The story the new Census data tells

September 16, 2010

Jacqui Broughton

Today the U.S. Census Bureau released new data from the Current Population Survey which gives us a look at what happened to household income, health insurance and poverty rates in 2009. As expected, things were worse in 2009 than they were in 2008 on both the national and state level.

Nationally, the two-year (2008-2009) median household income was $49,945 which is a fall of 3.2 percent in one year and a drop of 4.5 percent from 1999-2000 (when put into 2009 numbers). The one-year poverty rate moved from 13.2 percent to 14.3 percent, an increase of 3.7 million people.

For Michigan, the numbers are not surprising. The state’s median household income fell and poverty increased. Between 2008 and 2009, the poverty rate moved from 13 percent to 14 percent. Median household income was $47,797, using 2008-2009 two-year average numbers. This is a decline of 7 percent from 2006-2007 to 2008-2009 and of just over 17.5 percent from 1999-2000.

Additionally, while Michigan is still below the national average in the percentage of people under age 65 without health insurance, this figure still increased to 14.4 percent, or 1.3 million people.

Today’s data release only confirms what we already knew and what so many families have been experiencing: income has been falling, fewer people have employer-based health insurance, and more people are struggling to afford day-to-day necessities. In addition, though Michigan’s rate of those with health insurance coverage is still much higher than the national average, more individuals and families are losing coverage due to unemployment. The increase in the number of those without health insurance further illustrates the need for federal health care reform and including the provisions that will take effect next week.

Despite the bad news, things could have been much worse without the federal Recovery Act which helped create thousands of jobs in Michigan and helped keep at least that many people out of poverty. With that in mind, Congress should act to support the extension of key Recovery Act changes that help low-income families, such as the expanded benefits for low-income, working families through the Earned Income Tax Credit (EITC) and preserving the refundable Child Tax Credit. Also, Congress should act to preserve funding for the Emergency TANF Contingency Fund which is scheduled to end on September 30.

Moreover, these new data should send a message to the Michigan Legislature that now is not the time to further decrease support for safety net programs, which help Michigan families make ends meet.

More detailed information will be coming on September 28 when the Census Bureau releases its 2009 American Community Survey data. These data, however, give us a preview of what is to come with that release.

-Jacqui Broughton

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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


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


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