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National Insurance NewsHealth Care Costs May Deter Entrepreneurs Source(s): Jim Hopkins, USA Today (August 19). Some experts say the rising cost of health care coverage keeps individuals from leaving jobs at big corporations and starting their own businesses, according to an article in USA Today. This could have an impact on the economy by limiting innovation and job growth. Meanwhile, President Bush is promoting entrepreneurship as part of his "ownership society." Health insurance and other medical expenses are a larger part of start-up costs for entrepreneurs and have become a "bigger burden." Also, individuals with health problems may not be accepted by insurers in the individual market. Other experts disagree, saying the competition among health insurance companies will bring costs down, and health savings accounts, which stay with employees if they leave a job, may also help individuals from feeling "locked in" at a job. However, according to one study by Alison Wellington, a labor and health economist at the College of Wooster in Ohio, if universal health coverage were available, the country's self-employment rate would increase by 3.5 percentage points. (August 19, 2005) Doctors on Federal Medicaid Commission Balk at Charging Copays Source(s): Robert Pear, The New York Times (August 18). At a meeting of the federal Medicaid advisory commission, doctors "clashed" with the Bush administration over charging Medicaid patients higher fees, saying that the cost could preclude some poor people from obtaining necessary care. The commission is considering allowing states to charge higher copayments for doctor visits—$5 for adults and $3 for children—in an effort to make beneficiaries more "price-sensitive.” Dr. John C. Nelson, a former president of the American Medical Association and a commission member, said that raising copayments would put some patients at risk. Dr. Carol D. Berkowitz, president of the American Academy of Pediatrics, said even small copayments could add up quickly to "substantial costs" for a low-income family with four children. (August 18, 2005) State Legislatures Propose Medicaid Plan Source(s): Ralph Thomas, The Seattle Times (August 18); Scott Finn, Charleston Gazette (August 20). As the federal government looks for ways to cut $10 billion from Medicaid spending over the next five years, the National Conference of State Legislatures (NCSL) unanimously passed a proposal "asking for stability and flexibility in Medicaid.” Currently, the federal government regulates how the states raise and distribute their Medicaid budget, but the rules are unclear. In addition to clarifying the rules, state lawmakers would like more authority to determine "who and what should be covered under Medicaid." Over the past five years, Medicaid has increased by one-third, and now covers more than 50 million people. The NCSL proposal would give the states a lump sum from the federal government. From there, each state would decide how to set up its Medicaid program. States would be able to offer "scaled-down benefit packages" for some individuals, and determine if they would like to add copayments, deductibles and premiums for individuals with higher incomes. Hurson also warned that some states have been dropping individuals from Medicaid programs and more states will have to do the same if greater flexibility is not granted. (August 18, 2005) Congressional Panel on Health Care Reform Concludes Nationwide Meetings Source(s): Stephen Smith, The Boston Globe (August 16). The Citizens Health Care Working Group, an advisory panel created by Congress and charged with developing "a populist cure for an ailing medical system," ended a nationwide "fact-finding mission" in Boston, reports the Boston Globe. The 14-member group has toured the country to get accounts of what does and does not work in health care. "You have this situation where our nation is an international leader in medical science," said Richard Frank, a professor of health economics at Harvard Medical School and a member of the group. "Nevertheless, we seem to be having a tremendous amount of difficulty efficiently getting the good stuff to people. There is a convergence of vision about the problem of quality, cost and access." Turning this vision into action has been difficult, but the group, whose recommendations will be sent to President Bush and Congress, maintains it has more of a chance because it has the support of the federal government. Nonetheless, Anthony Robbins, M.D., a public health specialist at Tufts University School of Medicine, doubts that the panel's recommendations will lead to reform. (August 16, 2005) In Efforts to Cut Medicaid Spending, Some States Try to Make Recipients More Responsible Source(s): Kevin Freking, Associated Press (August 15); Julie Rovner, NPR's Morning Edition (August 17). Aiming to make major changes in its Medicaid program that it claims will "redefine health care in the United States," South Carolina is trying to establish personal health accounts for most of its 850,000 Medicaid beneficiaries. The amounts allocated to the accounts would vary according to the recipient's age, sex and physical condition, and would include caps. If low-income people exceed the cap, they would have to make up the difference or go without coverage. The change is "based on the belief that Medicaid has created little incentive for frugality." The state now spends nearly 19 percent of its budget on Medicaid, but the percentage is expected to increase to 24 percent in five years and 29 percent in a decade. If South Carolina's waiver request is approved by the federal government, many believe other states will attempt similar reforms, which will then lead to changes in national policy. (August 15, 2005) Underinsurance Leads to Problems Paying Medical Bills for 2 Out of 5 Working Adults Source(s): Marguerite Higgins, Washington Times (August 11). More than two out of five working adults have difficulty paying medical bills or are in medical debt, according to a study by The Commonwealth Fund. In 2003, nearly 71 million working adults had problems paying medical bills, while almost 28 million were in medical debt. About 62 percent of those with unpaid medical bills were insured at the time. There were an estimated 16 million underinsured adults in 2003, according to the fund. The study was criticized by the National Center for Policy Analysis, which claimed it oversampled low-income blacks and Hispanics and therefore, "did not give an accurate view of working Americans." Michelle Doty, the study's author, said that it was an "absolutely representative sample" of working adults. The study argued against high-deductible health savings accounts (HSAs), which are endorsed by the Bush administration, because they make it harder for participants to pay their medical bills. Forty-nine percent of those with deductibles of $500 or more reported payment difficulties, compared to 32 percent of those with lower deductibles. However, advocates for HSAs contend that the plans cover more medical expenses than regular insurance plans once the deductible is met. (August 11, 2005) Bush Cites Health Care Costs as a Leading Economic Concern Source(s): Nedra Pickler, Associated Press (August 10). Speaking after the Federal Reserve raised interest rates, President Bush said that energy prices and health care costs are his chief economic concerns, reports the Associated Press. Ben Bernanke, chairperson of the President's Council of Economic Advisors, said that the rising cost of health care is more of a problem than energy costs. "It's certainly a major drag on the economy, on family budgets," he said. Bernanke said that health care costs have risen more than 30 percent since Bush became president, and now cost the average family about $600 beyond insurance costs. "These are issues we are going to have to address because they are significant." Trying to "reassure Americans that he is working to address problem areas," Bush encouraged Congress to pass his health care plan, which features tax-preferred health savings accounts (HSAs), subsidies to assist low-income people with purchasing insurance and association health plans (AHPs). Critics say his plan "does not do anything drastic enough to have a significant impact" on health costs. Polls show that a majority of Americans disapprove of Bush's handling of the economy, reports the AP. (August 10, 2005) Insurers Report Slowed Growth of Medical Costs Source(s): Dinah Wisenberg Brin, Wall Street Journal (August 9). Major health insurers such as WellPoint Inc., Aetna Inc. and PacifiCare Health Systems Inc. continue to report stable or slowing growth of medical costs, reports the Wall Street Journal. For example, Aetna had forecasted cost increases of 8.5 percent, but rates in the second quarter rose by a rate of about 8 percent. Employers, which have been sharing more of the increased costs with workers, "are seeing some health-cost pressure ease." Human resources consulting firm Hewitt Associates said HMO rates for 2006 are expected to "rise at their most moderate pace nationally in more than five years." (August 9, 2005) Covering Kids & Families Garners Significant Media Attention Source(s): Rene Syler, CBS News: The Early Show (August 2); Petula Dvorak, The Washington Post (August 3); Marguerite Higgins, Washington Times (August 5). The August 2 launch of the annual Covering Kids & Families Back-to-School Campaign, an effort sponsored by the Robert Wood Johnson Foundation to get families to sign their uninsured children up for health coverage, continued to receive media attention. Speaking at the kick-off event, U.S. Surgeon General Richard H. Carmona said, "The number of uninsured children continues to be in the millions. No child should go without health care," reports the Washington Post. "An assortment of soccer stars, entertainers, health care officials and politicians" joined Carmona in promoting the effort. "The intensive period is now and September, when the kids are heading back to school and the parents are more aware of enrolling them in these programs," said RWJF spokesperson David Morse, reports the Washington Times. Noting local statistics showing that 10 percent of D.C. kids, 9 percent of Maryland kids and almost 11 percent of Virginia kids lacked insurance from 2002-2003, the Post also reports that an RWJF study found that one in three uninsured children went an entire year without seeing a doctor. Uninsured minority children are especially likely to go without health care, according to the study, which found that 20 percent of uninsured African-American children went a year without seeing a doctor. "Inequality in health care is just plain unacceptable in our great country," said Risa Lavizzo-Mourey, president and CEO of RWJF. (August 2, 2005) Covering Kids & Families Launches with Study Showing Many Uninsured Kids Get No Care Source(s): Linda A. Johnson, Associated Press (August 2); Sarah Cooke, Associated Press (August 2). One-third of the estimated 8.4 million uninsured children in the U.S. go without medical care for an entire year, reports the Associated Press. However, more than 70 percent of America's uninsured children may be eligible for government health programs such as Medicaid and the State Children's Health Insurance Program (SCHIP). Medicaid and SCHIP have helped reduce the number of uninsured children by about 2 million since 1998, especially Hispanic and African-American children. The findings were released by the Robert Wood Johnson Foundation as part of its sixth annual Covering Kids & Families Back-to-School Campaign, aimed at getting more children enrolled in public programs. "No child in America should have to go without a doctor's visit or skip needed care, and no parent should have to make that decision," said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "Low-cost or free insurance coverage is available for seven out of 10 uninsured children." Parents can call 1(877) KIDS-NOW to find out if their kids are eligible. The report found Hispanic and African-American children were most likely to lack care, with 41 percent of uninsured Hispanic kids and 29 percent of uninsured African-American kids going without care, compared to 26 percent of uninsured white kids. There were large differences between states in how many uninsured children went without care for a year, ranging from 15 percent in Maryland to 43 percent in Arizona. In New York, 22 percent of uninsured children went without medical care for a year, compared to 8 percent of children with coverage. (August 2, 2005) Medicaid Expansion Is a Side Effect of Welfare Reform Source(s): Dennis Cauchon, USA Today (August 2). Medicaid's expansion from covering 34 million people in 1999 to 47 million in 2004 has "cemented government's role as the nation's primary health insurer," reports USA Today in a front-page article. The program's growth is "an aftershock" of welfare reform, which has moved people from welfare into low-wage jobs that often do not provide health insurance. The "far-reaching consequences" of this include more children