Archive for April, 2011

« Older Entries

In Washington and Beyond, It’s Go Time for Keeping Hospital Patients Safe

Monday, April 25th, 2011

“[The doctor] literally grabbed me by the hand and took me out into the hallway. He said, ‘Your mother is very sick. Her health is failing.’ I said, ‘Sir, it’s not her blood levels. It’s whatever she has caught in this hospital.’ He said to me, ‘Look, do you think I’d just discharge your mother to let her die in a nursing home?’ And I said, ‘Yes, sir, that’s exactly what I think you are doing.’” The doctor left without another word about discharge. […] My mother’s life was far too valuable to have ended this way.”

- Reverend Sally Jo Snyder, Pennsylvania Campaign for Better Care

By now, our readers may have heard about the recent launch of the Obama Administration’s Partnership for Patients: Better Care, Lower Costs (the Partnership), a new public-private initiative aimed at improving care quality and coordination. But did you also know about the Healthy Hospital Initiative? It’s the other new kid on the block — courtesy of the Campaign for Better Care — and it’s working to make sure this new effort to improve care goes down with adequate community representation and patient perspectives. Here’s the skinny on both efforts and what they might mean for your community.

First, the Facts
Past data shows that almost one in every 20 patients will experience an infection related to their hospital care. That’s about 1.7 million people nationwide. Of those, almost 100,000 people will die as the result of a medical error this year. Older Americans are even more susceptible: One of every seven Medicare beneficiaries is harmed in the course of their care, and one in five Medicare patients discharged from a hospital will be readmitted within 30 days, due partly to lack of appropriate coordination and support for people transitioning into rehab or other facilities. The cost to Medicare for readmissions alone runs upwards of $26 billion every year.

We can’t afford to pay for this kind of care. And as patients and community members, we shouldn’t accept exposure to infections and poor care as an unavoidable risk within our health care system.

The Partnership for Patients: A Smart Move in the Right Direction
Fortunately, the Partnership takes several steps to address these problems.

First, it will work with stakeholders — including patients, community groups and advocates — to lower the rates of preventable hospital-acquired conditions by 40 percent and hospital readmissions by 20 percent, all by 2013. (Not coincidentally, the Affordable Care Act includes provisions that will reduce Medicare payments to hospitals for hospital-acquired infections in the coming years. The Partnership will give hospitals an opportunity to take early steps to improve care and skirt financial penalties.) As an initial step, HHS is looking for hospitals, employers, payers, community groups, state and local government officials and others to sign a pledge to improve care coordination and quality.

But there’s more. HHS is currently accepting applications on a rolling basis for the Community-Based Care Transitions Program (CCTP) a new Medicare demonstration project authorized by the ACA. To apply for some of the $500 million in CCTP funding, acute-care hospitals have to partner with community-based organizations, such as area agencies on aging, that offer care transition services and include adequate consumer representation on their governing boards.

The Healthy Hospital Initiative: Demanding Better Care at the Bedside and Beyond
The Partnership is an important step to improving care and quality. But it’s not the only step. And it certainly won’t reach its full potential without engaging communities, patients and families to collaborate with and — where necessary — hold hospitals, providers, and government accountable for achieving Partnership goals.

That’s why we, along with other state and national organizations involved with the Campaign for Better Care , decided to launch a Healthy Hospital Initiative. We’ll build on the new federal initiative to ensure that patients, family members, and communities have the tools they need to participate fully in the Partnership and to push the envelope with providers and others, when necessary. Over the coming weeks, the Healthy Hospital Initiative will be rolling out more tools to help community groups gear up for this level of involvement.

How You Can Become Involved
What can you do right now to support the Partnership for Patients?

  • – Link up with the Healthy Hospital Initiative.
  • – Identify families in your networks who’ve been harmed by hospital-acquired infections, and let them know how their stories can be powerful tools to increase awareness about the need for these new programs.
  • – Sign the Partnership pledge, and encourage local hospitals and providers to do the same. To see a list of the hospitals and others that have already pledged in your state, check out the Partnership map and database.
  • – Reach out to your regional HHS director to find out more about local or regional efforts to build the Partnership, and offer to get involved.
  • – Learn more about patient safety.
  • – Reach out to hospitals and other providers in your area about developing a proposal to participate in the Community-Based Care Transitions Program.

