Health Care - An Update

Indiana’s new health insurance. Family & Social Service Administration’s Secretary Mitch Roob went to Washington to get a waiver of Medicaid rules so that Indiana can begin its newly-passed health insurance program this October 1. The Governor’s proposal morphed into a bi-partisan Healthy Indiana Plan that is designed to provide health insurance options for uninsured low-income Hoosiers. The number of people eligible for coverage depends upon eventual funding that comes from the 44¢ per pack increase in the state tax on cigarettes (HEA 1678). About $206M a year will cover 132,000 Hoosiers whose family incomes are below 200% of the federal poverty level.

The new coverage provides $500 in free preventive care, a $1,100 health savings account, and up to $300,000 annual insurance coverage from a private company. The bill also widens the eligibility pool for children and pregnant women for Medicaid, allows children to stay on their parents’ health insurance until they reach age 24, and offers tax breaks for employers to begin health insurance coverage for their workers, hopefully covering another 70,000 Hoosiers.

The federal children’s health insurance program (S-CHIP) will expire Sept 30 unless Congress renews it. In 2007, both the House and Senate passed versions of S-CHIP that will continue it for another 5 years and increase its funding to cover more children. But the bills differ on important details, and President Bush has threatened to veto anything that might cause some Americans who have private health insurance to dump it and get covered by the government plan—thus starting the U.S. down a slippery slope toward the “socialized medicine” that Michael Moore promoted in his movie Sicko. Here are key elements of the bills:

Some sub-features—affecting 639,000 adults, legal immigrants, and smokers—are likely to change as the House/Senate conference committee works out a compromise that can get enacted without a veto.

Indiana Covering Kids & Families works to help enroll eligible children into S-CHIP as well as expand health insurance for all low-income Hoosiers. Started as a Robert Wood Johnson Foundation (RWJF) grant progam, Indiana CKF is now an independent charity. Indiana averaged 9.5% of children (0-18) not covered by health insurance between 2003 and 2005. Check out http://covertheuninsured.org/media/research/
WhoseKidsAreCovered.pdf to see how Indiana compares to other states.

Currently, Indiana is one of half the states that set S-CHIP eligibility at 200% of the FPL. The US Census Bureau says there are nearly 97,000+ uninsured Indiana children in families below the 200% FPL. Some 74,500 Hoosier kids were enrolled in S-CHIP in July—about 24% with co-pays (depending on the size and composition of the family) and 76% with no co-pays. Those numbers are down from January’s 78,145, due in part to understaffing and processing delays, according to Indiana CKF. Under Indiana’s new state healthcare plan, S-CHIP will cover 37,000 more kids in families up to 300% FPL starting January 2008. The Bush administration has adopted rules to stop rising S-CHIP eligibility rolls.

Indiana is one of several states that have expanded their healthcare coverage of children and their parents, reports the Kaiser Commission on Medicaid and the Uninsured. See www.kff.org/about/kcmu.cfm for studies on healthcare options for low-income Americans.

A new study from Consumer Reports (CR) found 43% of Americans with health insurance said they would be “completely” or “somewhat” unable to pay for a costly medical emergency if it came up in the coming year. Another 16% have no health insurance at all. Altogether, CR says 40% of U.S. adults have “inadequate access to health care.”

The non-partisan Commonwealth Fund (CF) ranked the USA against other industrialized nations and said:

Although national health spending is significantly higher than the average rate of other industrialized countries, the U.S. is the only industrialized country that fails to guarantee universal health insurance, and coverage is deteriorating, leaving millions without affordable access to preventive and essential health care.

CF developed a National Scorecard with 37 data factors and set benchmarks based on the top 10% of countries, states, health plans, hospitals, and other health providers. These are some of USA’s high and low scores compared to other nations:

France topped the list of nations with the lowest death rate due to conditions that are “amenable to health care,” with the USA ranking 15th. America came in last among the group for infant mortality rates, with Iceland, Japan, and Finland as the best three nations.

Indiana ranked 38th on the Commonwealth Fund’s State Health System Scorecard, with Hawaii #1 and Texas, Mississippi, and Oklahoma at the bottom. Grades were based on five factors. On all variables, Indiana was ranked in the 3rd lowest quarter of states. It placed 30th on access, 28th on quality, 33rd on avoidable hospital use and costs, 34th on equity, and 33rd on healthy lives. The Fund’s Aiming Higher and international reports are at www.commonwealthfund.org.

Indiana fails at tobacco control according to the American Lung Association’s report on 2006 federal and state policies. Indiana got an F for tobacco prevention, smokefree air, and youth access, along with a D for cigarette taxes (a grade that may improve with Indiana’s 2007 tax increase). Of Indiana’s neighbors, only Ohio scored better with an A for smokefree air and Cs for tobacco prevention and taxes. See http://lungaction.org/reports/overview06.html.

Healthcare improvements are driven by quality measurement, says the National Committee for Quality Assurance (NCQA), an initiative sponsored by foundations and major healthcare companies. For the 7th year, NCQA reports that 70 million Americans benefited more from health plans that measure and publicize medical performance data. Yet, there’s still a big gap between “the performance of the health care system as a whole and the top 10% of health plans who report quality.” See an analysis of various health industry trends at http://web.ncqa.org.

Boomers’ healthcare challenge. As the 65+ population triples from 1980 to 2030, the U.S. health system will get “stressed-out,” says a new report. When the first Boomers turn 65 in 2011, 60% will be managing chronic conditions—14 million with diabetes, 30 million with arthritis, and 21 million with obesity. See www.aha.org/aha/content/2007/pdf/070508-boomerreport.pdf.

The Retirement Project says the number of frail older adults getting long-term care will double to 11 million, www.urban.org/UploadedPDF/311451_Meeting_Care.pdf.

The Deloitte Center for Health Solutions found that “state governments, in their roles as legislator, employer, and payor, are uniquely positioned to advance price transparency” in health care reform. Indiana is one of 33 states that affect disclosure and public reporting of charges and fees. Indiana reported that 77 medical errors occurred in healthcare facilities in 2006. Check out
www.deloitte.com/dtt/cda/doc/content/
us_chs_pricetransparency_031307.pdf for strategies for a healthier Indiana.

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