and insurers will be able to provide "only very rough estimates" of the potential out-of-pocket costs for out-of-network care. All 17 insurers will make the estimates available by Sept. 1.
The insurers will not provide information about the actual prices of services nor which provider has the lowest prices (Boulton, Milwaukee Journal Sentinel, 5/27).
Connecticut Attorney General Richard Blumenthal (D) said legislation that would allow workers at small businesses, municipalities and not-for-profit groups to join the state employee health insurance pool would preserve, and not change, the existing contracts the state has with insurers, the Hartford Courant reports.
Blumenthal was asked by state House Majority Leader Christopher Donovan (D) for his professional legal opinion on the legislation (Levick, Hartford Courant, 5/27).
In a letter recently released by Gov. M. Jodi Rell (R), Anthem Blue Cross and Blue Shield wrote that if the pool is expanded, the insurer would be forced to increase premium rates for state employees by 4%, or by more than $24 million, in the fiscal year that begins July 1.
In a separate letter, ConnectiCare called on Rell to veto the bill, stating that the bill would have a negative impact on competition, put a burden on the state and prevent municipalities from effectively controlling costs (California Healthline, 5/27).
Blumenthal said the legislation would actually create a separate pool for small businesses, municipalities and not-for-profits. The state would then receive separate rates for the additional pool for "equivalent" or "substantially the same" coverage as state employees, he said, adding that the state could either negotiate rates with the same insurers or solicit new bids.
Neither option would increase costs for the state, Blumenthal said (Hartford Courant, 5/27).
In May, Louisiana Department of Health and Hospitals Secretary Alan Levine said that the state likely would face a lawsuit from nursing home owners if Medicaid cuts approved by the state House are not restored, the New Orleans Times-Picayune reports (Moller, New Orleans Times-Picayune, 5/24).
The House this month approved a $30 billion state budget for fiscal year 2009 that is $240 million less than Gov. Bobby Jindal's (R) proposed budget.
Jindal's original budget called for a $600 million increase in Medicaid funding, including about $21 million for new initiatives. The House Appropriations Committee cut the spending increase by $183 million but did not specify from where the reductions would come.
Levine said that implementing the Medicaid cuts would include $38.6 million in payment cuts to nursing homes (California Healthline, 5/27).
During a recent state Senate Finance Committee hearing, Levine said nursing homes are entitled by law to receive a rate increase that would cost the state about $69 million.
Commissioner of Administration Angele Davis has asked lawmakers to restore the health care cuts. Doing so, however, could bring the proposed budget near the constitutional cap on state spending, according to the Times-Picayune (New Orleans Times-Picayune, 5/24).
There are not enough primary care physicians in Massachusetts to meet the demand for care created by the state's health insurance law, according to health care reform advocates and medical professionals, the Boston Globe reports.
Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, said that as of Jan.1, about 340,000 state residents, most of whom had previously been uninsured, are now insured through state programs.
Bruce Auerbach, president of the Massachusetts Medical Society, said, "What [the Massachusetts health insurance law] has done is highlighted the crisis and the problem that we have with the primary care work force."
A medical society study found that in 2007, 42% of patients who had an appointment with a PCP were able to see a doctor within one week of initiating contact, down from 53% in 2006.
State officials and health care advocates are trying to increase recruitment of physicians through a medical school loan repayment program, and the state Legislature is considering legislation (SB 2526) that would establish a primary care recruitment center in the state.
However, some health care advocates and providers say that the real problem is that the state underestimated the number of uninsured residents (Perez-Brennan, Boston Globe, 5/29).
On Wednesday, the Buyers Health Care Action Group, a health care purchasing coalition in Minnesota for large employers, announced a pay-for-performance pilot program that will reward physicians who effectively treat depressed patients, the St. Paul Pioneer Press reports. The program will start in 2009 (Forster, St. Paul Pioneer Press, 5/28).
The program is modeled after similar pay-for-performance initiatives launched in recent years to improve treatment of diabetes and cardiovascular problems.
