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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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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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ACA Opponents Grab a (Partial) 11th Circuit Win

Tuesday, August 16th, 2011

In a 2-1 decision this past Friday, the 11th Circuit U.S. Court of Appeals in Atlanta handed ACA opponents a partial victory and dealt a partial blow to the Obama Administration and ACA supporters. While the ruling is frustrating to those working tirelessly on ACA implementation, the good news is that the entire law wasn’t ruled unconstitutional. The individual mandate provision – or the requirement that everyone who can afford insurance must obtain it – was struck down, raising doubts about the long-term sustainability of the ACA. However, let us grab the bits of good news that are sprinkled (lightly) throughout this ruling.

Medicaid is no bully.

 Medicaid expansion is at the heart of expanding coverage to millions of uninsured Americans in the coming decade. The appeals panel confirmed that the Medicaid program is a legitimate federal mechanism to expand coverage to the uninsured. It is not a coercive tool, as charged by the plaintiffs; rather, Medicaid is a longstanding federal-state partnership to address the uninsured in states. The panel writes “If states bear little of the cost of expansion, the idea that states are being coerced into spending money in an ever-growing program seems to us to be ‘more rhetoric than fact.’”

The individual mandate is one provision of many…

It is worth noting that the panel declined to uphold Judge Vinson’s lower court ruling that the entire law be thrown out. Therefore, it raises the possibility that the individual mandate could be severed from the ACA, leaving the law intact. This does raise concerns for ACA supporters and insurers alike because the mandate is a way to include everyone – healthy and sick – and is used as a tool for calibrating risk.

Politics aside…or front and center?

Pam Bondi, the Florida AG leading the 26 state lawsuit against the ACA, commented that due to the bipartisan nature of the 11th Circuit ruling, “politics are out of this now.” (Judge Hull of the majority opinion is a Clinton appointee; however, she is also cited as a compromise candidate during a fierce partisan nomination battle for judges during the mid-nineties). Did Bondi really say that? If that were the case, the 6th Circuit ruling where Republican appointed Judge Sutton upheld the individual mandate would have marked the beginning of the end of ‘politics.’ Saying ‘this is the end of politics’ surrounding these ACA legal challenges is merely politics. Yes, it is confusing. What is clear, however, is that the individual mandate provision of the ACA is bound for the Supreme Court. All pundits agree that the Justices cannot avoid taking an ACA case– as to when the Justices take the case may depend on, well, politics.

Therefore, perhaps you feel a tinge of pity for the Supreme Court as everyone waits to see what ruling they will choose to hear. Will it be the 4th Circuit where we are still awaiting an appeals decision? Will it be the 6th Circuit that has already petitioned the Supremes? Or will it be the 11th Circuit where we are awaiting the Administration’s decision as to whether or not to appeal (they have 90 days)? You can hear the chorus now – “Pick me! Pick me!” Most believe the Obama Administration will win this leg of the race (rare to turn down an Administration petition). Who will reach the finish line first? Well, that is the topic of another blog.

- Eva Stahl, Policy Analyst

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Pew report: The clock is running on another Heparin

Tuesday, July 12th, 2011

This blog was originally posted on PostScript.

The shipment of your birthday present from distribution to delivery can be tracked. A sticker in the grocery store tells you where your pineapple was grown. A tag in your t-shirt says where it was made. Your new car lists where its component parts are from, and where it was assembled. But if you rely on anything from Tylenol to cancer treatment, you have less information about where those drugs came from and what path they took to get to you.

That’s just one startling fact in a new report released today by the Pew Health Group. After Heparin: Protecting Consumers from the Risks of Substandard and Counterfeit Drugs echoes the FDA’s recent call to overhaul the system that monitors imported drugs, and puts forward a number of recommendations to close those safety gaps.After_heparin White paper

“Consumers should be alarmed by the increasingly complex, globalized, and outsourced drug supply chain described in the After Heparin white paper,” Robert Restuccia of Community Catalyst said in a statement. Community Catalyst has teamed with Pew to advocate for many of the recommendations in the report, and leads the broad-based Alliance for a Safe Drug Supply.

“After Heparin shows that outsourcing is growing and is a business strategy for all types of prescription and over-the-counter drug producers,” he said. “As one major brand-name drug maker put it: ‘If we can buy it cheaper than we can make it then of course that’s what we’re going to do.’

And indeed, the numbers bear that out. When it comes to drugs, the U.S. import deficit on pharmaceuticals grew to $18 billion in 2008, and it is estimated that 80 percent of pharmaceutical ingredients and 40 percent of all finished drugs in the U.S. now come from overseas.