– Jessica Curtis, Policy Analyst, Integrated Care Advocacy Project

Tags: , ,
Posted in Affordable Care Act implementation, Hospital Accountability/Charity Care | No Comments »

A Tale of Two Deficit Reduction Approaches

Friday, April 15th, 2011

In his speech on Wednesday, President Obama laid out his plan for deficit reduction, and last week, Congressional Republicans released their 2012 budget proposal. Both plans reduce federal expenditures on Medicare and Medicaid, but they take strikingly different approaches. What are the key takeaways for health advocates?

Takeaway #1: The president gets the big picture right on key health care issues. Before the president’s speech, we laid out three key issues health advocates should be listening for. Between his speech and accompanying documents, it’s clear that the president is in a resoundingly good place on all three issues:

1. The president explicitly rejected proposals to turn Medicare into a voucher program and to convert Medicaid into a block grant. These approaches, the backbones of the 2012 Congressional Republican budget, do nothing to tackle the underlying drivers of health care costs. Instead, they shift these costs onto those who can least afford them: seniors, people with disabilities, and low-income families.

2. The president also understands the harm imposed by federal spending caps. While this is less clear from his remarks, follow up with White House officials makes it clear that the administration understands that a global cap is just a back door to turning Medicaid into a block grant and Medicare into a voucher.

3. He articulated an alternative, far more rational approach to cost containment, which builds on foundation of the Affordable Care Act. The president identified key approaches to build on the cost-containment structure laid out in the ACA. For example, he suggests strengthening the mandate of an independent commission of doctors, nurses, medical experts and consumers, created by the ACA, to weed out wasteful spending in Medicare without reducing benefits or increasing seniors’ costs. He also proposes using Medicare’s purchasing power to negotiate lower prescription drug prices for America’s seniors. And he recommends changing the way we reimburse for health care services, moving us away from a system that pays providers for more services and towards one that pays providers for better health outcomes.

(For more on the ACA’s approach to cost containment and how it can be enhanced going forward, see our one page graphic and issue brief.)

Of course there are still many details of the president’s proposal to be filled in, and there are some concerns about specific elements such as the overall size of the proposed Medicaid cut and new limits on states’ ability to tax health care providers to fund Medicaid. But it’s also important to put the President’s proposal in context, which brings us to…

Takeaway #2: The president’s approach presents a stark contrast to the one endorsed by Congressional Republicans. This contrast is most obvious in two key areas:

1. Reducing costs vs. shifting costs. As we laid out above, the president’s approach looks to reduce health care costs primarily by tackling their underlying causes.

Congressional Republicans, on the other hand, treat rising health care expenditures like a game of “hot potato”: they merely toss these costs onto states, seniors, people with disabilities, health care providers, and other vulnerable families. First, they turn Medicaid into a block-grant program that, by design, would not keep up with rising health care costs. This would impose crippling burden on states, leading to rollbacks in health care coverage for millions of nursing home residents, people with disabilities and low-income children and families. It is no exaggeration to say that some would die as a result.

Second, they end Medicare as we know it and replace it with a voucher that seniors would use to buy coverage on the private market. These vouchers, like the block grants above, are designed not to keep up with rising health care costs, leaving seniors to pay an ever-increasing share of their health care costs. According to the nonpartisan Congressional Budget Office, under this plan the average senior would shoulder $6,000 more in annual out-of-pocket costs by 2022.

2. Bank accounts of millionaires vs. health security for seniors, people with disabilities and low-income children. Unlike President Obama, the Congressional Republicans would extend Bush-era tax cuts for the wealthiest Americans. Under this plan, the average person earning at least a million dollars a year would receive an average tax cut of $125,000 per year. Through severe cuts to Medicaid and Medicare outlined above, Congressional Republicans essentially force America’s most vulnerable citizens to finance these tax cuts for its wealthiest citizens.

These contrasting budget proposals offer us a clear choice: We can maintain and improve health security for American families, or we can have tax cuts for the wealthiest people and corporations. We can’t have both and still reduce the deficit. The American people have already indicated their policy preference—for example, three quarters think Medicaid funding should either be kept the same or increased, and 70 percent would prefer shielding the program from cuts to using it for deficit reduction.

The president is clearly listening. Is Congress?