being insured and vaccinated; higher Medicaid expenditures, which have increased from $159 billion in 1997 to $295 billion in 2004; and less private insurance, as low-income workers choose Medicaid over employer coverage that is more costly. Critics contend that Medicaid's growth is adding to the federal budget deficit, but supporters say that Medicaid recipients "have no other option and need coverage to keep working." A related article says that the expansion of Medicaid to cover the working poor has "fundamentally broadened the nation's safety net and changed the lives of low-wage workers," even as it has "put enormous strain" on federal and state budgets. Moving people from welfare to work has, "for better or worse, moved the nation a step closer to a government-run national health care system." According to the article, "the Republican-controlled Congress has retooled Medicaid from a program that helps mostly the poor and disabled into one that tackles the issue of working Americans who don't have health insurance." The effect has been that Medicaid is the biggest budget item in many states. While Tennessee and Missouri have cut back their Medicaid spending, most states have protected and expanded the program. Medicaid supporters hope that the expansion will save money in the long run by reducing emergency room visits and other health problems. (August 2, 2005) Southern GOP Governors Lead Way on Medicaid Reform with Market-Based Approaches Source(s): Sonji Jacobs, The Atlanta Journal-Constitution (July 31). Republican Governors Sonny Perdue of Georgia, Jeb Bush of Florida and Mark Sanford of South Carolina are "leading the charge to restructure [Medicaid] and create models for reform efforts nationwide," reports the Atlanta Journal-Constitution. Seeking waivers to loosen federal strictures on Medicaid, they are embracing a market-oriented approach to curbing soaring costs that will "encourage patients to take more responsibility for their health and require them to pay part of the costs of care." Consumer advocates are concerned that such strategies may lead to cuts in benefits that are currently mandatory, and that cost-sharing will be unaffordable to Medicaid beneficiaries. "I think this could be a really dangerous trend that could undermine the whole purpose of the Medicaid program, which is to ensure that vulnerable people who have no other access to health care have a real safety net," said Rachel Klein, deputy director of health policy for Families USA. GOP leaders "have been at the forefront of calls for dramatic Medicaid changes," according to the article. "The kinds of responses we're seeing are very ideological and seem to be testing a number of conservative policy themes," such as running Medicaid more like private insurance plans and giving patients more responsibility and options, said Joan Alker of the Health Policy Institute of Georgetown University. She is "skeptical" about whether such an approach will work for low-income groups, and concerned that the Southern states are moving too fast. However, Nina Owcharenko of the Heritage Foundation said the governors are taking the lead in reforming Medicaid because "quick action is needed to contain skyrocketing costs." (July 31, 2005) Crisis in Kids' Coverage Grows - 9 Million Have Gaps in Coverage, Adding to 9 Million Uninsured Source(s): Alicia Chang, Associated Press (July 27); David Tirrell-Wysocki, Associated Press (July 27). The actual number of uninsured kids is significantly greater than the number most often cited, according to a study about what happens to children in families with intermittent coverage, reports the Associated Press. According to federal data, at least 9 million children, or about 12 percent of all kids in America, are uninsured. However, the study led by the American Academy of Pediatrics found that another 9 million children have gaps in coverage and are just as likely as uninsured kids "to miss out on seeing a doctor or getting a prescription refilled." Indeed, the study found that children with intermittent coverage were more likely to put off medical care than uninsured children. Twenty percent of children who were uninsured for only part of the year delayed care because their parents were concerned about cost, compared to 16 percent of children who were uninsured for the entire year and 4 percent of insured children. About 80 percent of kids with gaps in insurance coverage have parents who work. (July 27, 2005) As Costs Continue to Soar, Governors Keep Their Legislative Focus on Medicaid Source(s): Dan Balz, The Washington Post (July 26). In an attempt to counter significant cuts to Medicaid sought by the Bush administration, the National Governors Association (NGA) recently gave Congress a bipartisan proposal designed to give states more flexibility to administer the program and save money. Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) met privately with the governors and reportedly "suggested that their proposal will be taken seriously by his committee this fall." Democratic Governor Edward G. Rendell of Pennsylvania said, "We're realists, and if those cuts are going to occur, we'd like them fashioned in a way that has the least fiscal impact on us and has the least effect on the provision of benefits to individuals. I think Senator Grassley gave us reason to be optimistic on both of those." The Center on Budget and Policy Priorities has criticized the governors' proposal for allowing more cost-sharing with Medicaid recipients than is currently permitted, and providing states with greater flexibility to structure benefits packages. Some governors contend that pilot programs suggest Medicaid recipients are willing to share some costs to retain benefits, while others worry that the cost-sharing will "backfire" and end up raising costs overall. (July 26, 2005) Former Rivals Hillary Rodham Clinton and Newt Gingrich Unite on Health Care Source(s): Chris Mondics, Philadelphia Inquirer (July 22); Dana Milbank, The Washington Post (July 22). The time when former Republican House Speaker Newt Gingrich and New York Democratic Senator Hillary Rodham Clinton were "mortal political enemies" seemed to be "a distant memory" at a Washington, D.C., forum sponsored by former Democratic Louisiana Senator John Breaux and American University, reports the Philadelphia Inquirer. The forum is one of a series "aimed at creating a bipartisan approach to fixing the health-care system." According to the Washington Post, agreement between Clinton and Gingrich means "there may be relief yet for the 40 million uninsured Americans." Clinton and Gingrich "called upon both parties to fix a national health-care system that they said was crumbling." The two agreed that the nation's health care system was "plagued with inefficiency, waste and rapidly rising costs, with one consequence being the growing number of people without health insurance." The implication of the meeting was that the two "were moving away from ideologically rigid positions toward more practical approaches-and that the rest of Washington ought to follow." Clinton "now acknowledges the private sector's preeminence in health care reform," while Gingrich "endorses some federal mandates," reports the Post. Agreeing to "piecemeal reform," Clinton said "there is enough money in the system right now to cover the uninsured." (July 22, 2005) Health Care Costs to Companies Eat into Employee Raises Source(s): Theresa Agovino, Associated Press (July 18). Not only will employees pay more for their employer-sponsored health care, but the cost of that coverage to their employers may eat up a share of their raises as well, according to a study by PricewaterhouseCoopers. Half of large U.S. companies said that increased health care costs have contributed to slower profit growth, which means that more than 75 percent may ask employees to bear an even greater share of the cost. Also, 25 percent of the companies said soaring health care cost increases of 12 percent per employee last year-which are predicted to increase by another 11 percent this year-may force them to lower raises for employees. Twenty percent expect to slow hiring of permanent workers in the coming year. Companies now spend 12 percent to 15 percent of their payroll costs on health care, up from around 8 percent five years ago. "Health care costs are the reason job growth isn't where the Bush administration would like it to be," said PricewaterhouseCoopers consultant Barry Barnett. (July 18, 2005) At Meeting, Governors Endorse Medicaid Reform Source(s): Kevin Freking, Associated Press (July 15); Robert Tanner, Associated Press (July 17); Dan Balz, The Washington Post (July 17). The summer meeting of the National Governors Association (NGA) focused on Medicare and Medicaid and highlighted the governors' "widespread view that health care is their most urgent issue, for constituents and for states' financial future. United over "sweeping Medicaid changes that could help President Bush's budget goals," the governors all agreed with the NGA plan to "alter Medicaid in hopes of slowing its growing costs, and to give states the chance to experiment with more effective ways to deliver health care." The governors are proposing that Washington allow them to require copayments from the poor. The cost-sharing proposals "are perhaps the most controversial" of the Medicaid restructuring recommendations, according to an earlier AP article. However, "there is overwhelming support" for copays, according to Republican Governor Mike Huckabee of Arkansas, incoming president of NGA. Liberal groups argue that "even nominal increases become extraordinary barriers" for the poor. The article cites a study showing that Medicaid recipients in Oregon began dropping out of the program when premiums and copays were increased two years ago. Some governors warn that "opening the door to co-pays must be accompanied by limits that don't drive the poorest recipients off government-provided health insurance." Ron Pollack, executive director of Families USA, said, "It's ill-advised to increase cost-sharing because what it will do is merely have people covered on paper. But in reality, they won't truly have health coverage because they can't afford it." (July 15, 2005) HSAs, Growing in Popularity, Represent a Philosophical Shift Source(s): Julie Rovner, CongressDaily; Eileen Alt Powell, Associated Press (July 14); Beth Fitzgerald, Newark Star-Ledger (July 15); Jennifer A. Kingson, The New York Times (July 16). More than 60 percent of Americans have job-based health coverage, but it is becoming increasingly unaffordable for employers. HSAs allow companies to provide less generous health benefits to workers, who are then able to set aside tax-free dollars to pay for the health care costs that their plans do not cover. In this way, HSAs lead to a 15 percent to 25 percent drop in premium costs to employers. These savings "might be the thread that weaves more Americans into the nation's health care system," according to the article. Because HSAs give consumers "incentives to hold down their health spending," they are "highly attractive to free-market advocates," according to CongressDaily. Democrats contend, however, that the plans do "exactly the opposite of what health insurance should do," because they help the "healthy and wealthy far more than the poor or the sick." More than 1 million Americans have signed up for HSAs since the Medicare bill's passage, reports the Associated Press. Recent surveys show that awareness of HSAs is low but growing, reports the Times. Eight percent of large employers now offer them, but 18 percent are planning to offer them in 2006 and 47 percent are considering offering them. (July 14, 2005) HHS Head Leavitt Defends Bush Strategy on Uninsured Source(s): Morton M. Kondracke, Roll Call (July 11). In an interview with Roll Call executive editor Morton M. Kondracke, Department of Health and Human Services Secretary Mike Leavitt "addressed many of the trials the nation will face as government and health care providers struggle" with issues such as covering the nation's 45 million uninsured and overhauling Medicaid. Asked about the adequacy of President Bush's plan to cover only about 9 million of the uninsured, Leavitt responded, "The question of how many people are uninsured in this country is a sticky issue," with figures varying from 30 million to 54 million because of different ways of counting. "I don't want to minimize the dilemma," he said, "but the president has offered proposals that would increase the rolls of the insured by 12 to 14 million" through such means as better use of Medicaid resources and increased use of health savings accounts. (July 11, 2005) Fed Up with Soaring Costs, More States Consider Universal Health Coverage Source(s): Matt Leingang, Associated Press (July 10). Soaring health care costs paired with little federal action are leading to a "push for universal health coverage" in some states, reports the Associated Press. Advocates of a single-payer system have introduced bills in at least 18 state legislatures. "The level of misery with private insurers is rising, and