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In this Issue:
1.
SCI Summer Workshop: States Compare Notes on Coverage
Strategies
2. SCI Co-Funds New Brief on Dirigo Health Reform Act
3. SCI and Rutgers Release New Medicare Report and
Will Hold State
Meeting
This Fall
4. New Briefs Synthesize Research on Coverage Issues
5. SHADAC Releases Chartbook of Health Care Access
Indicators for States
6. AcademyHealth Annual Research Meeting Informs State
Policymaking
7. SCI Recruiting New Associate
8. Coming Soon from SCI
9. Reports of Interest
1.
SCI Summer Workshop: States Compare Notes
on Coverage Strategies
The
State Coverage Initiatives program recently hosted a meeting for
nearly 100 officials from 38 states, who gathered to learn how states
are pressing forward with coverage expansions in the midst of tight
economies. The meeting, which took place in Chicago on June 28-29,
addressed many timely issues relevant to states, including strategies
for partnering with the private sector, how to use state-conducted
research to inform policymaking, approaches to consumer-driven health
care, and recent experiences
with scaled-back benefits packages.
“We’ve
all learned that keeping coverage at the forefront is not just about
universal coverage,” said Alan Weil, who chairs SCI’s
national advisory committee. “It’s also about making
small improvements when you can—and that’s something
that’s different from 12 years ago.” Weil is currently
the director of the Assessing the New Federalism Project at the
Urban Institute; he will become the new executive director of The
National Academy for State Health Policy this fall.
Another
trend that has emerged over the past decade is an increasing interest
among the states in partnering with the private sector to expand
coverage—whether through developing premium-assistance programs,
subsidizing reinsurance mechanisms, or engaging in public pool buy-ins.
“More and more, there is a recognition that many of the uninsured
are employed,” said Lynn Zehnder, director of health and welfare
plans at Sears, Roebuck, and Company.
A
Look at the Uninsured through an Employer’s Lens
For
that reason, some large employers have begun to come together to
address the uninsured from a private-sector perspective. “The
employer-based system seems inherently more promising than a government
alternative—or so our employees tell us,” said Zehnder.
At
the meeting, Zehnder described Sears’ collaboration with 50
Fortune 500 employers to provide access to health care for the companies’
workers and retirees who are ineligible for coverage, such as part-time
employees and pre-65 retirees. The group of employers, called the
“Affordable
Solutions Coalition,” is working together to develop unsubsidized
health care at a lower cost than would otherwise be available to
employees
through the individual market.
In
conjunction with 28 large employers, Sears is also working on another
initiative—“Care Focused Purchasing”—which
is intended to provide consumers with quality and efficiency data
about hospitals and physicians. Currently, the initiative collectively
represents more than 2 million enrolled health plan members.
The
coalition hopes to draw from their employers’ self-insured
data and their carriers’ books of business to create a consumer
data repository. At this point, the effort is in its early stages,
but Zehnder is excited about its potential. “We have to be
sure that if we put measures out there, we can back them up with
credible data.”
Zehnder
said she would also like to acquire data from states and partner
with them in this effort. “We’re not looking at this
as proprietary,” she said. “States will have access
to the data in our warehouse.”
States
Seek Solutions that Build on ESI
The
meeting also explored how states are looking to build on employer-sponsored
insurance in new ways. For example, Arizona is one of several states
using a subsidized reinsurance program to help support uninsured
small businesses and their employees. Arizona’s Health Care
Group (HCG) contracts with carriers to offer health insurance to
small firms and self-employed individuals and reinsures them for
that coverage. To protect the program against adverse selection,
HCG requires high employee participation
for groups to qualify. However, there are no income criteria for
participating employees, and no employer contribution is required.
According
to Anthony Rodgers, director of Arizona’s Medicaid and State
Children’s Health Insurance Program, the state wanted to use
the program to address increasing premiums and the decrease in coverage
that resulted from them. “We needed to tackle this issue or
we feared we’d have a state divided into ‘haves’
and ‘have-nots,’ or with a large number of people in
public programs who could never afford other coverage,” he
said. In addition, an initiative that targeted the small-group market
seemed a logical choice, given that 93 percent of Arizona’s
businesses are small ones. As of June 2004, HCG covered 3,900 small
groups, as well as a school system and two towns.
More
Meeting Content Available Online
The
meeting explored many other coverage efforts and health policy issues
from the states’ perspective. Representatives from Illinois,
Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico,
Oregon, Pennsylvania, Rhode Island, Utah and West Virginia described
their innovative public and private programs and the lessons they
learned by designing and implementing them. The workshop also included
expert analyses of health savings accounts, health care consumerism,
and premium-assistance programs.
