Posts Tagged ‘children’s health’

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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Posted in Affordable Care Act implementation, children's health, Uncategorized | No Comments »

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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Posted in Affordable Care Act implementation, children's health, Medicaid, Uncategorized | No Comments »

Taking Care of Business… and Children’s Health

Thursday, February 3rd, 2011

Here at the New England Alliance for Children’s Health (NEACH), an initiative of Community Catalyst, we have long focused on regional coalition-building. It’s been our experience, since NEACH began back in 2006, that fostering new relationships within and among the six New England states has played a vital role in advancing children’s health policy. And whenever possible, we’ve worked to engage constituencies that — at first glance — might not seem to be natural partners for child health advocates because we believe that diverse stakeholders can often find common ground on policy issues related to children’s health.

As part of this work, we are pleased to announce the release of our new publication entitled Investing in Our Future: New England Business Leaders’ Views on Children’s Health Advocacy. It presents findings from a series of six focus group discussions held in 2008 with New England business leaders about their perspectives on children’s health and their interest in public policies that could improve health outcomes for children. We engaged the New England Council, a well-respected business association, as a partner in this project to help facilitate discussions with selected regional business leaders.

Key findings from the report are as follows:

– Though many business leaders view children’s health as far removed from their everyday activities, they understand that children’s health status impacts the workforce, and therefore, directly impacts their businesses.
– The business community representatives are supportive of children’s health care initiatives associated with preventing illness and fostering healthy behaviors.
– The represented businesses perceive our health care system as dysfunctional and irrational and are somewhat skeptical of public health insurance programs’ objectives and results.
– Most of the represented businesses are not willing to pay additional taxes to finance an expansion of health insurance coverage or finance children’s health care in general.
– The business community representatives would like to see more evidence of a connection between health insurance status and health outcomes for children.
– When judging the success or value of children’s health programs, these business leaders focus on specific and measurable outcomes.
– Most of the businesses represented believe health care consumers should bear at least some fraction of the cost burden of their coverage.

Of course, it’s important to recognize that these findings illustrate both differences and commonalities between child health advocates and business leaders. However, by educating children’s health advocates about business leaders’ viewpoints on children’s health policy issues, our hope is that this publication will further the ultimate goal of helping business leaders and children’s health advocates to establish productive relationships that will benefit all of our children.

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

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A New Push to Pass Child Nutrition Reauthorization

Monday, November 15th, 2010

While there is no shortage of issues vying for the attention of Congress during the lame-duck session that begins this week, we believe reauthorizing the federal child nutrition programs should be near the top of the list. Before Congress headed into recess for the election back in late September, the House of Representatives did not take action on the child nutrition reauthorization (CNR) bill passed by the Senate, the Healthy, Hunger-Free Kids Act of 2010 (S. 3307).

As a quick reminder, the federal child nutrition programs include the National School Lunch Program, School Breakfast Program, Summer Food Services Program, After School Snack and Meal Program, and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These programs help more than 30 million low-income children every year access healthy, nutritious food.

While the Senate CNR bill is far from perfect (in particular, it frustratingly uses money from the Supplemental Nutrition Assistance Program (SNAP) as a funding source), it represents the best opportunity we are likely to have for the foreseeable future to improve the federal child nutrition programs in ways that will promote childhood health, reduce childhood hunger and obesity, and improve and simplify access. How so?

Well, for starters, the bill provides $4.5 billion in new funding for these programs — period. This investment is the single largest increase in funding the federal child nutrition programs have ever seen.

More specifically, the bill contains a number of provisions that expand access to healthy, nutritious food for low-income children. For example, it would allow children who are enrolled in Medicaid and reside in families with incomes below 133 percent of the federal poverty level (FPL) in select school districts to automatically qualify to receive free school meals. By 2015, the CBO estimates that about 115,000 low-income children annually would be newly certified for free school meals under the bill as a result of this provision.

As the lame-duck session begins next week, House members need to hear from their constituents that passing the Senate CNR is a priority. Opportunities like this do not come often. Contact your representative today and help make a difference in lives of low-income children across the country.

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

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Insurers behaving badly

Friday, October 1st, 2010

You may have heard that many health insurers across the country (including several major insurers such as WellPoint, UnitedHealth Group, Aetna, Cigna, and Humana) have been announcing the discontinuation of new child-only policies. These are insurance products sold in the individual market to children under age 19 that comprise approximately 8 percent of all individual policies. This is a relatively small group of children to be sure but it’s also a particularly vulnerable one. Parents who work for employers that do not offer insurance plans with dependent coverage and grandparents enrolled in Medicare who act as the primary caregiver for children often rely on these policies.