that's why we're seeing this increased activity," said Larry Levitt of the Kaiser Family Foundation. While "mainstream" medical groups such as the American Medical Association oppose single-payer systems, proponents such as United Autoworkers say "there's no other solution out there." The bills propose a single-payer system financed through payroll taxes and new taxes on personal income, which would replace the insurance premiums that people now pay. States would "use their leverage" to negotiate lower prices for drugs and health services. Such a system could cost less, according to John Sheils of the Lewin Group, which conducted a study last year of how a single-payer system could work in California. Voters remain "leery," according to the article, with 55 percent of Americans opposed to a single-payer system, according to a recent Kaiser poll, and 37 percent favoring it. (July 10, 2005) Two-Thirds of Uninsured Women Forego Needed Medical Care Due to Costs Source(s): Lawrence M. O'Rourke, Star Tribune (Minneapolis) (July 8). Continued growth in health care costs means that millions of American women forego needed medical care, according to a new study by the Kaiser Family Foundation. "A sizeable share of women are falling through the cracks, either because they don't have insurance or even with insurance can't afford to pay for medical care or prescription drugs," said Alina Salganicoff of the Foundation. The study found that in 2002, 67 percent of uninsured women did not seek the health care they thought they needed due to costs, compared to 27 percent of non-elderly women overall. These percentages were higher than in 2001. The study also found that women were not receiving appropriate preventive care due to costs. Only 40 percent of uninsured women over 40 had a mammogram during the study period, compared to 75 percent of women on Medicare or with private insurance. Rates of Pap tests and colonoscopies also fell. According to Carolyn Clancy, director of the U.S. Agency for Healthcare Research and Quality, the drop in usage "coincides with a government policy that encourages the shifting of health-care costs from insurers to individuals." (July 8, 2005) Growth in Medicaid Costs and Enrollment Prolong States' Fiscal Crisis, Despite Revenue Rebound Source(s): Robert Pear, The New York Times (July 8); July Robert Tanner, Associated Press (July 7). While state revenues rose significantly in the last year, states remain cautious about the fiscal outlook over the next decade, in part because health costs continue to increase, reports the New York Times. Medicaid is now the "largest, fastest-growing category of state spending." State revenues rose 4.7 percent in the 2005 fiscal year, which ended in June in most states, and are expected to increase by 3.6 percent in 2006. But Raymond C. Scheppach, executive director of the National Governors Association, predicted that Medicaid would continue to grow an average of 9 percent to 10 percent a year over the next decade, as it has for the past five years. Those percentages are higher than the 7.8 percent a year projected by the Congressional Budget Office. Scheppach also predicted that more people would qualify for Medicaid because of "continued erosion in health insurance coverage provided by employers." Twenty-four states had shortfalls between the amount budgeted for Medicaid and the amount needed in the past year, and enrollment continues to increase by about 4 percent a year, reports the Associated Press. "Medicaid and health care continue to be a crisis at the state level," said Scheppach. He anticipates cuts in higher education will be necessary to help fund Medicaid if states are not given more leeway in controlling its costs, according to the Times. (July 7, 2005) Number of Uninsured Children Drops Slightly, But No Change for Adults Source(s): Carol Ann Campbell, Newark Star-Ledger (June 30); Reuters (July 4). The number of uninsured American children has "dropped steadily since the late 1990s", reports the Newark Star-Ledger. The decrease, reported by the Centers for Disease Control and Prevention's National Center for Health Statistics, is mostly due to government insurance programs that "have stepped in to help working-poor families." More than 9 percent of children and 14 percent of all Americans were uninsured in 2004, according to this new data, reports Reuters. The findings show a "slight improvement" in coverage for children, but not for adults. Seven million children under age 18 were uninsured in 2004, compared with 10 million, or 14 percent, in 1997. Nearly 70 percent of the nation's children rely on public health coverage, primarily the State Children's Health Insurance Program. New Jersey was one of the first states to provide coverage to children of the working poor, according to the Star-Ledger, and the state is currently trying to enroll more eligible children. The state estimates that about 200,000 of the 265,000 uninsured children in the state are eligible but not enrolled. "New Jersey was at the forefront of children's health insurance. We're concerned about building on our earlier successes and covering as many children as possible," said Keri Logosso of the state's Office of Child Advocate. (June 30, 2005) Three-Quarters of Adults Support Medicaid Despite Drain on State Budgets Source(s): Kevin Freking, Associated Press (June 29). Nearly three-quarters of adult Americans support Medicaid, despite the toll it takes on state budgets, according to a survey by the Kaiser Family Foundation, reports the Associated Press. "We expected Medicaid to be relatively unpopular with the public, much like welfare was," said Mollyann Brodie of Kaiser. "But we found that Medicaid ranks closer to popular programs like Medicare and Social Security in the public's mind." The survey also found that 56 percent of respondents had some sort of dealings with Medicaid, either themselves or through a family or friend on the program. The results of the survey are "relevant as lawmakers grapple with how to slow the growth of the program by $10 billion over the next five years," the article reports. "Proposals to cut funding for the program or scale back the coverage it offers do not appear to be popular with the public," said Kaiser Executive Vice President Diane Rowland. (June 29, 2005) Federal and State Legislation Attempts to "Shame" Large Companies into Offering Benefits Source(s): Stephanie Armour, USA Today (June 23); Amy Joyce, The Washington Post (June 23). In an effort to shame large companies into providing better health benefits, 24 states have passed or are considering bills that would publicize those companies with large numbers of employees in public health programs. In addition, in "an effort to pressure Wal-Mart Stores Inc. in particular to improve employee health coverage," several congressional Democrats introduced the Health Care Accountability Act, a bill that would force states to report the names of companies that have 50 or more employees who receive government-funded health care. The bill's proponents, including Democratic Senator Edward M. Kennedy of Massachusetts and Democratic Senator Jon S. Corzine of New Jersey, said "they are concerned that large employers such as Wal-Mart are transferring responsibility for health care to government-funded programs such as Medicaid." They estimate that more than 600,000 of Wal-Mart's 1.3 million employees do not have company insurance. These efforts come as states end up "shouldering more costs" of health coverage, due to climbing costs that cause employers to drop coverage and the rising number of uninsured workers. Because a large number of Wal-Mart employees in some of the states are on Medicaid, some of the bills have been nicknamed "Wal-Mart bills." This "hall-of-shame approach is rankling some state chambers of commerce and large employers such as Wal-Mart, which has been lobbying against the bills," according to USA Today. Wal-Mart claims it is "unfairly stigmatized because it may often top the lists simply because it is such a large employer." (June 23, 2005) Rise in Health Care Spending Could Force More in Middle Class to Ranks of Uninsured Source(s): Ceci Connolly, The Washington Post (June 21); Julie Appleby, USA Today (June 21); Heather Won Tesoriero, Wall Street Journal (June 21). A "brief reprieve" in health care spending is over, and the resumption of "soaring costs [is] likely to force more people out of the market," reports an annual study by the Center for Studying Health System Change, showing that health spending by privately insured Americans rose 8.2 percent in 2004, about the same as the previous year and the eighth straight year that the growth in medical costs "far outpaced" wage growth, by nearly four times in 2004. The cost increase was largely attributed to an 11.3 percent increase in expensive outpatient care, such as angioplasty and arthroscopic knee surgery, which accounted for 54 percent of the total increase. Prescription drug spending rose, but its rate of growth declined. Costs are expected to remain high in the coming years, reports the Wall Street Journal. The rise in costs forces more businesses to limit or drop coverage. A related study by the Center for Health Solutions found that 83 percent of employers increased the amounts their employees contributed to health benefits last year. However, employers are passing on a smaller amount of the cost increase to workers this year than in the previous three years, reports USA Today. "Most employers right now feel they have shared as much of the cost as they can," said Helen Darling of the National Business Group on Health. "Now they're looking for new ways to manage costs, such as working on the health care system and on health improvement efforts." (June 21, 2005) Governors Offer Congress Sweeping Bipartisan Medicaid Reform Plan Source(s): Robert Pear, The New York Times (June 16); Associated Press (June 16); Ceci Connolly, The Washington Post (June 16); Ricardo Alonso-Zaldivar, The Los Angeles Times (June 16); Sarah Lueck, Wall Street Journal (June 16). The National Governors Association "offered sweeping bipartisan proposals" to Congress on how to "rein in" Medicaid growth, reports the New York Times. Democratic Governor Mark Warner of Virginia, chairman of the association, and Republican Governor Mike Huckabee of Arkansas said states would be allowed to charge higher copayments, design different benefit packages for different beneficiaries and receive larger discounts on drugs. Current law usually limits copayments to $3, according to the Wall Street Journal. While the governors want to increase that amount, they said the poorest beneficiaries should not have to pay more than 5 percent of total family income, and higher-income Medicaid recipients should not have to pay more than 7.5 percent. The governors' plan, supported by at least 35 governors, was "spurred by a congressional budget that trims $10 billion from Medicaid over the next five years," according to the Washington Post. Medicaid currently consumes 22 percent of the average state budget, and spending has soared in recent years due to millions more uninsured and other cost boosters. The governors did not estimate their plan's savings, but did suggest that several billion dollars in reductions were likely. (June 16, 2005) Uninsured Immigrants Account for Most of the Increase in Number of Uninsured Source(s): Adam Geller, Associated Press (June 13); Ricardo Alonso-Zaldivar, The Los Angeles Times (June 13). Growth in the number of uninsured immigrants accounts for most of the recent increase in the number of uninsured Americans, according to a new study. The study, done by the Employee Benefit Research Institute, found that more than 11 million immigrants were uninsured in 2003, the most recent year for which data are available, representing about a quarter of the nation's 45 million uninsured. Between 1998 and 2003, immigrants accounted for 86 percent of the growth in the uninsured, compared to the years 1994 to 1998, when they represented only a third of the increase. The proportion of uninsured immigrants increased from 34 percent in 1994 to 38 percent in 2003. But for native-born Americans, the chances of being uninsured rose only slightly over the same time period, to 14.9 percent. In California, which has the largest number of uninsured immigrants "by far," nearly half of the uninsured were immigrants. The study did not distinguish between legal and illegal immigrants. "The unrelenting rise in the number of people without health insurance is widely seen as one of the most pressing social problems facing the country," according to the article, and the results of the study suggest that "any solution might require changes in immigration policy." (June 13, 2005) Soaring Health Care Costs Contribute to GM Cutting 25,000 Jobs Source(s): Michael Ellis and Jeffrey McCracken, Detroit Free Press (June 8); Sharon Silke Carty, James R. Healey and Chris Woodyard, USA Today (June 8); Danny Hakim and Jeremy W. Peters, The New York Times (June 10). After eliminating 22,000 hourly jobs over the previous four years, "struggling" General