As we’ve written about here in recent weeks and months, there’s been surprisingly broad consensus from industry, regulators and the public that the system in place to monitor these imports is broken down and in urgent need of fixing. Last year, 94 percent of pharmaceutical executives surveyed said using foreign-made raw materials was risky. And in a different poll, the same percentage of likely voters wanted FDA to be able to recall unsafe or adulterated drugs, as it can for food. Only Congress can give the agency that power.

At the Pew After Heparin conference in Washington D.C. in March, which informed today’s report, we heard that everyone should be inspected by somebody—and that companies should be fully accountable for checking out factories and quality conditions prior to contracting with a supplier. We heard that in this fractured supply chain, industry actors needs to work with each other and with regulators to share information they may receive on potentially dangerous or counterfeited drugs, and that a uniform tracking system to help verify a drug’s path from factory to pharmacy is sorely needed, but will most likely require the force of law to achieve.

Recently, we talked with pharmaceutical expert Prabir Basu about the importance of investing in good manufacturing science – both on the design side, and ensuring that the tests used to detect false or substandard medications are state of the art.

We talked with California Board of Pharmacy Director Virginia Herold, who illustrated the importance of having a national tracking system for drugs that enter our homes and hospitals.

We heard from API manufacturer Brant Zell, who said the FDA has had its hands tied for years when it comes to fulfilling its mission to ensure the safety of foreign-made drugs. Zell said he thought that the heparin crisis in 2008 would be the straw that broke the camel’s back, and moved Congress to act. To date, that’s not been the case.

We’ve seen the FDA go before Congress to ask for the authorities and tools to do a better job of ensuring the quality and safety of drugs before they get to U.S. shores, and keeping ones that don’t meet quality standards out and off the shelves. So far, Congress has yet to act on those requests.

At a hearing last week, some in Congress again pledged to take action and pass a law that would guide the building of these industry quality rules and give the FDA the authorities it needs to oversee a terribly complex and global supply chain. Today’s report reminds us that there are enough gaps in the supply chain to exploit and economic incentives to do so that the clock is surely running on another heparin-like crisis. The time to act is now.

You can read the full report or watch a webcast of the March conference here.

–Kate Petersen, PostScript blogger

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Setting the Record Straight on Medicaid

Friday, July 8th, 2011

Earlier today, Community Catalyst joined 118 groups representing consumers, people of faith, and health care providers in 34 states to raise our collective voices in support of Medicaid.

Together, we sent a response to the letter that Senator Hatch and Congressman Upton wrote to Governors last month. Their letter attacked Medicaid, falsely claiming that it provides poor quality care, lamenting its enrollment growth over the past decade, and blaming it for federal and state budget crises. Our letter sets the record straight:

• Medicaid provides high-quality care that is uniquely suited to meet the needs of the vulnerable Americans it serves. Medicaid is certainly not perfect, and there is always room to improve care. But studies consistently show that Medicaid beneficiaries get care that is equal to – and sometimes better than – the care they would get in private coverage. Just yesterday a new study was released documenting the positive impact Medicaid has on its vulnerable beneficiaries’ health and financial security.

• Medicaid plays an essential role in reducing the number of uninsured. Of the 46 million low-income children and parents that rely on Medicaid, the majority are in working families without access to private coverage. Policies that scale back on Medicaid eligibility for this population – like those promoted by Senator Hatch – would drive up the ranks of the uninsured, leaving vulnerable Americans without access to the health care they need.

• Medicaid is markedly more cost-effective than private coverage. If the low-income children and parents on Medicaid were insured instead on the private market, national health care expenditures would be significantly higher.

We felt particularly compelled to respond because Hatch and Upton’s letter perpetuates a larger anti-Medicaid narrative that would:

• Reduce the deficit on the backs of those with least political clout. Responding to their mandate from the tea-party, Republican Congressional leaders are insisting on trillions of dollars in spending cuts in exchange for their votes to lift the debt-ceiling (a vote Congress must take in early August to avoid going into default on our nation’s debt). It’s nearly impossible to achieve that level of savings without making devastating cuts in the “big three” entitlements that take up 40 percent of the federal budget: Social Security, Medicare, and Medicaid. But Social Security and Medicare are fiercely guarded by a well-organized political constituency – seniors – which makes cuts in those programs politically unpalatable. That leaves Medicaid, which serves a much more vulnerable and less politically empowered population, as the sacrificial lamb.

