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In this Issue:
1.
Save the Date: SCI Winter Meeting, February 3 - 4,
2005
2. Outcome of State Coverage-Related Ballot Initiatives
3. Louisiana Governor Proposes Tax Breaks for Businesses
Offering
Health
Insurance
4. SCI Team Helps Hawaii Sort Out Coverage Issues
5. Invitational Summit for State Policymakers: Medicare
Part D
Implementation
Issues
6. Report Finds that State Spending on Medicaid Will
Soon Eclipse Education
7. Access to Mental Health Services for Youths Varies
Across States
8. Coming Soon
9. Reports of Interest
1.
Save the Date: SCI Winter Meeting
The
Robert Wood Johnson Foundation’s State Coverage Initiatives
(SCI) program is pleased to announce the date and location for its
2005 Winter Meeting for state officials:
Renaissance
Washington, DC Hotel
February 3 – 4, 2005
The
SCI meeting will begin on the afternoon of February 3 and conclude
by 3 p.m. on February 4 at the Renaissance Washington, DC Hotel,
immediately following the 2005 National Health Policy Conference
(sponsored by AcademyHealth and Health Affairs). Registration for
the SCI meeting is separate from the National
Health Policy Conference registration.
The
SCI team is developing an agenda for this meeting. Please send your
ideas on topics you would like to see included on the agenda to
sci@academyhealth.org. A draft agenda will be available on the Internet
in December. Please the meetings
page to access updated meeting information and to register online.
For
further information on the SCI Winter Meeting, contact Alyson Brice,
at alyson.brice@academyhealth.org
or 202.292.6731. We hope that you will be able to join us for this
meeting! Please note that the SCI winter meeting is only open to
state officials and is free of charge.
2.
Outcome
of State Coverage-Related Ballot Initiatives
Health
care ballot measures appeared in eight states on Election Day 2004.
Voters made their opinions known on coverage-related initiatives
in three states: California, Oklahoma, and Montana.
SB2,
California’s controversial “pay or play” measure
would have required certain employers to provide health insurance
to workers or pay into a state fund to provide coverage. It failed
by a 51 percent to 49 percent margin.
Residents
of Oklahoma approved a tobacco tax increase in this election. Part
of the funds generated through the increase will go toward a pilot
program to provide incremental coverage to 100,000 uninsured working
adults and their dependents. The program will allow individuals
working for small businesses with less than 25 employees to access
health insurance for their families. The state hopes to implement
this program through a Medicaid HIFA waiver. This coverage model
was developed in part as a result of Oklahoma's State Planning Grant
through the Health Resources and Services Administration, which
helped to crystallize the state-level issues related to the uninsured
and engaged many stakeholders in the health sector.
Montana
residents also approved by a wide margin a tobacco tax increase
that will bolster the state’s health programs. “The 2004
Healthy Kids, Healthy Montana Tobacco Increase Act,” will provide
new funding for Montana’s State Children’s Health Insurance
Program, allow for the creation of a prescription drug program,
and possibly support development of a coverage program for small
businesses.
The
proposed prescription drug program would serve children, seniors,
chronically ill, and disabled persons. The tax revenue may also
fund the establishment of a tax credit program to assist small businesses
with the cost of health insurance; this proposal will be finalized
later this month. Approximately 60 percent of small businesses in
Montana do not offer coverage.
Preliminary plans indicate that the tax credits would be available
for small groups with nine or fewer employees (which is the predominant
size of small businesses in the state), and would give preference
to groups with two to four employees. The tax credit would be:
-
Refundable and advanceable;
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Available to small businesses on a sliding scale, depending on
the average age of the group;
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Significant enough so that small business owners have an incentive
to participate in the program; and
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Valid up to an income limit of $150,000 for any employee or employer.
Although
the initiative passed, it has to be approved by the Montana Legislature
which will meet in January.
3.