Motors Corp. will cut 25,000 more hourly jobs, or about one in five, between now and the end of 2008, reports the Detroit Free Press. CEO Rick Wagoner is "now trying to wrangle health care costs concessions from the union" after some "modest" concessions in the last contract negotiations, but "was not confident any solution was imminent." GM said it is "making little progress" in getting union members to pay a higher proportion of health care costs. Union members pay about 7 percent of the total health care costs, compared to the 27 percent paid by GM salaried workers. GM claims that the U.S. average is 32 percent. UAW President Ron Gettelfinger said in April that he will "work within the confines of the contract to cut GM's health care tab, but has no plans to reopen" the four-year contract. GM is the nation's largest provider of health care benefits, covering 1.1 million Americans. (June 8, 2005) Study Finds the Cost of Caring for the Uninsured Raises Everyone's Premiums Source(s): Kevin Freking, Associated Press (June 8); Marguerite Higgins, Washington Times (June 9). A study by Families USA found that caring for the uninsured increases annual health insurance premium costs for the average worker by $341, and by $922 for the average family. About $1 out of every $12 spent on health insurance premiums indirectly pays for caring for the uninsured, according to the study. "This is the first time that we have quantified what the impact is for businesses and for workers in terms of paying for the care of the uninsured," said Families USA Executive Director Ron Pollack. But Princeton health economist Uwe Reinhardt said that universal coverage would raise the costs to the insured even more, because the uninsured would be likely to get care more frequently. The report predicts that the number of uninsured will increase to 48 million by year's end. (June 8, 2005) Study Finds States Need Different Strategies to Cover the Uninsured Source(s): Marguerite Higgins, Washington Times (June 7). States require "a variety of options" if they are to reduce their uninsured populations, according to a study published in the health policy journal Health Affairs. The study looked at how successful five federal health care proposals for covering the uninsured would be at a state level. "The uninsured population is extremely varied in each state" in terms of income level and access to coverage, said Columbia University health policy professor Sherry Glied, lead author of the study. The proposals included tax credits for consumers and small businesses, two Medicaid expansions, and expanded coverage through the State Children's Health Insurance Program. Tax credits and expanding Medicaid to cover more poor adults would have the most benefit, the study found. However, the effects would vary across states. For example, while tax credits would lower the rates of the uninsured by more than 15 percent in Utah and Kansas, where insurance rates are relatively low, they would have little effect in New York and New Jersey, because these states have high health insurance rates. (June 7, 2005) Wall Street Journal Series Examines Individual Insurance Market Source(s): Sarah Lueck, Wall Street Journal (May 31); Vanessa Fuhrmans, Wall Street Journal (May 31). The Wall Street Journal published a series of articles on the uninsured, with a front-page article on the "vagaries of individual insurance - the private option of last resort for many of the roughly 60 million Americans who don't get health insurance from their jobs." Some 10 percent of Americans under age 65 buy such policies, which have "a big problem" because they box out those who are sick, or make coverage for them "prohibitively expensive." The individual insurance market is now "at the center of a debate" on how to expand health coverage to the uninsured. The dominance of employer-based coverage, which provides tax benefits for both workers and employers, leaves a "smaller pool of possible customers for the individual market." In addition, these customers are more easily bumped from coverage. Republicans say that state-run high-risk pools, created to provide coverage for those who find it hard to obtain, are "a solution for people whose medical conditions make it difficult or impossible to get individual policies." These pools, which enroll only 181,000 people nationwide, "have their own problems," however, as the premiums can still be too high and enrollment is limited, the article notes. Another article notes that the nation's 45 million uninsured have become "the insurance industry's hottest new growth market." The insurance industry has realized that many of the uninsured "are the same relatively healthy Americans they used to cover or administer to in employer health plans," but have lost or opted out of expensive coverage. Insurers are now creating targeted policies for 20-something uninsureds, part-time workers and early retirees. Most of these plans offer more limited benefits than employer-based coverage, covering only catastrophic illness and a set number of doctor visits. "Maybe it's better to have some coverage rather than nothing," said Sara Collins of The Commonwealth Fund. "But are we setting up a system in which we have fewer uninsured but substantially more underinsured?" (May 31, 2005) Two Separate Bipartisan Groups Work on Proposals to Expand Health Coverage Source(s): Alexandra Marks, Christian Science Monitor (May 25); Robert Pear, The New York Times (May 29). Two bipartisan groups, each comprised of business and labor leaders, patient advocates, and insurance and health care providers, have been working separately on strategies for expanding health coverage. Members of the National Coalition on Health Care, a bipartisan group of more than 150 major corporations, health care organizations, pension providers, unions and religious groups that represents 150 million Americans, told Congress that health care, not Social Security is the problem it should be focusing on. And, "at a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders...have been meeting secretly for months to seek a consensus on proposals to provide coverage" for the uninsured. Members of the National Coalition on Health Care said that "the nation's health care problems are dragging down the nation's overall economy" by making it less competitive and lowering Americans' standard of living. The coalition "called on Congress to embrace a plan for universal coverage" within five years, and provided an analysis saying that such reform would save the nation up to $125 billion annually within the decade. The Times reports on a group of 24 leaders representing "the health care industry, corporations and unions, and conservative and liberal groups, including the AARP, the AFL-CIO, the American Hospital Association, America's Health Insurance Plans, the National Governors Association, Pfizer, the liberal Families USA and the conservative Heritage Foundation. While "far from any final agreement," the group supports a range of incremental options, including tax incentives, Medicaid expansion to cover more low-income adults and state-based insurance purchasing pools. It aims by year's end to agree on proposals to expand coverage "to as many people as possible as quickly as possible." The group will present its recommendations to the Bush administration and Congress. (May 25, 2005) High-Deductible Insurance Plans Become Increasingly Popular with Employers and Workers Source: Ricardo Alonso-Zaldivar, The Los Angeles Times (May 23). As medical costs continue to climb, high-deductible health insurance plans that were once relegated to small businesses or the self-employed "are spreading to the giant corporations that have long been the backbone of traditional job-related, low-deductible health insurance," reports the Los Angeles Times. In a trend that may "reshape the medical insurance landscape and sharply redistribute costs," 26 percent of large employers said they would offer high-deductible plans in 2006, compared to 14 percent this year, according to one survey. Another survey found that half of large companies were considering the plans. Because employees "are caught in a painful bind" of smaller wage increases offset by larger premium shares, the plans are "proving popular with workers who might once have scorned" them. The high-deductible plans feature lower premiums and can be tax-deferred, so employees often retain a "bit more take-home pay." The plans also give large companies an "upfront savings" of about 10 percent. However, the plans "may do little or nothing to solve the basic problem of soaring health costs." Employers say the plans are not simply cost shifters; rather, they actually cut health care costs by "changing consumer behavior" by making employees more cost conscious of how they spend their health care dollars. (May 23, 2005) Diverse Group Agrees on Range of Strategies for States to Help the Uninsured Source: Julie Rovner, CongressDaily (May 20). Health insurers, health care providers, government officials and academics participating in the 12th annual Princeton Conference agreed that "legislation that would allow states to experiment with dramatically disparate ways to cover the uninsured might help break the Washington logjam over the issue." A proposal from Stuart Butler of the Heritage Foundation and Henry Aaron of the Brookings Institution won "surprisingly strong support from the diverse group." The proposal recommends that states receive a "policy toolbox" that allows them to experiment with various solutions, including a single-payer plan and tax credits. States that improve coverage would receive rewards. The proposal would allow states to "truly test which approaches work" over a five-year period, as neither Congress nor the administration would have the final say over state decisions. But Alan Weil, executive director of the National Academy for State Health Policy, opposed the state-based approach, saying, "Placing our hopes on the states is not sound public health policy...this is a job for the national government." (May 20, 2005) BusinessWeek Cover Article Looks at Americans' Wariness over Bush's "Ownership Society" Source: Lee Walczak and Richard S. Dunham, BusinessWeek (May 16). A BusinessWeek cover article examined how Americans' fear of losing the safety net of Social Security, Medicare and Medicaid is causing them to turn away from President Bush's idea of an "ownership society." Though "many members of Safety Net Nation have nothing against investing and choice, they're worried that the country's web of public and private social protections is fraying," according to the article. "They believe in more, not fewer, safeguards against downward mobility in a world that's already pulsing with economic uncertainty." The article notes that "Safety Netters include plenty of card-carrying Republicans and independent swing voters, and the group may represent a broader swath of America than the White House imagines." With employer-provided pensions and health care no longer taken for granted and costs being shifted to employees, this group wants "a middle-class security blanket that gives them protection as they build wealth." A recent survey by the nonprofit Civil Society Institute found that 67 percent of Americans support guaranteed health care for all citizens, while only 27 percent disapprove of it, the article reports. Federal spending on the safety net for the poor "has grown briskly," according to the article, but, as witnessed by some states that have downsized their Medicaid programs, it "hasn't kept pace with society's needs." At the same time, "huge holes have been ripped in the private safety net as the cost shift to workers has accelerated." The result is that a "political boulder" stands in the way of Bush's ownership society. (May 16, 2005) Lack of Specialty Care for Uninsured Is a Crisis Source: Judith Graham, Chicago Tribune (May 15). There is "a growing sense of crisis surrounding specialty care for the uninsured," with millions of uninsured Americans who might receive basic medical services at community health clinics not being able to obtain specialty care when they need it, according to a Chicago Tribune article. The uninsured are more likely than the insured population to require specialty care because they tend to have more chronic illnesses, are more likely to develop complications because they forego routine care, and are treated at public hospitals that are "under intense financial pressure as governments cut back support." As an example, the article notes that 200,000 uninsured cancer patients each year spend twice as much out of pocket on care, while seeing physicians less often than insured patients. The uninsured are also much less likely to receive "sophisticated medical tests such as MRI scans, high-tech services such as heart bypass operations and preventive screenings such as colonoscopies." While the federal government has "poured significant amounts of money" into community health centers that deliver basic care, neither it nor state and local governments "devoted funding to expanding specialty care," the