So, why are insurers saying that they will stop selling these products?

Insurers are discontinuing the sale of new child-only policies to avoid having to comply with a provision in the Affordable Care Act (ACA) that prohibits new group and individual plans from denying coverage for pre-existing conditions for children under age 19. This provision applies to all new plans except grandfathered individual plans (those in existence prior to September 23, 2010). Insurers claim that they are afraid families will only purchase insurance for their children when they are already sick or have significant health expenses (known to health policy wonks as “adverse selection”).

While the concern about adverse selection is not entirely unreasonable, the decision of insurers to address it by ceasing to sell new child-only policies is unnecessary. There are solutions available to insurers that can help to mitigate the risk of adverse selection, as outlined by Secretary of Health and Human Services (HHS) Kathleen Sebelius in this letter to Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP). Measures permitted by HHS include (to the extent allowed under state law): allowing insurers to establish open enrollment periods, allowing insurers to adjust rates based on health status, permitting child-only rates to be different from rates for dependent children, and allowing a surcharge to be assessed for dropping coverage and subsequently reapplying.

However, many of AHIP’s members don’t seem to believe that these measures are adequate. Advocates should contact their state insurance departments to explore what creative policy options can be pursued that will result in the continued sale of new child-only policies. For example, the New Hampshire Insurance Department recently issued a bulletin warning insurers that New Hampshire state insurance law and the ACA taken together “require all health insurance carriers to take an application for any of their individual products from any New Hampshire resident, regardless of that person’s age. For an applicant under age 19, a health carrier must guarantee issue any of its individual products.” In other words, insurers offering coverage in the individual market in New Hampshire must offer child-only policies and can’t deny coverage based on a pre-existing condition to a child who applies for such a policy.

Children in New Hampshire are fortunate that advocates and regulators there are working together to require insurers to continue to offer child-only policies. In some states, policy options may be more limited due differences in state insurance laws but it remains important that advocates and regulators across the country work together to ensure that child-only policies remain as widely available as possible.

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

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Posted in Affordable Care Act implementation, children's health, private insurance | 1 Comment »

Dental care for every community

Tuesday, December 8th, 2009

Last week, the New York Times reported on the dire need to improve health care on Native American Tribal Lands. Unfortunately, one of the major components of overall health and the health care system was overlooked as part of the article – oral health and access to dental care.

Today, Native American Indian children and adults are suffering disproportionally because of lack of access to dental care. Untreated dental decay is two to three times higher among Native Americans than in the general population.

For example, at the Pine Ridge Clinic in South Dakota, children ages three and four attending a Head Start program were recently given screening exams by a dentist near the village of Wounded Knee.  Of twenty kids who were screened, 18 of them were found to have severe dental problems that could only be treated in an operating room due to the extent of their dental problems. That means the children had severe decay deep into their teeth that was causing pain, multiple infections and made eating difficult. More than half of each of these children’s teeth were severely decayed because of lack of access to dental professionals and services.

The Indian Health Service dental clinic in Pine Ridge is understaffed, making it impossible to provide care to all the children on the reservation suffering from tooth decay.  In short, if children are able to get to the clinic, which is 17 miles away, dentists are so overwhelmed by the demand to provide more serious treatment that they are unable to provide preventive care or treat cavities or decay.

While a shortage of dental professionals is a major problem throughout the country, it is worse on tribal lands. The Indian Health Service (IHS) has a 34 percent vacancy rate for clinical dentists; in some areas, the vacancy rate is 50 percent. In fact, there is only one dentist per 4000 Indians, compared to one dentist per 1700 in the general population.

Fortunately, Alaska has found a solution to this critical need for dental professionals to serve Native American Indians and the general population, who lack access to quality, affordable dental care. There, the Alaska Native Tribal Health Consortium (ANTHC) has added a dental therapist to the dental team to increase access to care.

Dental therapists are home-grown health professionals who serve their own communities. They fill a critical role in the dental partnership by providing complementary services to those dental hygienists and supporting the work of dentists. For nearly 100 years, dental therapists have been providing cleanings, sealants, fillings, and simple extractions to underserved urban and rural populations in countries with advanced dental care systems similar to the U.S., such as Canada, England, and New Zealand.

