House stimulus package would give CT $474 million for Medicaid; COBRA subsidies for unemployed

Yesterday the US House passed an $819 billion stimulus package meant to reverse the declining economy. A great deal of the package is devoted to health, including $228.6 million in increased Medicaid funds to CT in 2009 and another $245.8 million in 2010. Those funds are from raising the federal Medicaid matching rate to states by 4.9%, according to Federal Funds Information for States (FFIS). Across all areas – health, education, highways, energy, fiscal stabilization, and dislocated workers – CT would receive an extra $2.3 billion over two years. The legislation also includes relief for newly laid off workers including a 65% subsidy of COBRA premiums for a year and extending COBRA benefits for workers over age 55 and workers who have been at their jobs for at least ten years until they are eligible for Medicare or employer sponsored coverage. The bill also subsidizes states to cover unemployed workers under Medicaid. The package includes $20 billion for health information technology nationally; this funding should bring electronic medical records to 90% of US physicians and 70% of hospitals within ten years. The bill also includes $3 billion for prevention and wellness programs, $1.5 billion for community health centers, $600 million for health care workforce training and $1.1 billion for research in treatment effectiveness. The Senate is expected to vote on their version of the stimulus package next week.
Ellen Andrews

The character of our social networks may be genetic; why women have more trouble losing weight; inaugural luncheon weighs in at 3,048 calories

A new study finds that the structure and size of our network of friends may be genetic. Researchers found identical twins were more alike than fraternal twins in the size and interconnectedness of their social networks. The results may have important implications for the incidence of smoking and the spread of disease. The original article was published in PNAS on Monday.

Researchers have found clues to explain the annoying fact that men lose weight faster on diets than women do. Brain scans found that women have more trouble putting thoughts of tempting food out of their minds than men. The authors suspect hormones are to blame.

The same Washington Post article (scroll down) puts the menu for the luncheon held directly after the inauguration last week at 3,048 calories and 142 grams of fat. But it sounds delicious.
Ellen Andrews

Health 1st Authority worsens individual mandate language

In their last meeting, the Health 1st Authority announced a change to their draft report in the individual mandate language attempting to accommodate some members who are holding out for the provision. The CT Health Policy Project has published research and analysis challenging the effectiveness of an individual mandate and outlining the impact on stressed low-income state residents, the challenges of enforcement, and the harm to any potential reforms. An individual mandate is a case of blaming the victims and attempts to fund health care reform on the backs of those least able to pay and least responsible for the mess.

The language was changed from:
“While admitting the potential virtues of a mandate in moving the state closer to universal coverage, the Authority did not think that Connecticut was prepared at this time and in this economic climate to accept an individual mandate.”
Bad enough.
But the new language is far worse:
“The Authority recommends that serious consideration, based on analysis of data from other states as well as local conditions, be given to the issue of an individual mandate as the health reform process moves forward in Ct. Any consideration of individual mandate necessitates examination of both affordability and quality/adequacy of coverage and benefit design.”

Reportedly, the Authority did not take a vote on the draft report because they didn’t have the votes to pass. Sources say the votes against are Mickey Herbert (ConnectiCare), Lt. Gov. Fedele, former Rep. Lenny Winkler, and Brian Grissler (Stamford Hospital); Mike Critelli (Pitney Bowes) was leaning against the draft. The sticking points remain the individual mandate and the state employee pooling plan, according to reports. It is not surprising that the insurance industry is pushing for an individual mandate – anyone who sells a product would prefer that all CT residents be legally required to purchase it.
We’ll see what happens at tomorrow’s meeting.
Ellen Andrews

Dodd hears from public, policymakers on national health reform

Friday 675 people attended a hearing held by Senator Chris Dodd in East Hartford to learn what CT residents need in President Obama’s health reform plan. Sen. Dodd has been tapped for a leadership role in development of the plan. The Senator heard about the struggle CT families face to hang onto their physical and financial health. Tom Daschle, new Secretary of Health and Human Services and the President’s main architect of health reform, will join Dodd at a future hearing in Connecticut.
Later Friday morning, Sen. Dodd and his staff met with a smaller group of legislative leaders, advocates, providers, labor and business representatives at the LOB. The Senator described current plans and the likely timetable for reforms and collected input on how those reforms might affect Connecticut. The harm that an individual mandate would cause was discussed at length. It was a lively and productive discussion that will continue.
Ellen Andrews