To
access this information through speaker slides and workshop Q &
A, please visit: statecoverage.net/meetings.htm.
2.
SCI Co-Funds New Brief on Dirigo Health Reform Act
The
National Academy for State Health Policy has written a brief that
provides an update on the implementation status of Maine’s
innovative health reform effort, titled, “Dirigo
Health Reform Act: Addressing Health Care Costs, Quality, and Access
in Maine”. The brief was financed through grants from
SCI and The Commonwealth Fund to the Maine Governor’s Office
of Health Policy and Finance.
The
report provides an overview of the Dirigo Health Reform Act, with
sections dedicated to three key areas: health care costs, quality,
and access. State policymakers who are engaged in coverage expansion
efforts may be particularly interested in the section on access,
which explores Dirigo’s proposed financing, eligibility, benefits,
cost sharing, and costs to employers.
Maine
officials currently are reviewing a bid from Anthem Blue Cross and
Blue Shield to run the initiative. Dirigo is scheduled to take effect
this summer. State officials hope to enroll 31,000 previously uninsured
Mainers in the first year and cover all residents by 2009.
As
noted in the April 2004 St@teside,
SCI is funding the design and pricing of the plan’s benefit
package and subsidy levels, an analysis of current health care spending
in Maine, the creation and pricing of the “savings offset
payment,” and dissemination efforts.
3.
SCI and Rutgers Release New Medicare Report
and Will Hold State Meeting This Fall
SCI,
in collaboration with The Rutgers Center for State Health Policy,
will host an invitational meeting on October 7 - 8, 2004,
to help states navigate the Medicare prescription drug benefit.
The meeting will explore topics that were identified during a recent
teleconference convened by Rutgers and SCI to assess the needs of
state officials in implementing Medicare Part D.
The
meeting will be held in Philadelphia, and is funded by The Robert
Wood Johnson Foundation (through SCI and the Center
for Health Care Strategies, the Agency
for Healthcare Research and Quality, and The
Commonwealth Fund.
As
states prepare to implement the new benefit, some of the issues
they are grappling with are how to:
-
Coordinate existing state programs with the benefit;
- Implement
the Medicare Prescription Drug Discount Card Program;
-
Assess the potential fiscal and structural impacts of the benefit
on existing state programs such as Medicaid and State Pharmaceutical
Assistance Programs; and
-
Coordinate coverage for individuals who are eligible for both
Medicare and Medicaid.
In
addition to the meeting, SCI addresses some of these issues through
a new report, “States
Issues and Concerns with Implementation of Medicare Part D Prescription
Drug Coverage--Summary of an Audio-Conference with States.”
The report elaborates on the topics discussed during the teleconference
and serve as an introduction to the themes that will be covered
at the October meeting.
4.
New Briefs Synthesize Research on Coverage Issues
Recently,
The Robert Wood Johnson Foundation's The Synthesis Project released
technical reports synthesizing research about crowd-out, state reforms
to the individual health insurance market, and geographic variations
in Medicare spending. The syntheses, titled, "Public
Program Crowd-Out of Private Coverage: What Are the Issues?",
"Expanding
the Individual Health Insurance Market: Lessons from the State Reforms
of the 1990s," and "Geographic
Variation in Medicare Per Capita Spending: Should Policy-Makers
be Concerned?" are intended to translate research into
lessons for health care policymakers. These and other publications
can be found at rwjf.org/publications/synthesis/index.html.
The
syntheses are the latest briefs and reports to come out of The Synthesis
Project. By synthesizing what is known about health policy issues,
while weighing the strength of the evidence and exposing gaps in
current knowledge, the project provides reliable information about
complex policy issues. Researchers are paired with policy analysts
to produce the syntheses, thus providing new insights from research
results. Members of the project's advisory group help guide the
project and participate in the development and review of products.
5.
SHADAC
Releases Chartbook of Health Care Access
Indicators for States
The
University of Minnesota's State Health Access Data Assistance Center
(SHADAC) has recently released the State Health Access Profile,
which is a preliminary effort to develop a comprehensive profile
of state health care access. The profile, which was developed by
SHADAC researchers, goes beyond indicators of health insurance coverage
to measure the state resources that enable access to health care
for residents.
SHADAC
is an initiative funded by The Robert Wood Johnson Foundation. It
works to develop an understanding of the various factors associated
with access to health care in the states. Although health insurance
is one of these factors, a focus on coverage alone misses key differences
across states in terms of public program characteristics, the availability
of safety-net services, employer markets, and system-wide health
care resources.
While
many sources of data on health care access exist, the State Health
Access Profile includes 14 measures that:
(1)
Have underpinnings in the theoretical or empirical literature;
(2)
Are readily available in the 50 states and the District of Columbia;
and
(3)
Are likely to be provided consistently in the future.