Before the program was implemented, some residents had access to dentists who only visited once a year. With the support of philanthropic organizations, dental therapists were trained, first in New Zealand and now by the University of Washington’s Medical School, and have returned to provide critical care to Alaskan natives.  Now, 11 dental therapists are providing care in nine dental shortage areas to more than 7,000 previously underserved Alaska Natives.  By 2012, there will be 32 dental therapists living in and providing culturally competent, high, quality dental care in dental professional shortage areas.

The quality of care offered by the dental therapists is well documented. Research and evidence from other countries where dental therapists have been part of the dental team since the 1920s shows that the preventive and basic dental repair services provided by dental therapists are safe, high quality, acceptable to the public and cost-effective.

Despite the successful use of dental therapists as part of the dental team,  the American Dental Association is trying to prevent dental therapists from joining dental teams on tribal lands in the lower 49. Thursday afternoon, ADA President Ron Tankersley testified that Native American Indian people should not receive care from dental therapists.

With 83 million Americans lacking access to dental care, now more than ever, we need to look at ways to improve the system. Dental therapists can benefit everyone, including dentists because they can provide critically important basic treatments to patients and allow dentists to focus on more serious services and surgeries.  We need to work together to provide all residents with access to quality, affordable, dental care – the dental therapist model is a proven solution for bringing care to every community.

–David Jordan, Dental Access Project director

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Posted in dental care, Health disparities, national health reform | 2 Comments »

Harry Reid’s Flying Circus

Monday, December 7th, 2009

Oops! Read the Public Option Post-Mortem and Dec. 14 Health Reform Insider here.

And now for something completely different, Senator McCain proclaims himself a defender of Medicare

The first week of Senate debate has seemed, at times, more like Monty Python satire than serious debate. Like when Sen. John McCain took the Senate floor to decry proposed Medicare savings in the bill. Apparently, McCain forgot his own proposal as a presidential candidate to make much deeper cuts. The Medicare debate highlights the extent to which the reform debate has become much less about health care and much more about partisan positioning. The main purpose of the McCain amendment appears to have been to afford Sen. McCain the opportunity to record a “robo-call” message casting Democratic politically vulnerable Senators as opponents of Medicare.

Perhaps as a sign of the significance Politico attaches to the floor proceedings, the Capitol Hill online news rag’s weekend health reform coverage focused more on President Obama’s meeting with the Democratic caucus and whether Sen. Baucus did something inappropriate by recommending his girlfriend for a job as a U.S. Attorney than on anything happening on the Senate floor.

Health Reform Punching Bag
It’s a good thing Democratic Majority Leader Harry Reid is a former boxer. He’s going to need everything he learned in the ring to keep health reform from becoming a giant punching bag for opponents while he works to corral 60 votes. The Republican strategy seems to be to throw everything but the kitchen sink up against health reform and hope some of it sticks.

The Democrats’ counterstrategy is to file and debate their own “message amendments” meant to shape the news coverage and allow members, especially those facing difficult reelection fights, to champion popular causes. Examples include an amendment sponsored by Sen. Michael Bennet (D-CO) to ensure that there would be no cuts to Medicare benefits (passed 100-0), and an amendment by Sen. Blanche Lincoln (D-AR) to cap the tax deductibility of pay for insurance company executives (which fell short of passage by four votes, 56-42).

About those 60 votes
We’ll see a short break from these posturing and “message amendments” today as the Senate tackles abortion, one of the two main issues that appears to be hampering its ability to lock down 60 votes for reform (the other being the public option). Senator Ben Nelson (D-NE) has said that he would not support reform legislation unless it included language restricting abortion similar to the language inserted in the House by Michigan Congressman Bart Stupak. But the Senate does not seem likely to approve an amendment that mirrors the House provision.

If Reid loses Nelson’s vote, he will need to rely on the pro-choice but anti-public option Republican Senators from Maine in order to get the 60 votes he needs. In the process, he could possibly pick up the vote of Sen. Lieberman, who has said he would support a filibuster if the public option was included in the Senate bill, but Reid risks losing support from progressives who feel that the “state opt-out” provision in the Reid bill is already too weak. A new public option proposal could emerge from negotiations between liberal supporters, conservative opponents and the White House sometime this week.

Two issues that divide the Democratic caucus but are not likely to get resolved in the Manager’s Amendment are: How far to push the drug industry for savings, and how best to structure health coverage for children.