China to spend $124 billion to boost health care system

Today’s Wall Street Journal reports that China, facing economic problems like the US, will invest $124 billion over the next three years to expand insurance coverage, overhaul public hospitals and expand access to care. The goal is to have 90% of China’s 1.3 billion citizens covered by 2011 and have basic health care services available universally. The government is responding to significant public pressure over uninsurance and lack of care but also responding to concerns that people are not spending money because of health cost worries dragging down the economy. China’s shift to a market economy in the late 1980’s came with privatization of health care and reductions in public health services. The government is also instituting cost containment strategies, particularly to control drug costs.
If they can do it, why can’t we?
Ellen Andrews

Universal Health Care Foundation unveils comprehensive health reform plan

The Universal Health Care Foundation of Connecticut released its plan for health care reform on January 13, 2009 at a rally held at Union Station in Hartford. The room was packed with about 1,000 people from advocacy groups, labor unions, religious organizations and other groups. There were also quite a few legislators there, including President of the Senate Don Williams, Speaker of the House Chris Donovan, and Co-chair of the Public Health Committee Jonathan Harris (who all said a few words in support of the plan). It reminded me of the healthcare4every1 rally held in Bushnell Park a few years ago and it was exciting to be in the company of so many like-minded people who believe in health care reform.
The plan, called SustiNet, would eventually be opened to all CT residents but would start by creating a pool with state employees and retirees, and people covered under the HUSKY and SAGA medical programs. Eventually others will be able to buy into the plan, including: people who don’t have access to insurance from an employer, people whose employer-based insurance doesn’t provide affordable access to health care, and employers (starting with small businesses, nonprofits and municipalities and eventually including any CT employer).
SustiNet would offer affordable and comprehensive health coverage as well as coverage for residents without regard to job changes, pre-existing conditions, self employment or divorce. The plan also will have more coordination of patient care, more competitive reimbursement rates for doctors, and extensive use of electronic medical records. The healthcare4every1 Campaign will work this year to raise support for the plan with the legislature and the Governor and urge them to adopt it into law. “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” --Martin Luther King, Jr.
Jen Ramirez

HUSKY/PCCM update

Yesterday’s meeting of the Medicaid Managed Care Council was lively, but ended before addressing some important issues. The Commissioner acknowledged that they are still assessing the costs of the program under the current non-capitated arrangement. He stated that they know that the current system costs more than before Nov. 2007 when the capitated contracts ended; data brought to the Council in October bears that out. However using their numbers, the current system is costing less per member per month than the new capitated rates, which include a 24 % increase granted to the HMOs by DSS this summer. Nationally state Medicaid costs rose 5.5 % last year. (CT’s state budget overall grew by 8.8% for FY 2008 when the national average was 5.3%).

Despite not having information on the costs of the current program vs. the new capitated HMOs, the state intends to go forward anyway with requiring all HUSKY members to choose an HMO by the end of January. At the meeting we learned that members who do not choose a plan will be defaulted February 1st, but not into all three HUSKY HMOs, but only into the two new ones. Those plans, Aetna Better Health and AmeriChoice, have faced severe challenges recruiting providers and have significantly weaker capacity than the other plan CHN, which is based on CT’s community health clinic system and has participated in the program since its inception. It is expected that, given the significant problems in the program over the last year, numerous transitions and resulting confusion among members, that the default rate will be very high this month. Advocates are very concerned that forcing families into inadequate HMOs will reduce access to care, increase ER visits, and reduce access to preventive care services. Unfortunately, we never reached this part of the agenda during the meeting, so DSS never explained their reasons for limiting default enrollment to just the two new HMOs. But, as always, the decision appears to be made anyway without any chance for input, so it really doesn’t matter.
Ellen Andrews