article concludes. (May 15, 2005) Leavitt to Appoint Panel to Recommend Medicaid Changes Source: Robert Pear, The New York Times (May 12). The Bush administration announced that it would create an advisory panel "to recommend big changes in Medicaid eligibility and benefits and in the financing of the program," reports the New York Times. Despite "bipartisan Congressional pleas for an independent commission under the auspices of the National Academy of Sciences," the panel will have up to 15 voting members, all appointed by Health and Human Services Secretary Michael O. Leavitt and 18 nonvoting members." According to the panel's charter, voting members will include Leavitt or his designee; federal officials who run programs for the Medicaid population; former or current governors; former or current state Medicaid directors; three health care experts from public policy organizations; and other "individuals with expertise in health, finance or administration." Eight members of Congress, appointed by Congressional leaders and split between the two parties, will be the nonvoting members. The panel will also "receive advice" from 10 people involved in Medicaid, including consumer representatives and health care providers. The panel is charged with recommending by September 1 ways to save $10 billion in Medicaid, and making "longer-term recommendations on the future of the Medicaid program" by December 31, 2006. (May 12, 2005) State Governments Outline Steps for Medicaid Reform That Reign in Costs Source: Robert Pear, The New York Times (May 9). The National Governors Association and the National Conference of State Legislatures (NCSL) have drafted proposals for "sweeping changes in Medicaid" designed to cut spending by $10 billion over the next five years, as called for in the fiscal year 2006 Federal budget resolution. The proposals require some beneficiaries to pay more for care, and give states more flexibility to limit services. The recommendations include raising copayments for Medicaid services; using incentives and penalties to encourage individuals to take more responsibility for their own health care; creating purchasing pools to help small businesses buy health coverage for employees; using health care tax credits to slow the growth of the Medicaid-eligible population; and streamlining or eliminating the federal Medicaid waiver process. A coalition of health care providers, labor unions and patient advocates "is already gearing up to fight any significant cutbacks in Medicaid." However, with Congressional leaders anxious to control Medicaid costs, the proposals "have a substantial chance of becoming law." John Adams Hurson, a Democratic Maryland legislator and president of NCSL, said, "I am ... a liberal Democrat, but we can't sustain the current Medicaid program. It's fiscal madness. It doesn't guarantee good care, and it's a budget buster. We need to instill a greater sense of personal responsibility so people understand that this care is not free." (May 9, 2005) States and Businesses Battle Over Who Is Responsible for Workers' Health Coverage Source(s): Reed Abelson, The New York Times (May 6). Rising health care costs are leading to battles between states and businesses over who is responsible for insuring workers, reports the New York Times. With the jointly funded federal-state Medicaid program consuming about 16 percent of state budgets, and states facing cuts in the federal allotment as the number of uninsured rises, "the states' burden seems likely to grow." But employers question whether they are responsible for a national problem. The article examines some of the ways that nearly two dozen states are "looking to shift more of the financial burden" of covering workers onto their employers. For example, Maryland has passed a bill requiring large employers to spend at least 8 percent of their payrolls on health benefits; New Jersey would only let companies that provide coverage for their workers to bid on state contracts; and Tennessee and Minnesota have been dropping people from public coverage. "There's momentum around these efforts," said Jeff Munn of Hewitt Associates. According to its backers, support for the Maryland bill "indicates a growing recognition of the growing financial burden of caring for the uninsured," with tax payers footing the bill for uninsured workers. "Few policy analysts expect the struggle between states and employers to end anytime soon," the article concludes. (May 6, 2005) Surveys Look at Appeal of Health Savings Accounts Source(s): Sarah Lueck, Wall Street Journal (May 4); Marguerite Higgins, Washington Times (May 5). In "a slow start to a coverage option being pushed by President Bush and top administration officials," fewer than 5,000 people have enrolled in health savings accounts being offered to federal employees, reports the Wall Street Journal. However, since they were authorized in 2003, 1,031,000 HSAs have been opened overall, according to a survey by America's Health Insurance Plans. An article about the survey in the Washington Times calls the accounts "booming." This year was the first time health savings accounts were offered to the more than 8 million people covered under the Federal Employees Health Benefits Program. "Federal employees, like most consumers in America, are slow to adopt something new," said Michael Orenstein of the Office of Personnel Management. Backers expect HSAs-high-deductible plans that allow workers to set aside tax-free money for medical costs-to increase in popularity as they become more available. The Washington Times reports that individual enrollment in HSAs was higher than employee enrollment in HSAs. Among small businesses offering the accounts, 37 percent said that they previously offered no coverage to workers. Twenty-seven percent of individuals enrolled in HSAs were formerly uninsured. (May 4, 2005) Young Adults Are Fastest Growing Group of Uninsured Source(s): Bloomberg News (May 4). Young adults ages 19 to 29 are the fastest growing group without health coverage, according to a Commonwealth Fund study reported by Bloomberg News. The number of uninsured in that age group has jumped 2.2 million in three years, to 13.4 million. The total number of uninsured Americans rose 5.2 million during the same period. The report concludes that about two-thirds of those aged 19 to 23 probably will lack coverage at some point during the next four years unless policies change. To tackle the problem, The Commonwealth Fund recommends expanding the State Children's Health Insurance Program to cover people until age 23, and requiring colleges and universities to offer coverage. (May 4, 2005) Congressional Action on Uninsured Appears Unlikely Source(s): David Espo, Associated Press (May 3); Emily Heil, CongressDaily (May 6). "Although groups around the country are calling for action in Congress as part of Cover the Uninsured Week and lawmakers are busy holding news conferences on the topic, most proposals have been hampered by inattention, budget constraints and lack of consensus among lawmakers," reports CongressDaily. Providing health coverage to the nation's uninsured is "one of the stated goals" of Senate Majority Leader Bill Frist and other congressional leaders, but Congress has not enacted any significant legislation to reduce the number of uninsured since 1997, and "most experts do not expect that to change any time soon." As part of this year's Week, House Democrats unveiled a proposal last week that would expand coverage. The plan would allow retirees between the ages of 55 and 65 to buy into Medicare, provide a 50 percent tax credit to small businesses and the self-employed if they purchase coverage, and expand the State Children's Health Insurance Program to 7.5 million low-income working parents of eligible children. The cost of these expansions was not disclosed. As the minority party, however, House Democrats "have no hope of winning passage of their agenda on their own," and little chance of obtaining sufficient Republican support. (May 3, 2005) Congress Passes Budget Featuring $10 Billion in Medicaid Cuts Source(s): Sheryl Gay Stolberg, The New York Times (Apr. 29); Jonathan Weisman, The Washington Post (Apr. 29); Janet Hook, The Los Angeles Times (Apr. 29); Jim Abrams, Associated Press (Apr. 29). "Resolving differences that revolved largely around Medicaid," Congress adopted a $2.56 trillion federal budget last week. The new budget features "the first curbs on entitlements for the poor in nearly a decade," including $10 billion in cuts to Medicaid over five years, which make up nearly a third of the total $35 billion in cuts. The budget is non-binding, but it "provides an economic blueprint" for lawmakers as they tackle specific tax and spending legislation. Medicaid was "a point of particular controversy" in the budget, with the House version calling for $20 billion in cuts over five years. The negotiated Medicaid cuts were "too much for many Democrats and liberal groups," and were "particularly galling ... because they were proposed in tandem with additional tax cuts," reports the Los Angeles Times. "It is unconscionable to balance the budget on the backs of our must vulnerable Americans, and that is exactly what the White House and congressional Republicans have decided to do," said Democratic Senator Hillary Rodham Clinton of New York. Democrats unanimously opposed the resolution. But Senate Budget Committee Chairman Judd Gregg (R-N.H.) said that the Medicaid savings accounted for only about 1 percent of the program's projected spending of more than 1.1 trillion over the next five years. (April 29, 2005) USA Today Examines High Rate of Medical Bankruptcy Among the Insured Source: Julie Appleby, USA Today (Apr. 29). Employers increasing the amount that employees must pay for medical care in an effort to control soaring health care costs is "having ripple effects" that can destroy personal finances and lead to bankruptcy. For the "fully insured middle-class people who become ill with critical or life-threatening illnesses, it can completely ruin their financial health," said Beth Darnley of the Patient Advocate Foundation. Elizabeth Warren, a Harvard professor who recently authored a study that found that medical bills contributed to half of all personal bankruptcies, said, "Families are paying more and more for health insurance that covers them less and less." According to Warren's research, medical bills lead about 1 million Americans into bankruptcy each year, with the average out-of-pocket medical debt at the time of filing being about $12,000. Sixty-eight percent of these filers have health insurance. (April 29, 2005) Cover the Uninsured Week Launches with Study Showing That Millions of Uninsured Adults Are Working Source(s): Ken Freking, Associated Press (Apr. 27); Julius A. Karash and Alan Bavley, Kansas City Star (Apr. 27); Celeste Katz, Daily News (New York, NY) (Apr. 27); USA Today (Apr. 27). A new study for the Robert Wood Johnson Foundation (RWJF) found that Texas leads the nation in the percentage of uninsured adults-most of them employed-while Minnesota claims the lowest percentage. The report "is aimed at a common misperception: that all working people have insurance through their jobs," reports USA Today. In fact, a "significant number" of these uninsured adults are employed. In Texas, 30.7 percent of adults are uninsured, including 26.6 percent of working adults. In Minnesota, 8.3 percent of adults are uninsured, including 6.9 percent of working adults. "There is an old image that people who are uninsured don't work or are on public assistance," said Stuart Schear of RWJF. "That's never really been accurate and is completely inaccurate today." Other states with high percentages of uninsured are Louisiana, with 26.4 percent of all adults uninsured, including 22.6 percent of working adults, and New Mexico, with 26 percent of all adults uninsured, including 22.6 percent of working adults. Another article about the study reports that 41 percent of uninsured adults say they were unable to see a doctor when they needed to during the previous year; 56 percent said they did not have a personal doctor or other health care provider, compared to 16 percent of those with coverage; and 20 percent said their health was fair or poor, compared with 12 percent of those with coverage. The New York Daily News reports that there are also racial disparities in coverage, with about 35 percent of working Latinos lacking coverage, compared with about 19 percent of working black adults and 12 percent of working white adults. (April 27, 2005) Launch of Third Cover the Uninsured Week Receives Widespread National Attention Source(s): Rachel Brand, Rocky Mountain News (Apr. 27); Jerry Spangler, Deseret Morning News (Apr. 28); Mike Snyder, The Houston Chronicle (Apr. 28); Katherine Marks, Arkansas Democrat-Gazette; UPI (Apr. 28); Reuters (Apr. 28). The third national Cover the Uninsured Week launched on April 27 in Washington, D.C. Sponsored by the Robert Wood Johnson Foundation (RWJF), the Week includes more than 1,700 events planned for May 1-8. Republican Senator Orrin Hatch of Utah and Democratic