• Undermine the Affordable Care Act. The attacks against Medicaid also play into a second tea-party-driven agenda to repeal the Affordable Care Act (ACA.) Since Congressional Republicans don’t have the votes for repeal, they’re trying the next-best approach: weakening the law’s foundations. Medicaid accounts for nearly half of the coverage gains expected under national health reform, so inflicting dramatic cuts on the program would jeopardize the ACA before its even been implemented.

But Medicaid is not a political chit. It’s a lifeline for millions. It provides long-term care to our nations’ seniors, enables people with disabilities to get the care they need to live independently and helps low-income children see the doctor when they’re sick.

The 118 consumer, faith-based and provider organizations from across the country who signed onto our letter know the value of Medicaid in their communities and why it’s worth protecting. And polls show that the overwhelming majority of the American public does too. Is Congress listening?

-Katherine Howitt, Policy Analyst

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Cross-Post: A Disappointing Rollback of Consumer Protections on Appeals

Friday, June 24th, 2011

June 23, 2011

The Affordable Care Act (ACA) established many consumer protections, but it was only the first step.  As decisions are made about implementation and regulations, the need for consumer engagement is critical. As an example of where protections could have been stronger, the Department of Health and Human Services just released regulations that relax a number of requirements on health plans and insurers, making it more difficult for consumers to successfully pursue appeals against them.

This is just a reminder that there will be many opportunities in the coming months and years to weigh in on federal regulations as the ACA is implemented – and it’s important for consumers to respond.  Community Catalyst will continue to provide updates about these opportunities and to work with consumer advocates to ensure consumer voices are heard, and state experiences inform the federal debate.

This blog was originally posted on Georgetown Center for Children and Families’ Say Ahh!

Imagine you’re a parent and your child has been diagnosed with cancer and is going through painful, debilitating treatment. You can imagine the sleepless nights, the worry, the exhaustion, the fear. Now imagine that your insurance company denies some of the claims for your child’s treatment – treatment that the doctors assure you are essential to saving your child’s life. If not paid by the insurer, the bills amount to tens of thousands of dollars – putting you at risk of bankruptcy. At a time when your sole focus should be – has to be – your child’s health, you are forced to spend hours on the phone, fighting with health plan bureaucrats.

For President Obama, it was exactly this type of situation that sparked his passion for health care reform. He watched his mother, dying of ovarian and uterine cancer, battle the insurance company from her hospital bed to get insurance coverage for which she’d faithfully been paying premiums. As he said in a 2009 speech to AARP: “That happens all across the country. We are going to put a stop to that.”

And he did. With passage of the Affordable Care Act, for the first time consumers across the country, no matter what plan they’re in, are empowered to appeal their health plans’ decisions to an independent, external review panel. This critical consumer protection is designed to stop the worst of insurance company abuses and was a great win for consumers. In fact, a recent study by the General Accounting Office found that when consumers appeal denied claims, the health plan has to reverse its decision as much as 50% of the time.

Yet, as with everything health reform related, the devil is in the details. And how the appeals provision is implemented matters just as much – if not more – than having the right in the first place. Unfortunately, in a regulation quietly released late yesterday, the Administration relaxed a number of requirements on health plans and insurers, making it more difficult for consumers to successfully pursue appeals. Here are a few specifics:

• Scope of Review. The Administration has significantly narrowed the range of issues consumers can appeal. Originally the rules allowed consumers to seek external review of any adverse benefit decision (except eligibility for the plan). In the new version, consumers can only seek review for claims that involve “medical judgment” or a rescission of coverage. This means that any decision that’s considered “contractual” cannot be appealed to the external reviewer. For example, a plan’s determination that a particular service, drug, or supply is not covered would probably be considered contractual. Unfortunately, according to a recent AMA study, that’s one of the top reason patients’ claims are denied.
•Urgent Care Claims. Originally insurers were required to make a decision on an emergency care claim within in 24 hours of receiving it. In this latest rule, in response to complaints from industry that the time frame was too “burdensome,” the Administration is giving plans up to 72 hours to make a decision. This, in spite of many comments from consumer groups and providers highlighting the need for fast turnaround in emergency situations.
•Translations for Patients with Limited English. The law is clear: plans must provide enrollees with information about their appeal rights in a “culturally and linguistically appropriate manner.” Yet the Administration has significantly weakened this requirement. First, in only 6 counties in the country will plans be required to translate materials into any language other than Spanish. Second, plans only need to provide translations orally. If an enrollee wants translated materials in writing (kind of important if you’re going through the legalistic process of pursuing an appeal), they must proactively request them. Third, the Administration eliminated a requirement that plans keep a record of an enrollee’s language preference. That was, you guessed it, deemed too “burdensome” for the plans.
•Allowing Plans to Forum Shop. Perhaps the craziest part of the new rules is that they allow plans to choose their own judge and jury. Thankfully, this won’t be true in all states. State laws that already have strong laws that ensure an independent, impartial review will not be preempted by the federal rules However, a significant number of states do not have adequate external review laws, and will be preempted by a federal process. The problem is, under the new rules, plans in states subject to the federal process will be allowed to choose their own external reviewer. This is at odds with the recommendations of the National Association of Insurance Commissioners (NAIC), whose model state law on external review requires that external reviewers be randomly assigned (not handpicked by plans) to ensure and independent, impartial process.
•Giving Patients Less Time to File an Appeal. The earlier rule allowed consumers to have 120 days before filing the appeal. In response to complaints from insurance companies that this was too long, the new rule gives consumers only 60 days. Yet for someone struggling with pain, a recent surgery, rehabilitation, or other after-effects of an injury or illness, this time can pass in the blink of an eye. Many patients are likely to miss the deadline, and thereby miss their opportunity to correct an insurer’s bad decision.
•Delaying Implementation. Finally, many of the new appeals protections were to have gone into effect next week.  But in March new rules gave plans until January 1, 2012 (some even later), to comply. For consumers, these delays effectively deny them access to an impartial, fair review of their claim.