Louisiana Governor Proposes Tax Breaks for Businesses Offering
Health Insurance
Governor
Kathleen Blanco (D) announced that she plans to require businesses
operating in the state that seek tax breaks and other financial
help to offer health insurance to their employees during the Ninth
Annual Health Care Conference in Baton Rouge. This will apply to
new businesses, as well as existing companies seeking new tax exemptions.
Governor Blanco is also focused on implementing a new program, LaChoice,
in the spring once it is approved by CMS. This program will provide
a subsidy to employers with fewer than 50 workers to provide health
benefits for their employees.
The
conference brought together more than 700 consumers, health care
providers, academics, and government and business representatives.
SCI Associate Isabel Friedenzohn was among the state and national
panelists at the meeting. Isabel highlighted the findings from her
July 2004 issue brief: Limited
Benefit Plans: Public and Private-Sector Experiences.
4.
SCI
Team Helps Hawaii Sort Out Coverage Issues
The
Hawai`i Uninsured Project held their 2 nd annual Health Policy Forum
on October 13, 2004. The forum brought together national leaders
and key stakeholders for a candid discussion of health insurance
coverage issues in Hawai`i and how to reclaim the status of lowest
uninsured rate nationally. The Hawai`i Department of Health, in
collaboration with the Hawai`i Uninsured Project, is considering
options for how to achieve this goal.
Hawai`i
is the only state to have in place an employer mandate—the
Prepaid Health Care Act—under which employers must offer health
insurance to all of their full-time workers. The employee contribution
for health insurance coverage cannot exceed 1.5 percent of their
wages—a percentage that was in line with the national average
when the law was created in 1974, but currently a much lower employee
contribution than workers in other states pay. Hawai`i has one of
the highest percentages of employers offering health insurance in
the nation—89.6 percent, compared to a national rate of 57.2
percent. The remarkable achievement of the Prepaid Health Care Act
is that 86.1 percent of small firms in Hawai`i offer health insurance
coverage vs. 44.5 percent nationally.
While
the Prepaid Health Care Act can be credited with a strong base of
employer sponsored insurance, there are gaps in coverage. The mandate
only applies to full-time workers and Hawai’i Coverage for
All research from the University of Hawai`i demonstrates that Hawaii’s
proportion of part time workers is greater than the national rate
even when comparing Hawaii to similar economic areas. Further, These
part-time workers, self employed, and and children of low-income
workersdependants, all of whom are not covered by the Prepaid Health
Care Act, and are more likely to be uninsured. Additionally, the
University of Hawai`i research has revealed that there are individuals
who report being uninsured who should be receiving coverage under
the Prepaid Health Care Act, raising questions for the state about
enforcement of the law.
The
Hawai`i Uninsured Project’s uncovered workers group met over
the last year to consider options to insure these uncovered workers.
One of the strategies that the work group proposed is an individual
mandate for the working uninsured, through the development of an
affordable insurance plan. The Hawai`i Uninsured Project leadership
group is working with key stakeholders to discuss how such a proposal
would work and the possible public and private sector collaboration
for options the state has for ensuring the insurance productplan
is affordable for low-income workers.
During
the Hawai`i Uninsured Project's Health Policy Forum, a national
team of experts presented how private and public initiatives might
work to fill the gaps in Hawaii. SCI Director Alice Burton moderated
a panel that included Deborah Chollet of Mathematica Policy Research,
Inc. and senior advisor to SCI; former SCI Director Vickie Gates;
and Alan Weil of the National Academy for State Health Policy and
chair of the SCI National Advisory Committee. The panel discussions
focused on why coverage matters, why health care costs so much,
and how Hawai`i compares to other states in coverage trends. Presentations
are available online.
Ted Halstead of the New America Foundation provided the keynote
for the forum, addressing how the Foundation’s New
Solution for our Struggling Health Care System might fit with
in Hawai`i's health care system coverage mandate.
5.