Under the program, patients will complete a nine-question survey to help primary care physicians determine whether a patient is depressed and gauge the severity of his or her condition. Patients will be reassessed at six months and throughout the course of treatment (Lerner, Minneapolis Star Tribune, 5/29).
The goal of the program is to reduce depression within the first six months and achieve full recovery in one year. Physicians who meet the goal would receive a $100 bonus per patient.
Insurance companies participating in the program have committed to paying the bonuses through 2010 (St. Paul Pioneer Press, 5/28).
As many as 35,000 New Jersey children enrolled in SCHIP could be left without health coverage over the next five years if stricter eligibility requirements proposed by the Bush administration go into effect, according to a recent report by the New Jersey Policy Perspective, the Newark Star-Ledger reports.
The SCHIP program has been funded by Congress through March 2009, but under new rules scheduled to take effect in August, the federal government would not provide payments to states for SCHIP coverage of children in families with incomes greater than 250% of the poverty level.
More than 128,000 children and 80,000 low-income parents are enrolled in the state's version of SCHIP, called NJ FamilyCare. However, new income eligibility requirements could force many out of the program, according to the report.
The report also found that the rules could cost the state $215 million in funding and could lead to a loss of $486 million in business activity and 3,600 jobs in the state (Hepp, Newark Star-Ledger, 5/23).
On Thursday, Pennsylvania Gov. Ed Rendell (D) announced that CMS earlier this month granted approval of a waiver program that allows the state to allocate part of its federal Medicaid funds toward services for adult residents with autism, the AP/Philadelphia Inquirer reports.
According to Rendell, Pennsylvania is the first state to receive permission to use federal Medicaid funds for services aimed at autistic adults. The approval will authorize Pennsylvania to spend $20 million annually for home and community services to benefit autistic adults, the AP/Inquirer reports (Raffaele, AP/Philadelphia Inquirer, 5/23).
Senior advocates and Rhode Island lawmakers have expressed concern that a proposal by Gov. Donald Carcieri (R) to overhaul RIte Care, the state's Medicaid program, could create problems for 186,000 state residents enrolled in the program, the Providence Journal reports.
Carcieri announced the plan in January, saying it would save taxpayers an estimated $67 million. Under the proposal, the state would agree to a federal spending cap on Medicaid programs for the next five years in exchange for the state having more flexibility from the federal government to change Medicaid programs.
According to the Journal, the changes "have yet to be determined in many cases." Likely changes include stricter criteria for elderly beneficiaries who want to move into nursing homes.
Maureen Maigret, former director of the state Department of Elderly Affairs and current policy director for the state Senior Agenda Coalition, said that "a second new group of persons with lower care needs, who under today's standards would be eligible for nursing home care, would now be limited to home and community care services, but they would only get services if funding is available."
If Medicaid costs exceeded the negotiated cap, the state would have to cut services for some beneficiaries or fund the additional programs using state money.
Some advocates have expressed concern that the proposal would lock Rhode Island into spending levels that are "based on unrealistic assumptions," according to the Journal.
According to the Journal, "Vermont is the only state to have arranged something close to what the Carcieri administration is seeking" (Peoples, Providence Journal, 5/23).
On Tuesday, the South Carolina House failed to override Gov. Mark Sanford's (R) veto of legislation that would have increased the state cigarette tax to expand health care coverage for low-income residents, the Columbia State reports (O'Connor, Columbia State, 5/28). Lawmakers were about 20 votes short of overriding the veto (Wenger, Charleston Post and Courier, 5/28).
The bill would have increased the cigarette tax by 50 cents per pack to generate about $160 million for health care programs. The legislation would have extended Medicaid eligibility to children in a family of four with an annual income up to $54,000 and coverage for pregnant women with incomes between $7,000 and $14,000 (Columbia State, 5/28). The measure also would have provided assistance for lower-income workers to purchase health insurance.
State House Speaker Bobby Harrell (R), who voted against the bill, said next year he will sponsor legislation to increase the cigarette tax and study ways to improve health care through the private sector (Charleston Post and Courier, 5/28).