– Katherine Howitt, Policy Analyst and
Michael Miller, Policy Director

Tags: , , ,
Posted in Affordable Care Act implementation, Medicaid | No Comments »

Protecting Prevention Funding Is Key to Controlling Health Costs

Thursday, April 14th, 2011

As House Republicans hammered away this week at federal spending, they took another whack at the Prevention and Public Health Fund. But if their goal is really saving money, they just hit their thumb instead of the proverbial nail.

The Affordable Care Act established the Prevention Fund and allocated $15 billion over the next decade to help shift the focus of our health system from treating diseases to preventing illness. The ultimate goal is improving the health of Americans and reducing long-term health costs. Already, the Fund is supporting state and local initiatives to reduce obesity, cut tobacco use, prevent HIV/AIDS and train more public health workers.

This year, it will also fund the Community Transformation Grants, an innovative program to support local efforts to reduce chronic disease and health disparities. Expanding prevention initiatives is one third of the package needed to control health care spending, along with reducing waste and occasional bad care in Medicaid and Medicare, and cutting prices and high administrative costs in the private sector.

But Republicans in Congress have repeatedly targeted the fund for repeal, or attempted to take its funding for other purposes. Yesterday, amid claims that the money provides a “slush fund” for Health and Human Services Secretary Kathleen Sebelius, the Republican-controlled House voted 236 to 183 to repeal the fund and rescind all money not already spent. This struck a political blow against the Affordable Care Act, but if the repeal were to pass the Senate and get signed by the president, it would leave the country sicker – from both diseases and rising health costs.

Fortunately, President Obama and Senate Democratic leaders understand that prevention can both save lives and save money.  Senate President Harry Reid and Senator Tom Harkin, chairman of the Senate Health, Education, Labor and Pensions Committee and the father of the fund, are not likely to bring the repeal bill to the Senate floor for a vote. Also yesterday, the White House issued a statement  indicating that the President would likely veto any attempt to eliminate the Fund.  The “statement of administrative policy” said repeal “could worsen the nation’s health and increase system costs.” Indeed. The prevention funding is also key to expanding jobs and improving the health and productivity of America’s workers.

There continues to be some risk that money from the Fund will be used to pay for existing prevention efforts, rather than the new initiatives envisioned by Harkin and others. The Fund escaped a direct cut in the compromise plan to fund the federal government for the rest of this fiscal year, despite $38 billion taken from other programs. However, there remains the unfortunate possibility that the Obama administration may tap the Fund to replace some of the $730 million cut from the Centers for Disease Control and Prevention.

The bottom line: It remains important to educate all members of Congress about the long-term savings that result from reducing chronic diseases, and the important role the Prevention Fund plays in our nation’s long-term financial health. 

- Alice Dembner, Deputy Policy Director

Tags: , ,
Posted in Affordable Care Act implementation, Health disparities, Uncategorized | 1 Comment »

Obama’s Speech Today: A Listeners Guide for Health Care Advocates

Wednesday, April 13th, 2011

Later today when the President speaks about the national debt, what should health care advocates be expecting and hoping to hear? Given that long-term projections of rising public debt rest almost entirely on growth in health spending, we should expect at least some substantial attention will be paid to health care cost containment. However, don’t expect a detailed prescription. 

Since the President is addressing the public at large, he is unlikely to get too deep in the policy weeds, but there are a few key things health care advocates should be listening for (even if only “between the lines”):

Does the President address block grants and vouchers?
We should expect the administration to reject explicitly or implicitly both a Medicare voucher and a Medicaid block grant. It’s notable that two of the President’s top health policy advisors were leading public opponents of Medicaid block grants during previous efforts to transform the program, and it is very unlikely that the President will move off of this position.  This is where we should expect the most clarity as the President works to distinguish his approach from the one laid out by Congressman Ryan in the context of the FY2012 federal budget.

Does the President endorse a global federal health spending cap a la Bowles-Simpson?
While the Bowles-Simpson debt reduction plan does not call for either a Medicaid block grant or a Medicare voucher, it does call for limiting the growth of federal health spending to the rate of GDP plus one percent. Such an inflexible spending target would fail to allow for growth in the number of elderly or Americans with disabilities, an economic downturn, an epidemic, or changes in health care delivery that bring substantial benefits but also new costs. While we can expect the President to be somewhat clear in rejecting a block grant or voucher, his position on a global spending cap is truly unknown. Since the spending cap approach has garnered some favorable attention from a bipartisan group of Senators working on a debt reduction plan, a signal of Presidential approval or disapproval of this position could be very important. Silence on this point would also be important and would likely be interpreted on Capitol Hill as a green light to continue to negotiate a global spending cap.