Senator Ron Wyden of Oregon attended the launch, which "dovetails" with legislation sponsored by the senators. Called the Health Care That Works for All Americans Act, the legislation calls for a national dialogue on the health care crisis and mandatory congressional hearings on the findings of town hall meetings of average citizens held in all 50 states. "We want to hear from people outside of Washington, D.C.," about their concerns with the health care system, said Hatch. Wyden and Hatch challenged Americans to "come up with new ideas that can help avert a total collapse of the system," according to the article. A bipartisan approach such as the Wyden-Hatch legislation has never been tried before, said Wyden. He said the current way of trying to reform health care has failed for 60 years. "From President Truman to President Clinton, health care reform has been pushed on the American people from inside the beltway in Washington, D.C." According to Hatch, "Real health care reform will come from the people, not bureaucrats in Washington." Results of a Robert Wood Johnson Foundation study finding that 20 million uninsured individuals-almost half of the total number of uninsured-are working adults were released at the Cover the Uninsured Week kickoff. According to the Rocky Mountain News (Denver), Dr. Rick May, president-elect of the Colorado Medical Society, believes that nobody wants to pay to solve the problem because the uninsured tend to live at the "political margins." According to May, "If you had an AARP to represent the uninsured, you'd have a huge amount of outcry." (April 27, 2005) New Analysis Suggests Official U.S. Number of Uninsured May Be High Source(s): Ricardo Alonso-Zaldivar, The Los Angeles Times (Apr. 26). Two new government-funded reports that suggest that the number of uninsured Americans may be overstated by as much as 20 percent may have "broad consequences for the healthcare debate" and for financing of the State Children's Health Insurance Program (SCHIP). Rather than 45 million uninsured in 2003, the most recent year for which figures are available, the new findings purport the number should be 36 million. The reports conclude that the 45 million figure derived from the U.S. Census Bureau's Current Population Survey may be overstated due to technical analytic problems. Michael O'Grady, a top health economist in the Bush administration, "push[ed] to reassess the number of people lacking health insurance." One of the new studies, conducted by Actuarial Research Corp., estimated that 9 million of the 45 million had coverage. The other study, by the Urban Institute, a nonpartisan Washington think tank, found a smaller overcount of about 4 million based on 2001 data. Both studies claim the Current Population Survey undercounted the number of Americans on Medicaid. "Reflecting the political sensitivity of the issue, the White House said President Bush was determined to expand coverage, regardless of the precise number of uninsured," according to the article. "The president believes there are too many Americans who are uninsured," White House spokesperson Trent Duffy said. "We defer to the official experts on exactly what the count is, but the president thinks it's too many." However, Princeton health economist Uwe Reinhardt, while agreeing that the number of uninsured might be less than 45 million, said, "the administration's decision to commission the research showed that it was worrying more about counting the uninsured than about helping them." (April 26, 2005) Medical Bankruptcy Strikes an Increasing Number of Middle-Class Americans Source(s): Angus Loten, Chicago Tribune (Apr. 24). Several thousand Americans are "driven to financial ruin each year by sometimes life-threatening illness or injury," according to the recent Harvard study of bankruptcies caused by medical bills. Between 1.9 million and 2.2 million Americans experienced medical bankruptcy in 2001, a figure that includes family members and dependents of the filers. The 1.5 million individuals and couples who filed general bankruptcy petitions that year marked a 360 percent increase from 1980. Most were middle-class homeowners, the study found. Many had health insurance, but were "overwhelmed by co-payments, deductibles and uncovered services," or forced out of work by their illness and lost coverage. (April 24, 2005) Medicaid Reform Tied Up in Congress Source(s): Associated Press (Apr. 21). "The House and Senate stand far apart over proposed cuts to Medicaid and other government spending, an impasse that has deadlocked negotiations on next year's budget," reports the Associated Press. A proposed reduction in Medicaid spending, the centerpiece of Republican efforts to rein in federal deficits, is the "key disagreement." House lawmakers do not want to start negotiations with the Senate "until it is clear a majority of senators can support a budget" with restraints on federal spending. To date, Senate Republicans are not in agreement about whether to act now to restrain spending on the program. President Bush proposed $8.5 billion in Medicaid savings over five years, but the House, despite a letter signed by 44 Republicans protesting the cuts, would reduce spending over the next five years by $20 billion. The Senate took a plan for $14 billion in Medicaid reductions out of its budget and instead created a commission to study changes to the program. (April 21, 2005) With Medicaid Cuts Looming, States Try to Strategize Source(s): Kyung M. Song, The Seattle Times (Apr. 21); Stephanie Simon, The Los Angeles Times (Apr. 24); Robert Tanner, Associated Press (Apr. 25). U.S. Secretary of Health and Human Services Mike Leavitt, speaking in Seattle, said he wants states to have more flexibility in how they administer Medicaid. He argues that increased flexibility will allow states to offer basic coverage to more poor people instead of comprehensive coverage to fewer people. Leavitt, a "key architect of the Bush administration's Medicaid policy," also said he is in favor of allowing states to charge co-payments to those covered by Medicaid. Leavitt implemented such changes to the Utah Medicaid program when he was governor. By limiting benefits to basic medical coverage, he expanded coverage to 400,000 more uninsured residents. The co-payments that Leavitt supports "are not so much meant to generate significant revenue as to discourage patients from seeking unnecessary services." Washington state Medicaid director Doug Porter said he "was encouraged by Leavitt's stance on giving states more freedom to alter their Medicaid programs." Cost-containment strategies are underway in several states, such as Tennessee, where Democratic Governor Phil Bredesen plans to end coverage for more than 320,000 adults; and South Carolina and Florida, where Medicaid privatization has been proposed. It notes that a few states are expanding Medicaid, such as Kansas, where Democratic Governor Kathleen Sebelius wants to raise cigarette taxes to cover more poor working adults; and Illinois, where tens of thousands of children and parents have been added to the Medicaid rolls over the past two years. The "most drastic overhaul of all" is in Missouri, where nearly one in five residents is enrolled in Medicaid, and the program eats up more than 30 percent of the state budget. Republican Governor Matt Blunt is about to sign a bill that would eliminate the program entirely in three years, by which time he expects that the state will have "an alternative mechanism" for helping the poor. While eligibility details in the bill are still being negotiated, one leading proposal would deny coverage to a single mother of two who earns $3,800 a year, though her children would receive coverage. If she earns $23,000 a year, her children would not be eligible for coverage. Republican lawmakers in Missouri contend that the cuts are "about steering Medicaid back to its original purpose: to serve as [a] safety net for citizens who are too young, too old or too ill to help themselves," and not as "a welfare program for poor but able-bodied adults." But opponents such as Democratic State Representative Trent Skaggs, consider the new rules "cruel, especially at a time when more than 45 million Americans lack coverage." Skaggs notes that the new eligibility requirements could prompt parents to stop working so that their income falls low enough for them to qualify for the program. (April 21, 2005) Study Finds That HSAs Are Unaffordable for Most of the Uninsured Source(s): John Strahinich, The Boston Herald (Apr. 20). A new study found that fewer than 1 million of the 45 million uninsured Americans are likely to obtain coverage by opening up health savings accounts (HSAs), which are supported by President George Bush, reports the Boston Herald. More than half of uninsured adults are "too poor to pay taxes to begin with," and so tax-free HSAs hold no appeal, said economist and lead study author Sherry Glied of Columbia University. She estimates that even middle-income Americans would see savings of no more than 3 percent to 6 percent on the $2,000 annual premium cost of a typical high-deductible health plan. Those buying HSAs tend to be older people who have lost their jobs and are waiting until they are eligible for Medicare, and younger workers who are leaving their parents' coverage. However, Larry Akey, spokesperson for America's Health Insurance Plans, said that about a third of those buying HSAs were previously uninsured, according to a preliminary survey conducted by the organization. He said that it is too early to judge the appeal of HSAs. (April 20, 2005) Merck, Following Move by Competitors, Offers Drug Discount Card to Uninsured Source(s): Theresa Agovino, Associated Press (Apr. 19); Michael S. Rosenwald, The Washington Post (Apr. 20); Barbara Martinez, Wall Street Journal (Apr. 20). Pharmaceutical giant Merck and Co. announced that it would join other drug companies in providing uninsured Americans steep discounts on its drugs, reports the Washington Post. The company said it will launch a discount card for uninsured Americans regardless of their age or income, reports the Associated Press. People can obtain the card, which became available April 25, at www.merckuninsured.com or by calling 1-800-50MERCK. Most drug makers already have programs that provide free medications to those with incomes of less than $19,000, but many Americans making more than that "still struggle" to pay for their medications. The Merck plan offers discounts of between 15 percent and 40 percent off its medications. While the company denies that millions of Americans buying lower-cost drugs from Canada was the incentive for the program, it did note that its discount program "will bring prices closer in line with those found in Canadian pharmacies." Unlike a somewhat similar program launched by Pfizer, the Merck program will not require people to prove they are uninsured with low incomes. Responding to the Merck announcement, Ron Pollack, executive director of Families USA, said, "Any help that is provided to uninsured people with their medicines is certainly welcomed. However, uninsured people are often unable to go to a physician because they can't afford to pay ... Therefore they can't even get a prescription." (April 19, 2005) Uninsured at Los Angeles Public Hospitals Leads to Major Increases at Private Facilities Source(s): Jia-Rui Chong, The Los Angeles Times (Apr. 15). Uninsured patients being turned away at overcrowded public hospitals in Los Angeles County led to a one-third increase in the number of uninsured patients going to private emergency rooms over the past five years, according to a study reported by the Los Angeles Times. The recent closure of nine hospitals and emergency rooms in the county, which has one of the highest percentages of uninsured of any major metropolitan area, is largely attributed to this trend, according to the study. The study also found that uninsured patients were waiting longer before going for treatment, and so requiring more "extensive and expensive care." Most of these uninsured are aged 19 to 64 years old and are working, but at jobs that do not provide health benefits. Twenty percent are immigrants. Administrators at private hospitals say that they are losing millions of dollars from emergency room visits by the uninsured. For example, Downey Regional Medical Center reported losing more than $1 million in care of the uninsured in the ER in 2002, and by 2004, lost about $6 million. However, Lark Galloway-Gilliam, executive director of Community Health Councils in Los Angeles, was concerned that uninsured patients will be charged full price for their treatment at private hospitals, and "feared that the shift to private emergency rooms would leave patients with heavy debts that could bankrupt them." (April 15, 2005) House GOP Members Sign Letter Opposing Medicaid Cuts; Move Could Impede Bush Plan Source(s): Kevin Freking, Associated Press (Apr. 14); Tony Pugh, Philadelphia Inquirer (Apr. 15); Joel Havemann, The Los Angeles Times (Apr. 16). Cuts to Medicaid, which have been sought by the Bush administration and opposed by many