1994 principles relevant today

August 30, 2010

Jan Hudson

Federal health care reform is starting a new chapter in Michigan. Beginning tomorrow, enrollment will open for the new high risk pool  for those with pre-existing conditions who have been uninsured six months. Coverage will be effective Oct.  1.

This component of the health care reform law got off to a rocky start when the Michigan Legislature failed to approve the expenditure of the federal funds for the high risk pool.  The federal government had to step in and make alternate arrangements. 

Health care reform implementation merits ongoing and careful thought and planning by policymakers, with input and monitoring by consumers, to ensure the best possible outcome for all of us.  

The Michigan League for Human Services developed a set of health reform principles in 1994 that are still relevant today and can serve as a good resource. 

They provide a good road map for navigating many upcoming implementation issues including:

  • The critical importance of a comprehensive package of benefits for those newly eligible for Medicaid (there is an option to provide a lesser package of benefits) as well as for those who purchase coverage through the Health Insurance Exchange (the “Expedia” of private insurance options).  A comprehensive package would include the full range of mental and physical health services, as well as dental and substance abuse services.
  • Adequate state regulatory and monitoring resources to ensure mandates are implemented timely and effectively, and that there are strong enforceable consumer protections.
  • Availability of access to quality care both geographically and culturally.  There are many opportunities in the law to expand or promote primary care.
  • Reasonable and adequate provider payment rates in public programs to ensure that current and newly eligible persons have access to care and not just a card.
  • An increase in the meaningful and cost-effective use of health information technology.
  • Promotion of quality, not quantity, of care through incentives or payments for outcomes, or other payment reforms for providers; and quality consumer education to help guide treatment decisions.
  • A priority for funding prevention and wellness options included, but not funded, in the law.
  • Development of effective cost containment strategies that maintain or improve quality care and are not simply code words for cuts in programs or services.

 Additional food for thought is provided by the State Consortium on Health Care Reform Implementation in a State Health Policy Briefing. This brief describes 10 aspects of federal health reform that states must get right if they are to be successful in implementation.

The group’s top priorities include:

1. Be strategic with insurance exchange

2. Regulate the commercial health insurance market effectively

3. Simplify and integrate eligibility systems

4. Expand provider and health system capacity

5. Attend to benefit design

6. Focus on the dually eligible

7. Use your data

8. Pursue population health goals

9. Engage the public in policy development and implementation

10. Demand quality and efficiency from the health care system.

(The State Consortium on Health Care Reform Implementation is a collaboration among the National Governors Association, the National Academy for State Health Policy, the National Association of Insurance Commissioners, and the National Association of State Medicaid Directors.)

There have been and will continue to be numerous opportunities for comment as federal regulations are developed and finalized.  The federal government has established a website where you can readily view the regulations for which comments are being accepted.  You are encouraged to take advantage of these opportunities and let your voice be heard in this historic process.

It will take ongoing vigilance to ensure the best implemenation for all.

 —  Jan Hudson

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Chronic conditions: Attacking our wallets

August 12, 2010

Jan Hudson

The Center for Healthcare Research and Transformation (CHRT) recently released a brief on the high cost of treating chronic conditions in Michigan. 

Annual spending for someone with a chronic condition can range from $3,800 to $38,000 more than for someone without a chronic condition. 

The brief reports that nationally 5 percent of the people with the most complex conditions account for 49 percent of U.S. health care spending, while 20 percent of the population account for 80 percent of total health care spending. 

Heart disease was by far the most costly chronic condition both nationally and in Michigan. Total annual spending per patient by Blue Cross Blue Shield of Michigan in 2008 for heart disease ranged from $16,900 to $41,000.

These costs document the importance of good public policy and strategies to address chronic diseases – both their prevention and their effective management. Prevention programs have certainly not been a priority for Michigan policymakers in the last several years as funding for programs has been dramatically reduced and programs have been eliminated.

In FY2008, the Healthy Michigan Fund, a key funding source for prevention and health education programs, provided $26 million for programs.  By FY2010, the amount had been reduced to $11 million, and the FY2011 Senate-passed budget further reduces program funding to $5.9 million. 

Many of these programs are considered ‘nice, but not essential.’ Cardiovascular health programs have been cut by nearly 50 percent, diabetes programs have been cut by more than 60 percent, and smoking prevention programs have been cut by 30 percent. Michigan needs to reverse this trend in disinvestment. 

Fortunately, the Affordable Care Act provides many opportunities to develop new strategies and demonstration projects to determine what works best. Policymakers must be encouraged to fund these opportunities and to make these critical investments.

In addition, the Affordable Care Act requires new health plans, beginning on or after September 23, to provide recommended prevention services (e.g., screenings for high cholesterol, high blood pressure, or diabetes) without any cost sharing by the patient.  In January, Medicare beneficiaries will have access to these recommended prevention services without any cost sharing.