Does the President offer a rational framework for reducing health care spending, consistent with the Affordable Care Act?
One of the big lies about the ACA is that it doesn’t tackle health care cost containment.  In fact, the ACA approaches cost containment in a very rational way.  If you look at the sources of excess health care spending in the U.S. relative to the rest of the world, you see that high prices and high administrative costs, particularly in the private sector, are among the main causes. Within public programs, high administrative costs and high prices are much less of an issue (with prescription drug prices for Medicare beneficiaries being a notable exception). Instead, the sources of low-value public health care spending primarily include preventable hospital and nursing home admissions, preventable complications (such as infections and other medical errors) and improper payments. Finally, any long-term cost containment approach must include improvements in the underlying health of the population.

The ACA already tackles all of these issues with: Exchanges, Minimum Medical Loss Ratios, beefed up rate review, enhanced payment oversight for Medicare and Medicaid, new Medicare and Medicaid payment and delivery models, investments in community care and improving transitions between hospital and community, major investments in public health and more. 

Of course more could be done, but generally that would require reopening some of the deals that were negotiated in the context of the ACA debate.  It will be instructive to listen for clues as to whether President Obama stands behind the cost containment path chartered by the ACA and whether he indicates a desire to go further down that road, or if he signals a change in direction—one that would involve placing more of a burden on elders, people with disabilities, and low-income children and families. 

Stay tuned for follow up analysis tomorrow.

- Michael Miller, Policy Director

Tags: , , ,
Posted in Affordable Care Act implementation, Medicaid, Uncategorized | 1 Comment »

Ryan’s Plan CHIP-ing Away at Children’s Coverage

Monday, April 11th, 2011

House Budget Committee Chairman Paul Ryan’s Federal Fiscal Year 2012 budget blueprint, dubiously titled The Path to Prosperity, has damaging implications for children’s health. The Republican budget plan would dramatically cut funding for Medicaid and the Children’s Health Insurance Program (CHIP), health insurance programs that cover about 30 million children—almost a third of all children living in our country today.

Chairman Ryan would cut Medicaid and CHIP by a staggering $2 trillion over the next 10 years by doing the following:

  1. Slashing the Medicaid Budget: Ryan’s proposal would cut $771 billion in federal spending from the Medicaid program. According to the Congressional Budget Office, “federal spending for Medicaid would be 35 percent lower in 2022 and 49 percent lower in 2030 than currently projected.”
  2. Transforming Medicaid into a Block Grant: Under a block grant, states that use up their federal Medicaid allotment will no longer be able to receive additional federal funds when costs go up or enrollment increases. Cash-strapped states will be left high and dry, and will have to make up the difference by raising taxes, cutting other spending, or shrinking their Medicaid programs.
  3. Repealing the Affordable Care Act: Ryan’s blueprint repeals most of the new health law’s major provisions, including its language extending CHIP through 2019 and fully funding the program through 2015. This means that CHIP would not receive any federal funding past 2013, its reauthorization date prior to the Affordable Care Act’s (ACA) two-year funding extension. Repealing the ACA would also cut an additional $627 billion from Medicaid—bringing total Medicaid cuts to $1.4 trillion—and would have a host of other detrimental effects on children’s access to quality health care.

States will have to fill in these funding gaps somehow, which could mean cutting reimbursement rates to providers and hospitals, limiting benefits, or reducing eligibility levels. No matter how states work to fill in these gaps, children are likely to lose out. Children represent half of all Medicaid enrollees, but account for only 20 percent of Medicaid spending—meaning that huge numbers of children could be adversely affected by program cuts yet save the federal government comparatively little money.

The impact of limiting benefits is particularly concerning for children. As Jocelyn Guyer from the Georgetown Center for Children and Families points out in a recent Say Ahhh! blog post, families rely on these programs “for hearing tests and glasses so their children can grow and learn, as well as for physicals so they can play sports. In many families, Medicaid provides children with the medical care that they need so they can thrive in the face of common medical conditions such as asthma and ADHD.”

