Archive for the ‘children’s health’ Category

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Cross Post: Is Your State Reviewing Potential EHB Benchmarks?

Thursday, February 2nd, 2012

This blog was originally posted on “Say Ahhh!” the Georgetown University Center for Children and Families blog.

HHS’s essential health benefits bulletin is less than two months old—in fact, the comment period just closed this week, click here for our comment letter—but some states are already planning for what it could mean for their residents.

The Bulletin indicates that states will be able to choose the core of their essential health benefits package by copying the benefits from one of ten existing health plans. That immediately raises the question—what do those ten plans cover? And which one would be best for kids, families, and all health insurance consumers?

Answering these questions will be complex, but a great way to start is to look at the ten plan choices side-by-side to compare what they cover. In Maine, the Department of Insurance has put together a helpful table that compares coverage across plans in some key benefit categories. It’s by no means a complete analysis, but it’s a great way to begin this important comparison.

Have you seen a similar document in your state? If not, it could be something to ask your state’s insurance regulator to put together. Of course, you’ll still want to make sure that the full plan documents that provide detailed coverage information are released publicly for each of the potential benchmarks before your state’s selection is made. But getting the plan comparison underway with a summary table like Maine’s can be a good way to get started—the Bulletin says states should choose their benchmark plans by the third quarter of this year.

– Joe Touschner
Georgetown University Center for Children and Families 

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Recent Developments in Nutrition Policy Affecting Child Health: A Roundup

Friday, January 27th, 2012

The end of 2011 and beginning of 2012 saw significant developments—mostly positive but some negative—in nutrition policy affecting children’s health. From new school meal requirements to food marketing guidelines to evidence supporting the effectiveness of sugar-sweetened beverage (SSB) taxes, the landscape of nutrition policy affecting children’s health has been changing in important ways.

School Nutrition Standards: Would You Like (Sweet Potato) Fries with That?

First Lady Michelle Obama and Agriculture Secretary Tom Vilsack unveiled the new standards for school meals on January 25 in the form of a final rule, marking the first substantial changes to school meals in 15 years. The standards, a product of the Healthy, Hunger-Free Kids Act of 2010, have drawn significant public attention. People have strong feelings about school meals, as evidenced by the nearly 132,000 public comments the United States Department of Agriculture (USDA) received on the issue.

On the whole, the new standards promise to significantly improve the nutritional value of meals served in schools. Some positive developments in the final rule include:

  • • An increase in the amounts of fruits and vegetables served every day
  • • An increase in the amount of whole grains served
  • • A requirement to provide only no- and low-fat milk options
  • • A requirement to reduce the amounts of sodium, trans fat and saturated fat
  • • A requirement to focus portion sizes to reflect appropriate calorie amounts for children based on age

Despite these positive improvements, some important provisions were removed from the initial proposed rule (after Congress required this), which is disappointing. These include limiting the USDA’s ability to regulate the amount of starchy vegetables provided in school lunches as well as preventing the USDA from increasing the amount of tomato paste required in order to allow it to count as a vegetable serving within the new framework.

These changes will have a significant impact, as nearly 32 million children participate in school meal programs every day. The new standards will be phased in over a three-year period, starting in the 2012 to 2013 school year. To see what a sample elementary school lunch menu could look like both before and after the new standards take effect, click here.

Voluntary Food Marketing Principles: Further Setbacks or Ronald McDonald is Here to Stay

On a less positive note, important progress toward the development of voluntary principles for marketing food to children came to a standstill at the end of 2011. The voluntary guidelines, developed by an Interagency Working Group (or IWG, consisting of the Federal Trade Commission, Food and Drug Administration, Centers for Disease Control and Prevention, and USDA) have received enormous criticism from the food and beverage industry. Initial opposition to the voluntary guidelines in October resulted in a narrowing focus to reduce advertising targeted at children under the age of 12 rather than all children under the age of 17 and provided exemptions for holiday promotions and established marketing characters. Further setbacks occurred in December when Congress required the IWG to conduct a cost-benefit analysis of the proposed guidelines, significantly delaying finalization of the proposal. At this stage, the ultimate fate of the guidelines remains unclear at best.