Policymakers often talk about the need for personal responsibility in health matters, but people need the tools to be successful.  We cannot wait any longer to address the impacts of chronic disease.  As the CHRT brief notes, “chronic conditions are attacking our wallets,” particularly the state and the business community that pay for much of Michigan residents’ health care.

— Jan Hudson


Hardships hit children

July 28, 2010

Jane Zehnder-Merrell

The Michigan numbers in the just released national KIDS COUNT report reflected  a 36 percent increase in child poverty in the state between 2000 and 2008 and a ranking of 44th (with 1 being the best) for the relatively large percentage of children living in families where no parent has a full-time year-round job. In response to this report, Michigan citizens and legislators might want to review the findings in a recent study about the impact of hard times on children.

Children in families suffering from multiple hardships, defined as inadequate food, inconsistent access to utility service, and unstable housing, sustain long-term harm to their health and well-being, according to the report Healthy Families in Hard Times. Children’s HealthWatch found that each of these hardships elevate the risk of poor health, hospitalizations, iron deficiency anemia, and developmental delay among children in these families. Children with severe hardship were at more than double the risk of developmental delay compared with children in families with none of these material hardships.

The ten-year study found that one-third of low-income families experienced no hardship while the majority (57%) suffered from moderate hardship, and 6 percent sustained severe hardship. Housing insecurity was the most pervasive—affecting roughly two of five low-income families compared with 27 percent with energy insecurity and one in five with food insecurity.

The impact of these hardships is real and profound for the affected children. Children who experience food insecurity were more likely to need special education services, mental health treatment, and remediation for low academic performance.

While the best solution for family economic security is a good job that can provide the income to meet material needs, roughly one-third of the state’s children lived in a family where no parent had a full-time year-round job in 2008. Children cannot wait for the economic engine; they are already on the road.

Until the economy rebounds, many families must depend on public programs to get through the current recession. The researchers found that many eligible families did not participate in available programs, but the health and development outcomes for children in those needy families who did were much better than for those who did not.

So in these hard times instead of cutting programs, curtailing outreach, and limiting access to programs the better approach might be to expand outreach, coordination, and access to programs that mitigate material hardship so that children who have been born during these hard times will have a chance to be ready for the new economy when it arrives.


Michigan Is Ours!

July 19, 2010

Jan Hudson

The League of Women Voters of Michigan recently completed a project called Michigan Is Ours! that documents the loss of state dollars to fund public services over the last 10 years, in part due to tax policies that reduce taxes. The group is advocating for a reversal of this trend.

In its background information, the League of Women Voters cites the negative consequences  to state services  because of the dramatic decline in state revenues, including:

  • the reduction in state workforce– 18 percent, over the last seven years.
  • the dramatic decline in public safety funding– $3 billion, since September 11, 2001.
  • the astonishing decline in state investments in higher education.

The group’s members believe that the “T” word is not a terrible word, but is a necessary word if we are going to have quality public services.  They further believe voters are concerned about such services as education, public safety, social services, health care, employment services, safe food and water, parks, libraries, and roads, and are willing to pay for them. 

As part of this project, the League of Women Voters has created a series of postcards on specific public services to be sent to legislators. These postcards have a simple message: they affirm the voter’s support for a specific public service and further affirm the voter’s willingness to pay more taxes to support it.  They encourage legislators to pursue tax changes to increase state revenues to support these essential public services.

The Michigan League for Human Services also advocates for tax policy changes to increase state revenues to support key public services.  Numerous options are available to policymakers.  Please see our Facts Matter report for more information. 

If you think a change in direction is in order, and support public services, including adequate taxes to pay for them, let your legislators know.  You can contact Jackie Benson at the Michigan League for Human Services, Jbenson@michleagueforhumansvs.org, for a supply of postcards.

Thanks to the League of Women Voters for creating such an easy way for us to communicate our priorities and willingness to pay more taxes for public services to our legislators.

— Jan Hudson


Penny Swan on being jobless

July 16, 2010

Judy Putnam

Penny Swan, 51, is an out-of-work respiratory technician in Hillsdale.

She’s one of the 104,000 jobless Michigan workers who, as of Saturday, will have lost their unemployment benefits this month after Congress failed to pass an extension. Swan found out she was eligible for 20 more weeks of unemployment, then a week later she got a letter saying it wouldn’t happen. Her benefits ended two weeks ago.

“It’s just wrong,’’ says Swan, who has been looking for work for 18 months. “It’s not only affecting me, it’s affecting everyone I pay bills to.’’

Swan says she hears the talk show chatter about people who say the jobless need to just get off their couches and get to work. It’s hard for her to hear because she spends long days sending out resumes and looking for work. She wants to work but is running into brick walls.

“I’m not getting any calls back. I’ve never experienced anything like this. Before this, I’ve never been out of work for more than two weeks,’’ she says.