While Ryan’s budget proposal may be a path to prosperity if you’re a wealthy individual or corporation in line to receive some $1.8 trillion in tax cuts, it certainly isn’t a path to prosperity if you’re a family who depends on Medicaid or CHIP for your child’s asthma medications, eye tests, or flu shots. Our nation cannot afford to ignore the needs of its children. We can and should do better.

—Maia Fedyszyn, Program Associate, New England Alliance for Children’s Health

Tags: , ,
Posted in children's health | 1 Comment »

In Minnesota — A New Approach to Filling Gaps in Dental Care

Monday, April 11th, 2011

In 2008, nearly 350,000 Minnesotans did not receive regular dental care. One of the major reasons was a lack of dentists to adequately treat the population. To meet their unmet needs, Minnesota policymakers embraced an innovative approach – enhance the dental team by adding a new member, a dental therapist, who can work in underserved and rural areas.

Last week, dental therapists in Minnesota finished taking their board examinations and are set to dive into helping dentists and the rest of the dental team help meet the unmet oral health needs of residents. The Minneapolis Star Tribune reported dental therapists will help “fill holes, literally and figuratively, in community settings where dentists aren’t going. Regular dental care is out of reach for about 350,000 low-income Minnesotans. And Minnesota’s ranking among the top five states for dental health masks an ugly truth — 80 percent of tooth decay is found in just 25 percent of our children, most of them low-income.”

Minnesota isn’t the only state with poor oral health. Just this week the Cleveland Plain Dealer reported that in Collinwood, Ohio, there is just one dentist to serve 28,000 residents. By accepted standards, this East Side Cleveland neighborhood should have the full-time equivalent of nine dentists. As a result of severe dental shortages in Ohio and other barriers to care such as cost, oral health is the top health need among children and low-income adults in the state according to the Ohio Department of Health.

Unmet oral health needs are not a new issue. More than a decade ago, Surgeon General David Satcher identified a “silent epidemic” of dental and oral diseases that burdens some population groups and called for a national effort to improve oral health among all Americans.

Oral health is essential to overall health, yet significant gains have not been made over the last decade to improve the oral health of the nation as a whole. Today, 49 million Americans live in communities without enough dentists and state dental policies fail one in five children. The two biggest barriers to oral health care for Americans continues to be the high cost of care and not enough providers to meet the needs of underserved communities.

While the problem is getting worse in places like Ohio, there is hope that states will embrace innovation as in the case of Minnesota or follow the trail blazed by Alaska Native communities who have taken tangible steps to improve the oral health of their community by adding dental therapists to the dental team.

While Alaskan policymakers struggled with the oral health crisis – a 1998 study found they had only 20 or so dentists to serve more than 200 hundred villages and 85,000 people, Alaska Natives responded by developing their own workforce to meet the needs of their communities. As I blogged here, dental therapists provide safe, competent care and help meet the unmet oral health needs of Alaska Natives.

Yet despite multiple studies and a recent Government Accountability Office (GAO) report that show dental therapists provide quality care and can increase access to care, opposition persists from organized dentistry that is based on little more than fear as noted by Dr. Frank Catalanotto at professor and chair at the University of Florida College of Dentistry.

Knowing that poor access to oral health care remains a critical priority that demands a real solution, in partnership with the W.K. Kellogg Foundation and partners in five states, Community Catalyst launched an effort to improve how dental care is delivered by enhancing the dental team in order to ensure millions of more Americans have access to care in their community.

Our efforts to bring dental care and dental therapists to underserved communities in Vermont, Kansas, New Mexico, Ohio, and Washington are gaining traction. And, as dental therapist begin to work on the ground in Minnesota, it will be tougher to ignore the need to enhance the dental workforce and the real benefits dental therapists will have underserved communities.

In New Mexico, Don Weideman, a hospital CEO from a small town, is excited by a bill that creates dental therapists because it could, “finally bring dental care a whole lot closer to home for thousands of people in rural communities throughout New Mexico… And as a hospital CEO, an employer whose workers have to take a whole day off to get dental care, a father whose kids miss a day of school every time they need to see a dentist and as a patient who waited more than four months to get a wisdom tooth pulled, I’m even more excited.”