New Article Adds Further Evidence to Support Taxation of Sugar-Sweetened Beverages

A new article published in Health Affairs adds to the overwhelming evidence that supports the idea of SSB excise taxes as a key public health measure aimed at addressing obesity. The study authors found that a penny-per-ounce excise tax on SSBs would reduce SSB consumption by 15 percent for adults ages 25 to 64 and a 1.5 percent reduction in obese adults as a result. From 2010 to 2020, the study projected that this decrease in consumption would prevent 26,000 premature deaths while avoiding over $17 billion in medical expenses. While this study focused on adults, it’s consistent with a previous report by the USDA that has demonstrated the similarly positive health benefits for both children and adults resulting from SSB excise taxes.

It’s exciting that addressing child health through nutrition policy is being seen as a major priority. Now, it’s up to child health advocates to continue to educate policymakers about the importance of this issue to keep it front and center amidst a range of competing priorities in the coming months.

—Patrick M. Tigue, Senior Policy Analyst and
Kyle Bogaert, Intern, New England Alliance for Children’s Health

 

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Oh so close…

Thursday, January 5th, 2012

While the New England states are leaders in the nation in reducing the number of uninsured children, with coverage rates from 94 to 98 percent across the region, there is one area where New England is falling woefully behind. According to a new report from the Center on Budget and Policy Priorities only half the New England states, Maine, New Hampshire and Vermont, offer online applications and renewals for families trying to enroll their children in Medicaid or CHIP. This places the region squarely behind other parts of the country including the South and Northwest. With online applications available for everything from credit cards to colleges, it seems hard to believe that applications for vital health services are not available on such an efficient and accessible platform.

Many families live in rural areas without easy access to local government offices. These families would benefit from the remote access offered by online applications. Making applications available online would also reduce the potential for incomplete and misplaced submissions. Through questions, prompts and blocks that do not allow incomplete forms to be submitted, online applications provide useful feedback in a way paper applications cannot.

Given the high tech business sector in many New England states and with all the efforts states have put into achieving such high enrollment numbers, it is surprising that they have not taken advantage of this common-sense extra push. Online applications, along with other streamlined application and renewal procedures may be just what New England needs to get to 100 percent enrollment of eligible children in health coverage. Hopefully New England will make 2012 a year of great advances in coverage and consumer access starting with online applications and renewal for health benefits.

– Nicole Tambouret, Project Director
New England Alliance for Children’ Health

Please note, this blog was updated to reflect Maine’s policy on electronic applications, which was not originally reflected in the report.

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The Affordable Care Act is Keeping Young Adults Healthy for the Holidays

Thursday, December 15th, 2011

Thanks to a key provision of the Affordable Care Act (ACA), 2.5 million young adults will be healthy for the holidays this year. As we’ve blogged about previously, the ACA allows most young adults under 26 to remain on their parents’ health plans if they don’t yet have access to coverage through their job. Prior to the ACA, insurers had the option of removing enrolled children usually when they turned 19 or perhaps a few years later if they were full-time students. By allowing young adults to continue to receive coverage through a parent’s plan, the ACA gives young adults and their families peace of mind that the transition to adulthood doesn’t have to mean forgoing access to essential health care.

The new figures released by National Center for Health Statistics confirm that since the provision went into effect in September 2010, an additional 2.5 million young adults gained coverage even as other age brackets remained steady in coverage levels. This means that from September 2010 to June 2011 the percentage of adults 19 to 25 with coverage increased from 64 percent to 73 percent and it’s clear that the higher levels of coverage are because of the changes brought about by the ACA.

We can’t think of a better way to start the New Year than healthy and worry free and the ACA has already made that a reality for 2.5 million young adults. This is truly something to celebrate during this festive time of year.

—Nicole Tambouret, Project Director
and Patrick M. Tigue, Senior Policy Analyst

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Medicaid and the Children’s Health Insurance Program Buffer the Impact of the Recession on Children

Wednesday, November 30th, 2011

In most respects, children have not been exempt from the impacts of the current economic downturn. The number of children living in poverty in the United States rose to 15.7 million in 2010—a 19 percent increase from 2008. Despite this bleak picture, a new report shows that the rate of uninsured children actually dropped by 14 percent during this same time. What accounts for these counterintuitive findings?

The new report from our partners at the Georgetown University Health Policy Institute’s Center for Children and Families (CCF) (click here for the executive summary) provides strong evidence that the uninsured rate for children decreased in the midst of the worst recession in decades because Medicaid and the Children’s Health Insurance Program (CHIP) were in place to prevent children from failing through the cracks.