Invitational
Summit for State Policymakers: Medicare Part D Implementation Issues
AcademyHealth,
in collaboration with Rutgers Center for State Health Policy, held
an invitational summit for state policymakers on states' issues
and concerns with implementation of Medicare Part D prescription
drug coverage on October 7-8 in Philadelphia.
Beyond
sharing concerns and potential solutions with each other, state
Medicaid and Pharmacy Assistance Program officials had the opportunity
to communicate directly with representatives from the Centers for
Medicare and Medicaid Services (CMS) and Social Security Administration
(SSA). A number of key issues were discussed, including dual-eligible
requirements, the impact on state Medicaid programs, and particularly,
disease management and long-term care programs.
Slides
from the summit can be found at online.
6.
Report
Finds that State Spending on Medicaid Will Soon Eclipse Education
Spending
The
National Association of State Budget
Officers (NASBO) recently released its 2003 State Expenditure
Report an annual
review of state budget and state spending trends.
In
fiscal year 2003, state total spending increased by 4.5 percent,
with state funds rising by 1.4 percent and federal funds by 10.3
percent, according to the report. Medicaid growth continues to outpace
every other functional category of state expenditure, increasing
by 8 percent in fiscal year 2003. Medicaid now totals 21.4 percent
of all state spending. Although a number of states have employed
a number of cost-containment strategies, 23 states experienced Medicaid
shortfalls in fiscal year 2003 and 18 states anticipated shortfalls
in fiscal year 2004.
States
continue to be squeezed by Medicaid spending pressure. For proposed
fiscal year 2005 budgets, states estimated growth rates of 12.1
percent in state funds and 3.9 percent in federal funds. For the
first time, state spending on Medicaid is expected to eclipse education
spending. Even considering that states are largely experiencing
economic recovery, increases in Medicaid costs will continue to
outpace the growth in state revenues.
7.
Access to Mental Health Services for Youths Varies
Across States
Discrepancies
in mental health care for children and adolescents appear to vary
significantly on a state-by-states basis, according to new
research funded by the Changes
in Health Care Financing and Organization (HCFO) program.
Roland
Sturm, Ph.D., and Jeanne Ringel, Ph.D., both of RAND, recently completed
a study examining differences in mental health need and services
use among children and adolescents across 13 states. “Whether
you live in Phoenix or Boston is a better predictor of whether you
get mental health services than whether you are black or white,
or come from a rich or poor family,” says Sturm.
8.
Coming
Soon
Upcoming
SCI Products
Check
in for updates on SCI's latest publications. We have several
in the pipeline, including:
- A
“Profile in Coverage” with Healthy New York (Q &
A with Governor Pataki and Commissioner Serio);
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An issue brief on lessons learned from the Communities in Charge
program (SCI collaboration with Terry Stoller, project director,
Communities in Charge);
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State of the States 2005, SCI’s annual report summarizing
state coverage expansion efforts during the previous year.
Coming
Soon from AcademyHealth
AcademyHealth’s
2005 Annual Research Meeting
June 26-28, 2005, Boston
Call
for Abstracts
Take
this opportunity to showcase your important research at the Annual
Research Meeting (ARM). The ARM research brings together researchers,
practitioners, and key decision makers to address the critical challenges
confronting the health care delivery system. Submit your abstracts
for consideration to the call for papers, call for posters, or call
for panels by Friday, January 14, 2005. Submissions may be made
online.
9.
Reports of Interest
The
following are the most recently released reports on coverage. State
reports can be found in SCI's database
of state reports.
Health
Insurance Survey
Henry J. Kaiser Family Foundation
October 2004
The
Continuing Medicaid Budget Challenge: State Medicaid Spending Growth
and Cost Containment in Fiscal Years 2004 and 2005
Henry J. Kaiser Family Foundation
October 2004
Trends
in Health Insurance Coverage and Access among Black, Latino, and
White Americans, 2001 – 2003
Center for Studying Health System Change
October 2004
TOOLKIT
- Ideas that Work: Expanding Health Insurance Coverage for Workers
Families USA
October 2004
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