In Kansas, local dentists Dr. Miner and Dr. Minnis were joined by Dr. Nagel in testifying in support of adding a mid-level provider, a registered dental practitioner to the team to enhance the dental team’s ability to treat patients in underserved and rural communities as well as to save lives. As the Kansas Health Institute notes, Sen. Roger Reitz (R-Manhattan), a physician and member of the committee, said their remarks had been, “spellbinding. This is good stuff,”

While no other state has joined Minnesota in passing legislation that increases access to care by putting providers in communities where there are none, we need to remember that real change, while it takes time, is not out of reach. Not that long ago, dental therapists were a distant concept in Alaska. Now, dental therapists are providing care to nearly 20,000 previously underserved Alaska Natives and soon dental therapists will begin working to provide 350,000 underserved Minnesotans with regular care.

As the gains against the oral health epidemic in Minnesota and Alaska’s Native Communities are highlighted, policymakers will work toward real solutions, such as dental therapists, that can improve oral health for their constituents.

– David Jordan, Director, Dental Access Project

Posted in Uncategorized | No Comments »

A Government Shutdown of Women’s Health?

Friday, April 8th, 2011

Since the new Congress came to Washington DC some Republicans in the House have been very concerned with women’s health care; however, not necessarily in a good way.

In the last few months, the House Leadership has tried to eliminate funding for Title X, the federal family planning program, passed an amendment that bans Planned Parenthood from receiving any federal funds to provide health care services to their communities, and introduced legislation that attempts to further restrict access to abortion services.

(For more about the legislation see Kaiser’s side-by-side comparison.)

As I write this blog, the latest news reports are saying the federal government shut down may hinge on whether Planned Parenthood is allowed to receive federal funding to provide needed health care services like family planning, sexually transmitted infection testing and counseling, HIV/AIDS testing and counseling and pap smears. None of the federal funds Planned Parenthood currently receives are allowed to be used for abortion services.

Members of Congress who support slashing funding for Planned Parenthood and important women’s health programs are the same individuals who want to dismantle and defund the Affordable Care Act. What were their first actions when they came to Washington in January? They introduced legislation to repeal the ACA — including trying to dismantle the carefully crafted abortion compromise in the law. Tying the two issues together allows opponents to spread misinformation and confuse the public about the ACA.

We took big strides forward when we passed the ACA to ensure access to health care services for families. For women, in particular the ACA:

  • – Stops insurance companies from denying coverage for pre-existing conditions – including pregnancy;
  • – Covers preventive services like mammograms and other preventive screening without out-of-pocket costs;
  • –  Lowers health care costs for women by not allowing women to be charged more than men.

Allowing any of the proposals in the House discussed here to move forward is a slippery slope that could cause real harm to women’s health. Our elected officials should be working to ensure access to women’s health care services is not undermined so women can get the health care they need, when they need it.

– Reena Singh, Field Coordinator

Tags: ,
Posted in Affordable Care Act implementation | No Comments »

Toward Better Health for People of Color

Friday, April 8th, 2011

Focusing unprecedented federal attention on the barriers to good health for people of color, the US Department of Health and Human Services unveiled a two-part plan today of federal and community strategies designed to move the nation toward health equity. The plans mark an important step forward. The impact will depend on how strategies are implemented on the ground.

The goal is to reduce health disparities such as the fact that black babies are twice as likely to die in their first year as white babies, Hispanics die of diabetes at 1.4 times the rate of whites, and Asian-Americans are far more likely to contract Hepatitis A than whites. The causes of these problems run deep, far beyond access to insurance coverage or health care. They include the jobs we get, the places we live and the quality of schools for our children.

Part one is HHS Action Plan to Reduce Racial and Ethnic Health Disparities , which coordinates health equity measures in the Affordable Care Act, Healthy People 2020 and other existing federal initiatives. It sets out five broad goals, ranging from expanding access to health care to diversifying the health workforce. Specific steps include implementing the long-awaited Community Transformation Grants, creating an online registry of medical interpreters for patients who don’t speak English, expanding the use of community health workers in the Medicaid program, and expanding preventive dental care for children.

HHS Assistant Secretary Howard Koh called it “the most comprehensive federal effort ever to address racial and ethnic disparities.”