CCF found that private insurance coverage of children eroded during this period—dropping by 4.5 percent. This is no surprise, since the recession cost millions of families their jobs and their employer-sponsored insurance (ESI). But public insurance coverage of children increased by 5.8 percent during this same time, filling the gap left by declining ESI. This is simple, hard evidence that public coverage programs are irreplaceable sources of coverage that protect children’s access to care when the economy falters.

Ironically—maybe only in the Alanis Morissette meaning of the word—it’s during these hard economic times, when Medicaid and CHIP are most needed as a safety net, that their funding is most at risk. As policy makers scramble to fill state budget gaps, they too often turn to harmful Medicaid and CHIP cuts such as reductions in provider payments, restrictions on covered services, and increased premiums and co-payments. The findings in the report emphasize why it’s essential that policy makers turn instead to the dozens of delivery and payment system reform options that can achieve savings in Medicaid and CHIP without undermining—and often by actually strengthening—these programs. (See our Medicaid Report Card for ideas on how your state can save money in Medicaid.)

The report also highlights the importance of the maintenance of effort requirement in the Affordable Care Act, which prohibits state policymakers from cutting eligibility for children on Medicaid and CHIP until 2019. The heartening findings in the CCF report would simply not have been possible had states been permitted to slash eligibility in these programs.

The full report includes state-specific data on children’s insurance rates, so check it out and see how your state did (only one state, Minnesota, had a statistically significant increase in uninsured children). With our economic woes likely to continue for some time, this report should renew our commitment to protecting Medicaid and CHIP. The health of our children depends on it.

—Katherine Howitt, Senior Policy Analyst
and Patrick M. Tigue, Senior Policy Analyst

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New Steps in the Fight Against Childhood Obesity

Tuesday, October 11th, 2011

In the United States, childhood obesity is an epidemic. Data from the Centers for Disease Control and Prevention (CDC) indicate that 17 percent of children between ages 2 to 19 are obese. CDC data also show that since 1980 the prevalence of obesity among children and adolescents has nearly tripled. Childhood obesity is linked to a number of debilitating and expensive diseases including cardiovascular disease, diabetes, hypertension, several kinds of cancer, and other chronic conditions. Clearly, childhood obesity is one of the most pressing health issues facing children across the nation.

And that’s why here at the New England Alliance for Children’s Health, a program of Community Catalyst, we were excited to see that the CDC recently announced a new initiative aimed at addressing childhood obesity. The Childhood Obesity Demonstration Project was created by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and funded through the Affordable Care Act (ACA). It will provide $25 million over a four year period to comprehensively identify effective health care and community approaches to reduce childhood obesity in the areas of supporting healthy dietary choices and promoting active living. Children aged two to twelve who are enrolled in CHIP are the target population for the project.

CDC chose only four grantees to participate in the project. Three grantees will serve as research facilities (the University of Texas Health Science Center at Houston, San Diego State University, and the Massachusetts Department of Public Health) that will identify strategies that are effective means to reduce childhood obesity and one grantee (the University of Houston) will serve as the evaluation center for the project and share lessons learned across identified strategies. The project will conclude in September 2015 at which time CDC will widely share the findings from the initiative and make recommendations about effective strategies to prevent childhood obesity among undeserved children.

What we learn from this project needs to inform policy choices at the federal, state and local level if we are going to make much needed progress on the childhood obesity epidemic. And thanks to CHIPRA and the ACA, we now have an even better chance of doing so.

—Patrick M. Tigue, Senior Policy Analyst

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Check Health Care Off Your Back-to-Campus List

Tuesday, August 30th, 2011

For students heading to college, fall is a season full of the excitement and distraction of a new environment, new friends and new classes. With all of the activity, it can be easy to let signing up for health care slip through the cracks. However, health coverage is critical to keep students healthy and financially secure. Young adults need health care just like everyone else, and preventive care is vital for the long-term health of students. Moreover, 16 percent of young people have a chronic condition, like diabetes or asthma that can require expensive doctors’ visits. There’s also the unexpected – a broken bone or random accident could cause severe economic hardship for a student who’s not insured. In fact, young adults go to the emergency room more than any age group under 75, and can easily rack up thousands of dollars in a visit.