Swan’s life has been caught up in the national debate about debt vs. economic stimulus. Some in Washington have suddenly discovered the national debt. While it is a concern (See a recent Center on Budget and Policy Priorities paper on the recession and debt), failing to stimulate the economy, many economists fear, will lead to a double-dip recession. In other words, there’s a time to address the deficit, but the time is not now if we want our economy to return to health.

Beyond making it difficult to make ends meet for thousands of jobless workers in Michigan, the loss of unemployment benefits removes more than $200 million a month from Michigan’s economy, the National Employment Law Project estimates.

Michigan’s congressional delegation, for the most part, has been supportive of extending unemployment benefits. Only Reps. Candice Miller and Dave Camp voted ‘no.’ Rep. Peter Hoekstra was attending a fund-raiser for his gubernatorial campaign and didn’t vote.

Michigan has led the country in unemployment  for 49 out of  the last 50 months. It’s important that these benefits be reinstated quickly. A vote in the U.S. Senate could do that as early as next week. Please read the League’s statement issued today urging a fast vote.

Swan says many in Washington are out of touch with the reality she faces. The health care company she worked for, providing in-home assistance for respiratory patients, has cut its workforce from 25 to seven. Still, Swan says she’s lucky. She has an understanding landlord and she is considering moving in with a sister a few miles away. She is single, with just two cats to care for.

“I can’t imagine the pressure on someone who has a family to support,’’ she said.

Even with unemployment benefits, Swan says she’s watched her pennies. A crown on a tooth fell off more than a year ago, and she hasn’t had it replaced, instead using a temporary dental patch to fill the hole.

“I can’t go to a dentist,’’ she said. “I don’t have any choice.’’

— Judy Putnam


How to achieve health equity

July 13, 2010

Karen Holcomb-Merrill

A Path Toward Health Equity, a recently released report from Community Catalyst, contains recommendations on how to strengthen community-based work to reduce health disparities.  The report focused on six states, one of which was Michigan. 

I had the opportunity to share my perspective on health equity work in Michigan, as the report was being developed.  Although it focuses primarily on specific recommendations about how to more effectively address health disparities, the report also contains some important information about the status of health disparities in our state.

The numbers serve as yet another reminder of the disparities that do exist.  Overall, 13 percent of those in Michigan are uninsured.  Among Hispanics, 24 percent are uninsured and among African Americans, 20 percent are without insurance.

Across the board, African Americans in Michigan die from preventable diseases at a much higher rate than whites.  African Americans and Hispanics have significantly higher infant mortality rates than whites in our state.  You can find more detail about these and other disparities in a League report on health disparities.

The Community Catalyst report proposes five strategies that could strengthen efforts at the local and state level to reduce health disparities.  They include:

  • Building and strengthening community-based organizations
  • Encouraging statewide health access groups to prioritize equity work
  • Building coalitions of community, state and national organizations
  • Connecting various stakeholders
  • Developing a disparities reduction/health equity policy agenda

We are already doing some of these things here in Michigan.  But the numbers tell us that we need to do better.  The League will continue to look for opportunities to play a role in reducing health disparities in our state.

— Karen Holcomb-Merrill


Ouch! Survey results pinch

June 17, 2010

Judy Putnam

A recently released survey of local Michigan officials has a depressing finding: Only 1 percent of local officials think the American Recovery and Reinvestment Act has helped improve local economic conditions “very much.” Two out of every three say it has not helped at all to date, and more than half predict it won’t help at all over the long term.

Ouch! That’s a blow for those of us who have been advocating for extending vital features of the ARRA. (Those include extending the enhanced federal Medicaid match that will offer more than $500 million for next year’s state budget, Earned Income Tax Credit expansions, Child Tax Credit to benefit working poor families of nearly 600,000 kids in Michigan and 99 weeks of unemployment benefits for the state’s long-term unemployed.)

ARRA has poured critical dollars into our state at a critical time. Few of those dollars, however, went directly to local governments, a fact pointed out by the Michigan Municipal League in a well-publicized letter to Vice President Biden last year. Local governments struggle with the double whammy of sharply reduced revenue sharing from the state and declining property values, causing layoffs of public safety workers and other hardships.

But the Recovery Act money has flowed to many people in the communities: the unemployed, households on food assistance, those on Social Security and taxpayers. It is credited with saving an estimated 12,000 jobs in Michigan, most of them in education.  That help doesn’t go into a black hole — those are dollars that are quickly circulated in local economies.

The survey of more than 1,000 local officials was completed last fall. Perhaps, with time, more will see the benefit to their communities in projects such as weatherization.

Without doubt, the ARRA has paid off for local communities, even as tough times continue. What’s hard to imagine is how much worse it would be without the Recovery Act.

Michigan needed the Recovery Act in 2009. It needs it now – it’s important that Congress votes to extend the enhanced Medicaid match, EITC expansions, unemployment benefits and the Child Tax credit.

— Judy Putnam