Part 2 is the National Stakeholder Strategy for Achieving Health Equity, which provides a second set of goals and strategies for initiatives and partnerships designed to foster community-level engagement. This strategy was developed over several years through local, regional and national meetings called the National Partnership for Action. The document details 20 strategies ranging from training youth to be health leaders to ensuring the availability of health data on underserved populations. It calls for the formation of 10 regional health equity councils to coordinate and galvanize the work, and promises to provide local communities with technical assistance and tool kits to move forward.

Given the bruising budget battles underway in Washington, no new money is attached to the plans. The federal work will draw on existing funding, including money currently under siege from the Affordable Care Act – another reason to defend that funding. For the most part, the local initiatives will need to find their own resources. Fortunately, the stakeholder strategy lays out hundreds of objectives which could be the basis for local organizing and could be attractive to local funders.

– Alice Dembner, Deputy Policy Director

Tags: , ,
Posted in Health disparities | 5 Comments »

Sliding further down a slippery slope: Congress weakens ACA affordability protections again

Tuesday, April 5th, 2011

Earlier today, Congress approved a bill that reduces paperwork requirements on small businesses by repealing what’s known as the enhanced 1099 reporting requirements passed as part of the Affordable Care Act (ACA.) Congress paid for this change by weakening the ACA’s health insurance affordability protections for low- and moderate-income families. While repeal of 1099 reporting requirements is an important priority for small businesses, the costs of this adjustment should not come directly from the pockets of struggling families.

How did Congress pay for 1099 repeal?
Starting in 2014, the Affordable Care Act provides sliding-scale tax credits to help lower the costs of premiums for people earning up to 400 percent of the Federal Poverty Level (around $73,000 for a family of three.) The law allows the federal government to pay these tax credits directly to the insurer each month, so beneficiaries will only be billed for the amount of the premium they owe in excess of their tax credit. But if a person’s income changes during the year, they could potentially be eligible for an additional credit or owe an additional amount when they file their taxes. To strike a balance between recapturing subsidies and not hitting working families too hard, Congress placed caps in the ACA on how much low- and moderate-income families could be required to repay.

Earlier today, that balance was tipped against working families. Congress paid for the 1099 repeal by increasing the amount by $500, and sometimes more, that some low- and moderate-income families could have to repay at the end of the year if their annual income was higher than expected.

For example, a family may start the year off with a very low income and qualify for substantial premium tax credits each month. Midway through the year, one family member then gets a new job that raises the family’s income and offers health insurance, and they stop receiving monthly premium tax credits. However, at the end of the year that family will have to repay some of the tax credits they received when their income was lower, since their annual income turned out to be higher than their expected annual income when they qualified for the credits. The 1099 repeal bill passed by the Senate today increases the amount that many families in this situation will have to repay.

This provision is harmful to families and is politically dangerous because it:

  • – Increases financial penalties on low- and moderate-income families for having found a better job or gotten a raise. These new costs will impose financial hardship on already-struggling families.
  • – Reduces the number of people who will enroll in the advanced tax credits, since they will fear this type of unexpected cost. This means fewer people will get the coverage they need.
  • – Jeopardizes public support for the ACA. Stories of families owing substantial unexpected costs could lead to further decline in public support for the law.

Does this feel like déjà vu?
That’s because Congress already increased these repayment amounts to pay for a law passed last December that averted a scheduled 25 percent cut in Medicare reimbursement rates for doctors. We blogged about it then, warning that it was the first step down a slippery slope. We’re sorry to see Congress take yet another step down that dangerous slope today.

-Katherine Howitt, Policy Analyst

Tags: ,
Posted in Affordable Care Act implementation | No Comments »

Wellness Programs: Boon or Bust?

Tuesday, April 5th, 2011

We want Americans to live healthy lives and take good care of themselves. So does John Berry, the director of the U.S. Office of Personnel Management (OPM). As matter of fact, recently, Berry told health insurance companies that participate in the Federal Employees Health Benefits Program (FEHBP) to encourage healthy lifestyles by offering employees “concrete incentives to participate in wellness and prevention activities.” The next day, the OPM published its annual call letter, which outlines the benefits that participating insurance companies are expected to cover. In the letter, the OPM clearly states it expects the insurers wanting to participate in FEHBP to offer programs that promote health and wellness, which improve employee productivity, enhance healthy lifestyles, and lower long-term healthcare costs.”