The New England Alliance for Children’s Health, a Community Catalyst initiative, is partnering with Young Invincibles to bring students and their families a free Back-To-School Toolkit breaking down student options for health coverage in every state. The toolkit gives up-to-date information on the costs and benefits of student health plans, walks through how to stay on your parent’s plan, explains what to do if you have a pre-existing condition, and provides relevant updates on the new health care law (like the new rules on birth control and preventive services for women). It also has tips for young women, important information on young adults and cancer, and much more.

Click here to download the Back-To-School Toolkit. With your help, we can make sure that everyone has the information they need to stay healthy this school year.

– Nicole Tambouret, Program Manager
New England Alliance for Children’s Health

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How the Affordable Care Act Helps Youth Aging Out of Foster Care

Wednesday, August 17th, 2011

Mandatory Medicaid coverage for former foster care youth who have aged out of the foster care system but are in care as of their eighteenth birthday—an important provision in the Affordable Care Act (ACA) that isn’t as widely known as it should be—is finally getting some traction thanks to a recent paper in the Michigan Journal of Social Work and Social Welfare.

Finding quality, affordable health insurance can often be difficult for youth transitioning out of the foster care system, and providing Medicaid coverage as a bridge during this pivotal time up to age 26 is an incredibly significant step forward. According to the paper’s author, Aisha Hunter (having herself aged out of the foster care system), “the 2014 foster youth health care expansion plan represents the most comprehensive and profound legislation for this population in decades.” Here at Community Catalyst’s New England Alliance for Children’s Health program, we couldn’t have said it better ourselves.

The foster youth expansion provision goes into effect beginning in 2014. It builds  upon the Foster Care Independence Act of 1999, which, among other things, gave states the option of extending Medicaid coverage to foster youth up to age 21 through the John Chafee Foster Care Independence Program (otherwise known as the “Chafee option”).

The paper also helpfully points out that, despite the difference  this ACA provision will make in the lives of youth aging out of the foster care system, there are important implementation issues that need to be addressed to make it as effective as possible. For instance, because all foster youth aging out of Medicaid will qualify for the program up to age 26, individual applications for enrollment are an unnecessary burden for the youth themselves as well as for parents and child welfare workers. Instead, an automatic enrollment process should be put into place to ensure these youth can easily take advantage of this important ACA benefit. Additionally, in order to ensure continuous health insurance coverage during this transitional period for youth, states should not be permitted to deny youth’s access to Medicaid simply because they have another potential source of coverage.

The extension of Medicaid coverage to youth aging out of the foster care system is another example of how the ACA is full of commonsense reforms that enhance access to care for those who need it most. When we hear overblown rhetoric about this historic law, it’s worth remembering that it’s already helping real people every day, and will help even more as time goes on.

—Patrick M. Tigue, Senior Policy Analyst

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It’s Time to Reauthorize Funding to Train Pediatricians (and Use Funding to Train Other Physicians More Effectively)

Wednesday, August 10th, 2011

It’s hard to imagine how children can stay healthy if there aren’t enough pediatricians to take care of them. And this is precisely the issue at stake as Congress decides whether to reauthorize the Children’s Hospitals Graduate Medical Education Payment Program (CHGME) over the coming weeks. The House Energy and Commerce Committee recently passed CHGME reauthorization legislation (H.R. 1852), and its companion bill (S. 958) is due to be considered by the Senate Health, Education, Labor, and Pensions Committee in early September. However, CHGME’s current authorization expires on September 30 of this year, and the ultimate fate of the reauthorization effort remains very much in doubt at this point.

Putting the debate in context
There was a real concern about the nation’s pediatric workforce in the late 1990s after the American Board of Pediatrics noted that the number of pediatric residents had seen a decline of more than 13 percent, and the Pediatric Education Task Force concluded that the lack of adequate federal funding for graduate medical education at independent children’s hospitals was a significant threat to maintaining an adequate number of pediatricians going forward.

To address this issue, Congress created CHGME 1999 so that independent children’s hospitals could receive federal support to train resident pediatricians and pediatric specialists similar to the support provided to adult hospitals through the Graduate Medical Education Program (GME) through Medicare. Prior to the enactment of CHGME, independent children’s hospitals were receiving only half of a percent of the federal funding provided to adult hospitals for GME as well as unstable and varying support from Medicaid.

And CHGME has worked exactly as Congress intended by increasing the number of pediatric residents and pediatric resident specialists training at independent children’s hospitals, meeting pediatric workforce development needs in geographic regions across the country, and ensuring that even children living in states without independent children’s hospitals have some access to well-trained pediatricians and pediatric specialists.