of the nation's governors, continue to dominate Congressional budget debates. The latest development came when a letter signed by 44 House Republicans asked the House Budget Committee Chair Jim Nussle (R-Iowa) to abandon up to $20 billion in cuts over the next five years, and instead create a bipartisan committee to restructure the program. The letter poses "a serious threat to plans by President Bush and GOP leaders to curtail spending on a range of benefit programs," and could "hinder Congress' ability to pass this year's budget resolution," reports the Los Angeles Times. The Senate had voted to restore the Medicaid cuts recommended by its Budget Committee, setting the stage for conflict between the two Congressional branches. Republican Representative Heather Wilson of New Mexico, author of the letter, said she did not intend it as an obstacle to passing the budget. Democrats consider the letter "a significant development," according to AP. (April 14, 2005) Slowed Wage Growth Attributed to Soaring Health Premium Costs Source(s): Nicholas Riccardi, The Los Angeles Times (Apr. 11). Wage growth trailed inflation for the first time in 14 years, reports the Los Angeles Times. "Workers' wallets are being pummeled by something of a perfect storm of economic forces: a weak job market, rising health insurance premiums and other inflationary pressures," according to the article. The rising price of health premiums increased the cost of benefits to employers by 7 percent last year, "eating into the pool of corporate cash set aside for raises," which rose only about 2.4 percent. The falling value of wages is particularly hard on the 47 percent of workers who do not have employer-provided health coverage and have to pay for it themselves, especially lower-income workers who are more likely to be uninsured. "Healthcare has eroded the wage base," said Janemarie Mulvey, chief economist at the Employment Policy Foundation, a Washington, D.C. think tank. "In the long run, we can't continue like this. If healthcare keeps crowding out wages forever, something's got to give." (April 11, 2005) General Motors Struggles as Soaring Health Costs Threaten Profits Source(s): Lee Hawkins Jr., Wall Street Journal (Apr. 7); Jonathan Fahey, Forbes (Apr. 11); David Welch, Business Week (Apr. 11). General Motors Corp. (GM) expects to spend $5.6 billion this year on health care for its 1.1 million active and retired employees and their dependents. That cost amounted to an extra $1,525 on the price of every GM car produced in the U.S. last year, and according to Chief Executive Rick Wagoner is responsible for "much of GM's profit woes." The situation "is even worse than [Wagoner] says it is," according to Forbes. To cover future benefits already earned by its workers and retirees, GM would need to have $77 billion set aside, though it only has $20 billion banked for that purpose. This leaves Wagoner "walking a tightrope," needing to win concessions from Congress, such as having the government fund catastrophic medical bills, as well as from the United Auto Workers (UAW). (April 7, 2005) Dueling Massachusetts Plans to Cover the Uninsured Unveiled Source(s): Theo Emery, Associated Press (Apr. 6); Ann E. Donlan, The Boston Herald (Apr. 7); Scott S. Greenberger, The Boston Globe (Apr. 7); Scott S. Greenberger, The Boston Globe (Apr. 8). Republican Governor Mitt Romney of Massachusetts and Democratic State Senate President Robert Travaglini unveiled "dueling" health care proposals aimed at providing affordable health care coverage and reducing the number of uninsured in the state. Romney's plan would insure "virtually everyone in the state" by 2009, while Travaglini's goal is to provide coverage to half of the 500,000 uninsured residents by the end of 2006. Romney claims that his plan, called "Commonwealth Care," would cost about half the current cost of health care by offering less comprehensive coverage. By bringing down the cost of a basic insurance plan from about $350 a month to $200 a month for an individual, the plan would provide lower-cost coverage to about 168,000 uninsured people who cannot afford coverage at current rates. It would also expand Medicaid coverage to about 106,000 residents who are eligible but have not enrolled. Travaglini's "far-reaching" plan "goes further" than the governor's, according to the Boston Globe. His plan, which would draw on $168 million in state reserves, would make it easier for the uninsured to purchase their own coverage by encouraging insurers to offer affordable coverage to self-employed workers, employees of small businesses and others who do not have coverage. It would also boost Medicaid payments to hospitals and doctors that treat the uninsured by $90 million or more a year. By allowing patients to compare prices and quality of care, Travaglini says his plan would "unleash market forces to help contain costs." (April 6, 2005) Maryland Moves Closer to Employer Insurance Mandate Source(s): David Nitkin, The Baltimore Sun (Apr. 6); John Wagner and Michael Barbaro, The Washington Post (Apr. 6). A bill passed by the Maryland State Senate would make the state the first to tax large corporations that do not provide a mandatory level of employee health care benefits. Under the plan, called the Fair Share Health Care Fund Act, for-profit companies with 10,000 or more workers would be required to spend 8 percent of their payroll costs on health care or else pay the state a levy. Large non-profit organizations would have a 6 percent payroll requirement. Though there are four large Maryland companies covered by the bill, only Wal-Mart would be affected by the act because it does not meet the 8 percent threshold, though smaller businesses are "worried" that the measure would affect them in the future. Critics of the measure contend that lawmakers should not "target one company" and that the bill makes the state appear unfriendly to business. But supporters say that Wal-Mart employees and their dependents who do not receive health benefits are being subsidized by the state because they "disproportionately rely on Medicaid and other government programs." (April 6, 2005) Uninsured Americans Try to Lower Health Costs, But Often End Up Avoiding Care Source: Michael P. Regan, Associated Press (Apr. 6). Uninsured patients resort to "many unique strategies" to acquire affordable health care, reports the Associated Press. These range from travel to foreign countries where care may be cheaper, to intensive Internet searches for treatment information. But "toughing it out" is also common among those without coverage, according to Stuart Schear, director of next month's Cover the Uninsured Week campaign, sponsored by the Robert Wood Johnson Foundation. "It's estimated that nearly 18,000 people in the U.S. probably die each year because they do not have health coverage," Schear said. He also noted that high medical bills are the second-leading cause of personal bankruptcy. (April 6, 2005) More Pregnant Women Lack Health Coverage; Turn to Consumer-Driven Care Source: Vanessa Furhmans, Wall Street Journal (Apr. 5). As health premiums for family coverage rise and some dependents are dropped from coverage, more women lack coverage for pregnancy, reports the Wall Street Journal. About a quarter of working-age women lack employer health benefits or are not eligible for Medicaid. As a result, "pregnant women are by necessity and ingenuity paving the way in what is called 'consumer driven' health care." With the nation's 4 million annual births typically costing anywhere from $7,000 to $12,000 each, these women are "forced to navigate a murky system of health-care pricing and to make medical decisions based as much on checkbooks as maternal instinct." The task is both "daunting" and "an emotionally charged one that involves tough trade offs," with women worried about "alienating the doctors who will be handling the birth of their child." More employers are offering some type of consumer-driven plan that requires patients to bargain hunt, which is "exactly what many employers, health insurers and policymakers want patients to start doing to help control health costs." Maternity care is seen as a model for this approach, because families have months to evaluate options such as maternity discount care, prepackaged birth plans and less-expensive nurse midwives, the article reports. (April 5, 2005) Working Poor Faced with Soaring Costs Forced to Forego Heat and Food Source: Daniel Costelle, The Los Angeles Times (Apr. 4). A Los Angeles Times article profiles the "insured poor-those forced to make serious financial sacrifices in order to hold onto health coverage for their families, including skimping on food, heat, and car insurance; delaying home ownership; and not saving for their children's education. "Such sacrifices for health insurance are far from rare," as rising health care costs are forcing employers to ask their employees to shoulder more of the costs, or causing them to drop coverage altogether. Health costs have become "the single biggest expense" in some family budgets, with the number of people spending more than a quarter of their earnings on health care increasing by nearly a fourth, to 14.3 million people, between 2000 and 2004. According to Glenn Melnick, a Rand Corporation economist and a professor of health care finance at the University of Southern California, the "profile of the uninsured" will change over the coming years as soaring health care costs force more middle-class families to face harsh financial choices. Even now, 14 percent of those without insurance earn between $25,000 and $50,000 a year. "The newly uninsured will be more mainstream," he predicts. (April 4, 2005) Consumers Would Trade Choice in Health Provider for Lower Cost Source: Theresa Agovino, Associated Press (Mar. 24). A survey found that Americans with employer-sponsored health coverage are more willing to limit provider choice in exchange for savings in medical costs than in the past, reports the Associated Press. An annual study from the Center for Studying Health System Change found that 59 percent of Americans with employer-provided coverage would make that trade in 2003, compared to 55 percent in 2001. Low-income consumers were more likely to make the exchange to save on costs. Paul Ginsburg, president of the center, attributed the increase to higher premiums, deductibles and other health care costs paid by workers, which are the result of the rising health care costs faced by employers. The findings were "surprising," Ginsburg noted, because consumer preferences between choice and cost had been stable from 1997 to 2001. (March 24, 2005) Prestigious Health Care Administrators Call on Nation to Cover the Uninsured Source(s): Liz Kowalczyk, The Boston Globe (Mar. 24). The chief of Partners HealthCare System, Massachusetts' largest hospital and physician network, issued a national public appeal for higher taxes and employer mandates to solve the problem of the uninsured, reports the Boston Globe. In the New England Journal of Medicine, Dr. James Mongan, chief executive of Partners, and Dr. Thomas Lee, president of Partners' physician network, wrote, "How can a country as idealistic and generous as the United States fail repeatedly to accomplish in healthcare coverage what every other industrialized nation has achieved?" According to Mongan, Americans want universal coverage, but "shy away" from paying for it. The article appeared as Republican Governor Mitt Romney of Massachusetts and the State Legislature are preparing to debate how to expand coverage to the state's 460,000 uninsured. Romney and State Senate President Robert E. Travaglini (D) have ruled out the higher taxes and employer mandates that the Partners chiefs are advocating. According to Eileen McAnneny, vice president for government affairs for the employers' organization the Associated Industries of Massachusetts, employer mandates do not make sense because "most of the businesses that don't provide health insurance are small and they don't provide it because they can't afford to." (March 24, 2005) Tax Experts Tell Presidential Panel That Tax Credits Do Not Reduce Number of Uninsured Source(s): Mary Dalrymple, Associated Press (Mar. 24). Health insurance tax credits for employers and individuals do "more harm than good," tax experts told the President's Advisory Panel on Federal Tax Reform, reports the Associated Press. Tax experts Eugene Steuerle of the Urban Institute, and Mark Pauly, a professor of health care economics at the University of Pennsylvania, said that tax breaks "don't promote the spread of basic health insurance coverage," and instead encourage people to buy excess coverage so as to lower their taxes. This, in turn, leads to health care costs increases, which force some employers to drop coverage altogether. The panel's vice chairman, former Louisiana Senator John Breaux, asked tax experts about how best to use tax laws to decrease the number of uninsured. "It's the biggest problem, I think, in the country," said Breaux. Claiming that the current system disproportionately benefits the wealthy, Pauly recommended limiting