Wellness programs are not new. For the past two decades, large employers have been experimenting with wellness pilot programs for their employees. Gym discounts and smoking cessation classes are classic wellness incentives. Now, a growing number of employers are offering wellness or health promotion programs. The Affordable Care Act (ACA) allows employers to “reward” employees with lower premiums, up to 30 percent of the cost of employee-only coverage under the plan, with room to up this to 50 percent with the approval of the Secretaries of Health and Human Services, Labor and the Treasury.

Wellness programs work as employee benefits, but also as a cost saving mechanism for employers. How? The theory behind wellness programs is that by maintaining a healthy workforce, the employer enjoys higher productivity and, down the long-run, reduced health care spending.

The cost-savings theory is well-intentioned, and there has been some limited evidence among large employers, such as Pitney Bowes and Johnson & Johnson, that wellness programs do promote some improved health outcomes and lower health care spending.

But most wellness programs are run by large employers with hundreds of employees and low employee turnover rates. In these organizations, employers have the resources to be innovative and can afford to undertake a wellness program, where they may reap benefits in the long run.

Moreover, wellness programs vary widely between employers, and as more are implemented, potential risks are being identified that need to be addressed before programs are expanded.

The most pressing issue is the potential employee discrimination based on data collected through a health risk assessment (HRA). Such data include an individual’s health information, which may be sensitive and which the employee most likely doesn’t want to share with the employer. Recognizing this problem, various federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), the Americans with Disabilities Act (ADA), the Genetic Information Nondiscrimination Act (GINA), ban employers from discriminating against employees based on health factors, which would include information gathered through HRAs.

But how far can an employer go without triggering any of the discrimination laws? Can an employer discriminate against an employee because he has high cholesterol level? Because she smokes? Because he is overweight? The smaller the employer, the more serious the issue. At a smaller business, everyone knows each other, which may cause the employee to worry about revealing one’s health status to the employer.

The second issue is penalties. There are two types of incentives in a wellness program: One that provides rewards, and one that allows avoiding penalties. The latter only works if those who don’t receive the incentives receive penalties. If a program allows premium discounts for those who lose weight or reduce their cholesterol levels to a certain point but increases premiums for those who were unable to do so, that cost-shifting acts as a penalty. Sure, it can be seen that it is the individual’s responsibility to become healthier. However, a person’s health is highly complex and simply judging someone based on a single factor, such as weight or personal habits, is insufficient to impose mechanisms such as cost-shifting and penalties.

Such penalties can also lead to adverse selection, where less healthy employees are forced out of employment due to unaffordable premiums. Also of concern is wellness program participants getting penalized due to inadequate support to ensure their success in getting healthier.

What we do know: ingredients for wellness success
There are a few ingredients that are necessary for a wellness program to succeed. Programs must:

  • – collect baseline health information from the participating employees through completing an HRA.
  • – provide some incentive for the employees to continuously participate in the program. The incentive can be anything from gym discounts and free smoking cessation classes to actual premium discounts. Discounts can be based on simple participation in wellness programs, or on actual health changes, such as losing weight or reducing the cholesterol level compared to the HRA record.
  • – receive strong buy-in and commitment from the employer to sustain programs, because it takes time for positive results to surface while the employer invests money into implementing and maintaining wellness programs.

What is a sufficient wellness program?
Some larger employers who have had wellness programs for decades have some data showing positive results, such as increased employee health status and reduced overall health care costs. But because no wellness program is alike and employers run multiple programs at the same time, there really isn’t enough evidence showing which programs really work and which don’t. Furthermore, there is almost no qualitative or quantitative study that analyzes wellness programs in smaller employer settings. This is a huge issue for employees at smaller businesses who have limited resources. Unlike larger employers, they don’t have the luxury of trying the everything-but-the-kitchen-sink approach.

Promoting the wellbeing of individuals is a wonderful idea, but it must be done correctly so that employees are not discriminated against or penalized for health factors that are sometimes beyond their control. Wellness programs must also be continuously measured both quantitatively and qualitatively so that the participants can learn about the true benefits of the programs, not only for the employers, but for the individual employees.

– Jekkie Kim, Guest Blogger
Legal and Policy Analyst, Health Care for All Massachusetts

Tags: ,
Posted in private insurance | No Comments »

« Older Entries