Sadly, all of these changes add up to some unfortunate administrative hurdles that will prove challenging for those parents fighting with their health plan to pay for the care essential to cure their child’s illness. Or for sons who must watch their mother battle cancer and her insurance company at the same time. On the other hand, the health reform law provides many of these same families with rights they didn’t have before. I hope that as we transition to 2014, and people gain more experience with their new appeal rights, we can convince policymakers to enact the necessary rules to make them real.

- Sabrina Corlette, Research Professor
Health Policy Institute, Georgetown University

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A blueprint for health

Thursday, June 16th, 2011

The unveiling today of a National Prevention Strategy marks a new level of federal coordination aimed at improving American’s health and reducing health care costs. The plan goes far beyond vaccines and blood-pressure tests to stress the importance of addressing underlying factors, such as the environment where we live, work and play. It’s great to be hearing this message repeatedly from our leaders in Washington and to see the importance attached to eliminating health disparities, which is one of four “strategic directions” in the plan.

Seventeen federal agencies collaborated with stakeholders and experts to create the 122-page blueprint for action by the federal government as well as states, communities, businesses, nonprofits and individuals. Required under the Affordable Care Act, the National Prevention Strategy will guide spending from the National Prevention Fund, also created by the ACA, as well as spending from other sources.

The blueprint also sets out seven priority areas, including two that have historically gotten short shrift — enhancing mental health and preventing substance abuse.

What does all this mean for our work? Foremost, it helps bolster the third leg of the three-legged stool that we believe is the smart way to control health costs – along with reducing waste and occasional bad care in Medicaid and Medicare, and cutting prices and high administrative costs in the private sector. To cite a statistic in the blueprint, increasing use of preventive services, including tobacco cessation screening, alcohol abuse screening and aspirin use, to 90 percent of the recommended levels could save $3.7 billion each year in medical costs.

Secondly, it identifies specific activities – from policy and environmental changes to communications and clinical care and provides the evidence to back them up. This is a useful guide for everyone working in prevention, whether they focus on clean air, healthy homes or the cultural competence of health care providers. It also sets out measures of progress, such as reducing the number of Americans who die from major preventable illnesses, that can help us hold everyone accountable.

For those eager for more details, here are the four strategic directions:

  • –  Building Healthy and Safe Community Environments: Prevention of disease starts in our communities and at home; not just in the doctor’s office.
  • – Expanding Quality Preventive Services in Both Clinical and Community Settings: When people receive preventive care, such as immunizations and cancer screenings, they have better health and lower health care costs.
  • – Empowering People to Make Healthy Choices: When people have access to actionable and easy-to-understand information and resources, they are empowered to make healthier choices.
  • – Eliminating Health Disparities: By eliminating disparities in achieving and maintaining health, we can help improve quality of life for all Americans.

And here are the seven priority areas:

  • – Tobacco free living
  • – Preventing drug abuse and excessive alcohol use
  • – Healthy eating
  • – Active living
  • – Injury and violence-free living
  • – Reproductive and sexual health
  • – Mental and emotional wellbeing

– Alice Dembner, Deputy Policy Director

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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

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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

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Posted in Affordable Care Act implementation, Medicaid, Uncategorized | 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

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