Along
with coverage rates, the SHADAC State Health Access Profile includes
measures of employer health insurance offerings, Medicaid enrollment
for low-income populations, community resources such as hospitals
and providers, and routine access to health care. The Profile also
includes indicators of hospital uncompensated care spending and
hospital ownership.
The
SHADAC Health Access Profile is available for all states and the
District of Colombia at shadac.org/analysis/stateprofiles.asp.
If you have questions or comments, please send your input to nobbe002@umn.edu.
6.
AcademyHealth
Annual Research Meeting Informs
State Policymaking
On
June 6-8, AcademyHealth’s 2004
Annual Research Meeting (ARM) brought together more than 1,700
health services researchers and policymakers in San Diego. The meeting
highlighted significant research across a wide variety of topics,
ranging from health information technology to cost-containment to
the role of health services research in improving our nation’s
health care system. In addition, several forums were relevant to
state health policymakers.
At this year’s ARM, the State Health Policy Interest Group,
one of several new AcademyHealth Interest Groups, convened for the
first time. This group provides a forum for health policy analysts,
researchers, and policymakers to network and discuss state-level
research, research related to state health policy, and other health
services research from a state health policy perspective. To learn
more about the interest group or sign up for its Web-based discussion
forum, please visit: academyhealth.org/membership/interestgroups.htm
or e-mail Kristine Metter, AcademyHealth director of membership,
at Kristine.Metter@academyhealth.org.
A number
of ARM breakout sessions addressed issues of interest to state officials,
including the uninsured, the Medicare drug benefit, and how to translate
research into state health policy. Slides from most sessions, and
Kaiser Webcasts of selected breakouts, are available at academyhealth.org/arm/agenda.
For a substantive summary of the meeting, visit academyhealth.org/arm/summary.htm.
In
one session, titled, "View
from the State Legislature: Translating Research into Policy,"
three present or former state legislators discussed how health services
research can affect the legislative decision-making process. To
produce relevant results, researchers must start developing answers
years before being asked health policy questions, said Mitch Greenlick,
a freshman member of the Oregon State House of Representatives,
and past chairman of public health and preventive medicine at Oregon
Health & Science University's School of Medicine.
Bruce
Goldberg, director of the Office of Oregon Health Policy and Research,
the agency responsible for providing data to the state’s legislature,
stressed the importance of giving legislators state-specific information.
"All policy is parochial," he said. Although legislators
like to know what other states are doing, he continued, ultimately
they want information relevant to their state to make the final
decision.
According
to James Tallon of the United Hospital Fund of New York, researchers
must remember that framing the right questions is as critical as
generating results. "Research is commonly thought of as being
about findings, observations, and analyses," he said, "but
it also frames questions and creates context—which is equally
important."
7.
SCI
Recruiting New Associate
We
are hiring a new associate at the State Coverage Initiatives program.
The job description is available at statecoverage.net/openings.htm.
Please
forward the information about the position to anyone who you think
might be interested.
8.
Coming Soon from SCI
Check
in with statecoverage.net for updates on
SCI’s latest publications. We have several issue briefs in
the pipeline, including those focusing on:
- States’
experiences with scaled-back benefits packages in public and private
markets (Isabel Friedenzohn, SCI);
- The
Role of Reinsurance in State Efforts to Expand Coverage(Deborah
Chollet, Mathematica Policy Research);
-
Health Savings Accounts: Issues and Implementation Decisions for
States (Mila Kofman, Georgetown University); and
- New
ERISA developments and their implications for states (Pat Butler,
Consultant).
Look
for these products this summer and fall.
9.
Reports of Interest
The
following are the most recently released reports on coverage, most
of which are additions to SCI's database of state reports. For a
complete list of available reports, visit the State
Reports Database.
Dirigo
Health Reform Act: Addressing Health Care Costs, Quality, and
Access in Maine
National Academy for State Health Policy
June 2004
Facing
the Fiscal Crises in State Government: National Problem; National
Responsibility
John F. Kennedy School of Government, Harvard University
June 2004
The
Impact of Recent Changes in Health Care Coverage for Low-Income
People: A First Look at the Research Following Changes in Oregon’s
Medicaid Program
Kaiser Family Foundation
June 2004
Unintended
Consequences: An Update on Consumer Medical Debt
The Commonwealth Fund
June 2004
Health
Care Costs and Instability of Insurance: Impact on Patients’
Experience with Care and Medical Bills
The Commonwealth Fund
June 2004
One
in Three: Non-Elderly Americans without Health Insurance, 2002-2003
Families USA
June 2004
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