New administration plans to ease bankruptcy for medical debtors

According to the Wall Street Journal Health Blog, President- Elect Obama’s economic agenda includes an interesting bullet point --
“Reform bankruptcy laws to protect families facing a medical crisis: Obama and Biden will create an exemption in bankruptcy law for individuals who can prove they filed for bankruptcy because of medical expenses. This exemption will create a process that forgives the debt and lets the individuals get back on their feet.”
Ellen Andrews

Technical difficulties

The CT Health Policy Project has been experiencing technical difficulties with our website and with emails. The problems have been fixed, but it is possible that the last 48 hours of emails to us may be lost. If you sent something critical, please send it again. Thank you for your patience.

US health spending growth continues to slow

A new report by CMS finds that US health care spending grew only 6.1% in 2007, the slowest rate since 1998. However even that slower growth brought it up to 16.2% of the total economy, which grew 4.8% in 2007. Lower prescription drug spending and government administration were credited for the slowdown in spending; most other categories of spending grew at the same rate or faster than in 2006. Prescription drug spending grew only 4.9% in 2007, the lowest rate in 45 years. Use of generics rose to 67% in 2007 from 60% in 2005. In 2007, Medicare spending grew by 7.2%, Medicaid by 6.4%, and private health insurance by 6.0%. Consumer out-of-pocket spending grew by 5.3%, up from 3.3% in 2006. The increase was attributed to prescriptions, nursing homes and nondurable medical supplies. Out-of-pocket spending accounts for 12% of all US health care spending, down from 14.7% in 1998. In 2007, households paid 31% of all spending on health care, businesses paid 25%, and government paid 40%. Of government health care spending, including Medicare, Medicaid and employee health coverage, 57% was paid by the federal government and 42% was paid by state and local governments. It is expected that drug spending will continue to fall. Consumers are cutting back on prescriptions causing economic worries for drug companies.
Ellen Andrews

Why an individual mandate won’t work in CT

A new paper by the CT Health Policy Project outlines why an individual mandate, a law requiring every state resident to purchase health coverage won’t work. (For the shorter issue brief, click here.)

Mandates are no guarantee of compliance; CT requires drivers to have auto insurance but 12% of drivers are uninsured. Unreimbursed care for the uninsured is only a very small part of health care spending (2%), so it won’t solve our skyrocketing health cost problems. Very few people choose to be uninsured, most uninsured can’t afford coverage. CT is one of the most expensive places to buy health insurance; between 2000 and 2007, premiums in CT rose 8.2 times faster than our incomes. There is a lot of inadequate insurance for sale, our state regulatory agencies don’t do enough to protect consumers and ensure that they are getting their money’s worth. Health coverage is no guarantee of access to care – ask any HUSKY family. Connecticut cannot afford to build the state bureaucracy necessary to enforce an individual mandate, and there are far more efficient ways to use that money to improve CT’s health. And an individual mandate would invite legal challenges that CT also cannot afford.

Other states considered an individual mandate and decided against it including Maine and Vermont. It is too early to say whether MA’s individual mandate is working or not; penalties only become significant this April. California’s health reform proposal failed last year largely due to an individual mandate. One Senator, answering why he decided to vote against it, said, “I just came to the conclusion that the working people are going to end up paying for it. There’s control for everybody else – the employers are protected and the insurance industry. The only group that’s vulnerable is the working people.”

An individual mandate does nothing to address the real problems behind our broken health care system – too many incentives to over-treat, too few incentives for quality care, not enough emphasis on prevention and chronic care management, and fragmented payment systems that foster cost shifting. In fact, designing and administering an individual mandate would distract precious attention and resources away from solving the real problems with our health system.
Ellen Andrews

Happy New Year and You Won’t Believe This

Last week, the FDA approved the drug Latisse for “hypotrichosis of the eyelashes” according to the Wall Street Journal Health Blog. What’s that? It’s “another name for having inadequate or not enough eyelashes.” Honest. The company that makes Latisse also makes another critical health care treatment, Botox.
Happy New Year everyone from the CT Health Policy Project.