Success begets success
Given CHGME’s track record of success, advocates must remain vigilant to ensure that the program is reauthorized before it expires at the end of September. This becomes even more important given the shortage of pediatric specialists in many areas of the countrydespite the impressive progress made as a result of CHGME. Advocates can play an important role in the coming weeks by weighing in with their Congressional delegation.

For more information on CHGME, check out the new paper from our New England Alliance for Children’s Health program that outlines in greater detail the past success of CHGME, makes the case for why it is still needed, and offers some ideas about how to improve the program.

Training for docs for grown-ups needs help too…
It’s also worth noting that, unlike CHGME, the GME Program (aimed at training physicians who serve adults) receives a majority of its funding from Medicare to train medical residents. Currently, GME does not produce enough primary care providers to meet the country’s needs. Primary care is critical to fixing the health care system, and GME is one untapped tool for primary care workforce expansion, as outlined in another new paper we recently released. More can be done to redesign GME so that it is more nimble in its response to regional and national workforce needs. Policy makers have an opportunity to develop a framework of accountability that preserves our tradition of excellent medical education while tying it directly to the needs of consumers.

—Eva Marie Stahl, Policy Analyst
—Patrick M. Tigue, Senior Policy Analyst

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Solving the Specialty Care Issues for Medicaid and CHIP Children

Wednesday, June 22nd, 2011

The New York Times ran an article last week on the results of a new study published in The New England Journal of Medicine (NEJM) on access to outpatient specialty care for children on Medicaid and the Children’s Health Insurance Program (CHIP). The study found that children with public health insurance are much more likely to be denied specialty care or forced to wait for long periods of time for a specialist appointment than children with private health insurance. Medicaid and CHIP have been very successful in other important ways, but this study is concerning—particularly in the context of current proposals under discussion in Congress that would undermine these vital programs that provide a lifeline to millions of children as well as other vulnerable populations.

To conduct the study, research staff posed as parents and called specialty practices in Illinois to schedule appointments for their children. The two major findings from the study were:

  • – More than 66 percent of callers who said they had a child on Medicaid or CHIP were denied an appointment, compared to only 11 percent of callers who said they had a child on private insurance.
  • – The average wait time to see a specialist who accepted both public and private insurance was 22 days longer for Medicaid and CHIP children than for children with private insurance.

This study’s findings are consistent with the United States Department of Health and Human Services’ (HHS) 2010 literature review on access to care for Medicaid and CHIP children. HHS succinctly summarized its findings this way: “. . . access could be improved substantially for specialty care services (e.g., dental, mental health).” Reasons cited in the NEJM article for providers’ decisions not to treat patients covered by Medicaid and CHIP include: disparities in insurance reimbursement rates, delays in payment, and cumbersome payment procedures.

Access to specialty care for children on Medicaid and CHIP is clearly an issue that needs to be addressed. This begs the question of what effect current Congressional proposals to turn Medicaid into a block grant program, cap federal expenditures, or allow states to cut Medicaid and CHIP eligibility through repealing the Affordable Care Act’s maintenance of effort requirements (MOE) would have. The short answer is that all of these proposals would make this problem even worse. Block granting or a spending cap would result in reductions in Medicaid and CHIP spending, which would inevitably lead to provider rate cuts. Repealing the MOE provisions would result in reductions in overall coverage levels—leading to more uninsured children. Either way, these proposals would result in even less access to specialty care (not to mention to other essential health services as well).

Overall, Medicaid and CHIP serve our country’s children immensely well by providing cost-effective coverage for children that improves health outcomes and protects low-income families from financial ruin. For example, Medicaid and CHIP children actually fare very well when it comes to access to primary care. According to HHS, “Considerable evidence indicates that children enrolled in Medicaid/CHIP have much better access to primary care services than uninsured children and comparable access relative to privately insured children.”

In areas like access to specialty care, where further progress needs to be made, the answer is not to undermine these programs by reducing our investment in them. Instead, we need to implement innovative policy proposals that create savings in Medicaid by improving the health care delivery system, and that can be used to address outstanding issues like access to specialty care as well as for deficit reduction. And it’s up to all of us to make sure that members of Congress understand that we need thoughtful solutions to our nation’s problems, not mindless cuts.

—Patrick M. Tigue, Children’s Health Care Coordinator
New England Alliance for Children’s Health

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