On the drug issue, many Democrats believe that the deal Senate Finance Chair Max Baucus and the White House struck with PhRMA lets the industry off too easily. They want to wring additional savings from the drug companies and use the money to close the Medicare Part D “donut hole.” Other Democrats fear, though, that if they push the drug industry too hard, the major investment the industry has been making in supporting reform will flip to opposition and could sink the bill. Even if the Senate decides to continue the kid-glove treatment for the drug companies, they will have to wrestle with the issue again because the House takes a more aggressive approach.

The children’s issue mirrors the long-running debate on affordability in that it is not so much about principle as about cash. Both Senators Casey and Rockefeller plan to file amendments aimed at making sure that kids don’t lose benefits they have now. While the Senate supports enhancing coverage for children, the amendments have not yet been scored by CBO, and it is unclear if they are budget neutral or will require an additional revenue source.

As soon as Reid gets 60 votes worth of support on these two issues, watch for a rapid increase in the pace of Senate debate, with many of the Senate Democrats’ main concerns getting wrapped into a final Manager’s Amendment.

Assuming all goes according to plan…
The Senate will conclude their debate prior to Christmas, leaving the House, Senate and White House to work through the many differences in the respective versions. Here are the key ones to watch:

Financing
The House relies largely on progressive income taxes to finance health reform, while the Senate proposal taxes health benefits. Interestingly, this chasm may be the hardest one to bridge, though it hasn’t attracted nearly the press coverage of other tough issues.

Affordability
The House does much better for low-income people, while the Senate, at least on premiums, does better for moderate-income folks—though in general, the House provides better benefits. The obvious solution is to take the best of both worlds, but the challenge goes back to the financing debate: Where will the money come from?

Exchanges and Insurance Regulation
In most ways, the House bill establishes tighter oversight and more consumer-friendly regulation of the insurance industry, including less scope for discrimination against older subscribers, or opportunities for the back-door reintroduction of the practice of charging people more when they are sick. The House also gives the exchange more power to negotiate with insurers and exclude plans from the exchange if they do not offer good value.

Abortion
As of this writing, we don’t know the outcome of the Senate debate, but odds are against the Senate adopting the House language. The question for conferees is whether there is anything in the middle that both sides can live with.

Public Option
After the Senate gets through wrangling over the public option, members will have to take the matter up again in the House, where support for a public plan runs much deeper. A number of  progressive members of Congress are on record saying they won’t vote for a bill without a public option, and advocates are working to hold them to their word.

Employer Responsibility
The House includes a “pay or play” provision, while the Senate charges employers penalties only if their employees actually access subsidized coverage.

Undocumented immigrants
Though relatively few undocumented immigrants could actually afford to pay the full cost of an insurance policy, the Senate bill prohibits them from buying insurance through the exchange, even with their own funds. During the House debate, members of the Congressional Hispanic Caucus told Speaker Pelosi that they would not vote for a bill that contained such a restriction. If the same holds true for a conference report, the Senate may have to back down.

–Michael Miller, director of strategic policy

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Posted in Health Reform Insider, national health reform | 2 Comments »

Welcome to the Health Policy Hub!

Wednesday, September 9th, 2009

Today, Community Catalyst proudly launches our new blog, Health Policy Hub. While the word “policy” may sound a bit wonky to some, we hope to hit the wonk-life balance by providing interesting commentary on all things health care without coming off like policy geeks who spend our lunch hours ruminating over subtitle c of section 101(B) of Title I of the Acts of…Obviously, no one here does that.

We’ll bring you the insights, expertise and opinions of our Community Catalyst colleagues who have years of experience (we won’t say how many) and numerous successes working to improve health care at the local, state and national level. They’ve been on the ground organizing grass roots advocacy groups, at the table negotiating with insurers, hospitals and policymakers, and on their Blackberries working around the clock to ensure consumer interests are represented in our health care system. We’ll look at many issues – from health care reform to children’s health to making our hospitals more accountable to the communities they serve – through a consumer lens. We’ll also check in with our state and national partners on their efforts to make health care better, accessible and affordable.

Like any blog, Health Policy Hub’s success hinges on our ability to keep content fresh and interesting. We will work hard to make that happen. But we also need you readers to help out with the interesting part – sharing what you’ve heard and letting us know what you think. We welcome your comments, and hope this is the start of a lively and thought-provoking conversation.

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