tax subsidies for health coverage and combining them with a new, refundable credit to help low-income and uninsured people purchase coverage. The panel plans to issue a report this summer. (March 24, 2005) Employer Coverage of Retirees Declines, Especially for Early Retirees Source: Christopher Conkey, Wall Street Journal (Mar. 23). Fewer retired workers, especially early retirees, are receiving health coverage from their former employers, reports the Wall Street Journal. A report from the nonpartisan Employee Benefit Research Institute (EBRI) found that 29 percent of early retirees had employer-sponsored health coverage in 2002, compared to 39 percent in 1997. The percentage of older retirees who are eligible for Medicare and receiving such benefits also declined over the same period, from 28 percent to 25 percent. An aging population and soaring health care costs are partly responsible for the decline, but the survey cited a 1990 Federal Accounting Standards Board ruling that changed employers' financial reporting on retiree health benefits as the primary reason. EBRI said it expects the coverage declines to continue, and warned workers to "lower expectations for employer-based health coverage in retirement." (March 23, 2005) Senate Votes against Medicaid Budget Cuts Promoted by President Bush Source(s): Jonathan Weisman, The Washington Post (Mar. 18); Joel Havemann, The Los Angeles Times (Mar. 18); Tim Dillon, Associated Press (Mar. 18); Sheryl Gay Stolberg, The New York Times (Mar. 18). The budget approved by the Senate on March 17 "dealt a slap to President Bush and the Republican leadership" by abandoning most proposed deficit-reduction measures and restoring cuts to Medicaid, education, and other programs, reports the Washington Post. Opponents of the Medicaid cuts argued that federal and state experts needed time to work out changes to Medicaid "before Congress sets arbitrary spending limits" on it. Senator Gordon Smith (R-Ore.), who wrote an amendment to restore Medicaid dollars to the budget with Senator Jeff Bingaman (D-N.M.), said that cutting Medicaid "was a matter of life or death" to some of the program's low-income beneficiaries, according to the Los Angeles Times. "Those 52 million people are counting on us to do this right, not just to do it fast," he said. With a vote of 52 to 48 on the amendment, in which seven Republican senators joined with the 44 Democrats and one independent, the senators elected to restore $14 billion in Medicaid cuts and establish a one-year commission to explore measures to slow the program's growth. The Medicaid reductions, which total 1 percent of expected Medicaid spending over five years, "are the keystone of plans by Bush and GOP congressional leaders" for curbing federal deficits, reports the Associated Press. The Senate's move "set up a confrontation with the House," which earlier in the day approved its own version of the budget that "hews more closely to Bush's initial spending and tax proposals," reports the Los Angeles Times. Representative Jim Nussle (R-Iowa), chairperson of the House Budget Committee, said the Senate's Medicaid vote was "a setback" for Bush's domestic agenda. (March 18, 2005) Lack of Insurance Is One Reason Many Poor Women in Florida Fail to Get Mammograms Source(s): Mark Hollis, South Florida Sun-Sentinel (Mar. 15). New research conducted for the Florida Legislature shows that thousands of Florida women, especially low-income blacks and Hispanics who are uninsured, are not getting potentially life-saving mammograms, reports the Florida Sun-Sentinel. Only 4 percent of low-income women on Medicaid get a mammogram, even though Medicaid is supposed to cover the screen. "We cannot take this lightly," said Republican State Senator Evelyn Lynn. "It's getting harder and harder for people to have the access to this really basic and really vital health service." Medicaid reimbursements are "at the heart of the problem," according to the Academy of Florida Trial Lawyers. Twenty-one percent of all radiology centers in Florida will not accept Medicaid, leaving long lines at those that do. Republican Governor Jeb Bush wants to limit medical malpractice and restructure Medicaid. (March 15, 2005) Cancer Survival Shortened for Those Who Enroll in Medicaid after Diagnosis Source(s): The Washington Post (Mar. 14). Researchers found that people who do not enroll in Medicaid until after they have been diagnosed with cancer are most likely to die from the disease, and treating them "may be a waste of time," according to the Washington Post. The median length of survival for patients enrolled in Medicaid after disease diagnosis was 18 months, compared with 38 months for those who were already enrolled in Medicaid when they were diagnosed. The report, which was published in the journal Cancer and based on a review of the experiences of 13,740 people from the Michigan Tumor Registry, found that these patients usually lack insurance before their diagnosis and are unlikely to have been screened early enough for treatment to do much good. "From a policy perspective, cancer survival in the Medicaid population cannot be improved as long as 40 percent of the population enrolls in Medicaid with late stage disease," the Michigan State University researchers wrote. (March 14, 2005) Former Clinton Health Care Advisor Proposes Incentive-Based Program Focused on Providers Source(s): Roger Lowenstein, The New York Times Magazine (Mar. 13). Though Americans arguably "want health-care reform more urgently than anything else," the major reason that designing a national health care policy has not succeeded is because of the misconception that high costs are the major problem, and that curbing them is the solution, according to David Cutler, dean of social sciences at Harvard College, and the subject of a New York Times Magazine profile. Cutler helped draft the failed Clinton health care plan, and has been pondering what went wrong ever since. His new, "radically different" approach argues that most health care spending is good, because "it delivers positive, and measurable, economic value, and because it can do more things that Americans want." We should focus on improving the quality of care rather than reducing the consumption of it, according to the article. What Cutler imagines is a system "in which everyone could get insurance while free-market incentives would motivate health-care providers to be more effective as well as more efficient." He proposes broadening coverage with "a variant of the voucher system," in which the government finances Americans' health care with tax credits spent on private providers or insurers. Cutler's plan "would seem not to brake" the ongoing soaring health care spending. But he contends that a "more results-oriented, and a more health-conscious system" will mean that one will be able to buy care that is both better and cheaper. (March 13, 2005) Young Adults Make Up Large Portion of the Uninsured
Source(s): Thomas Lee, Star Tribune (Minneapolis) (Mar. 13). Young adults "get overlooked" in the debate on health care coverage because of their age and relatively low health risk, reports the Minneapolis Star-Tribune. However, Americans aged 19 to 34 comprise the largest group of adults who are uninsured, according to the Kaiser Commission on Medicaid and the Uninsured. From 2000 to 2003, the number of uninsured Americans under age 65 increased by 5.1 million, to 45 million. About 60 percent of them were in the 19-to-34 age demographic. Sudden catastrophic health care needs can "sometimes bankrupt" them. In addition, because they tend to be healthier, their absence from the health insurance market leads to rising health care premiums. However, being uninsured is not a choice for many young Americans entering a job market in which fewer companies offer coverage. The recent introduction of health savings accounts (HSAs) might prompt insurance companies to focus more on individual policies that tend to appeal to younger people. (March 13, 2005) Kerry Promotes Bill to Provide Universal Coverage to Children Source(s): Rick Klein, The Boston Globe (Mar. 10). Massachusetts Democratic Senator John Kerry continues to try to build momentum in Congress for providing universal health care for children, his biggest legislative priority, reports the Boston Globe. Speaking at a Capitol Hill news conference, Kerry said that 500,000 "citizen cosponsors" have signed up on his Web site to support his "KidsFirst Act," which would fund universal health care for children by repealing the tax cuts for those who earn more than $319,000 a year. The bill "faced long odds" in the GOP-controlled Congress, but Kerry said that his network of grass roots activists and lobbyists would campaign against Republican incumbents who do not support it. Several labor organizations, including the AFL-CIO, the American Federation of Teachers and the Service Employees International Union, have endorsed the bill and say they will lobby for it in Congress. Kerry has promised to use his influence as a former presidential candidate to ensure that Congress considers the bill. However, while he has signed up seven cosponsors, none of them are Republicans, which would be necessary for the bill "to have a realistic chance of passage." Republicans "scoffed" at his promise to target those who oppose his plan. (March 10, 2005) Senate GOP Leaders Look to Rein in Medicaid Source(s): David Rogers, Wall Street Journal (Mar. 8); Shailagh Murray and Jonathan Weisman, The Washington Post (Mar. 8). Recent Senate leadership meetings over Medicaid and tax targets "have frayed nerves," as Senate Republicans propose almost $14 billion in Medicaid savings over the next five years. With the "aggressive strategy" coming from Senator Judd Gregg (R-N.H.), the Senate's new Budget Committee Chairman, Medicaid promises to be the "biggest fight" in the debates. Gregg's budget "closely tracks" the net savings in President Bush's budget. The White House assumes gross Medicaid savings of about $20 billion over five years, and net savings of about $13 billion to $14 billion. "Offsetting tax breaks mostly for the affluent with spending cuts that could hurt the poor could be politically risky, particularly in the Senate, where moderate Republicans have already warned that the juxtaposition may be untenable," reports the Washington Post. Republicans tried to portray both the proposed tax and spending cuts as "modest," claiming that even with the cuts, Medicaid will still grow 7.3 percent next year, down only a bit from the current 7.6 percent growth. However, with the number of Medicaid recipients having grown 40 percent over the past five years, partially due to the fact that employers cutting back on health coverage have pushed low-wage workers into the program, "opponents do not buy that argument." (March 8, 2005) Companies Cut Benefits to Retired Workers' Dependents Source: Jennifer Saranow, Wall Street Journal (Mar. 3). The Wall Street Journal reports on the "wave of employers," including IBM and Boeing, that are cutting benefits to their retirees' dependents in order to lower their health care costs. Employers have already raised premiums for the dependents of current employees, and taken steps to encourage spouses to seek coverage from their own employers. According to a recent survey by the Kaiser Family Foundation and the consulting firm Hewitt Associates, 79 percent of large employers had increased retiree contributions to premiums in the preceding year, and 68 percent had increased contributions for dependent coverage. The result is that "retirees could be left bearing the brunt of covering their families, or left in the lurch if spouses with insurance elsewhere lose coverage." Companies say they "want to focus their resources on those who were actually employees." (March 3, 2005) Corporate Executives Worry More about Health Care Costs Than Social Security Source: Amy Martinez, The News and Observer (Raleigh, N.C.) (Mar. 3). According to a survey of 534 chief financial officers and corporate executives, respondents prefer that Congress "do something about the rising costs of health care" and the large federal deficit this year than try to change Social Security, reports the Raleigh News and Observer. The survey, done by Duke University and CFO magazine, included executives at companies "across a broad spectrum of the economy." It also found that CFOs overall "grew less optimistic" about the economy's direction in the past three months. Less than a third of them said it was very important that Congress tackle Social Security privatization. Geoff Chatas, CFO of the Raleigh utility Progress Energy, said, "That's something the country has to deal with, but Social Security isn't going to impact our medium- or short-term planning at Progress Energy. Deficit spending is a problem ... And we continue to be worried about escalating health costs." (March 3, 2005) Medicaid Battles Illustrate Nation's Health Care Funding Crisis Source(s): Gail Russell Chaddock, Christian Science Monitor (Mar. 3); The Economist (Mar. 5). Public funding of health care has increased dramatically over the past 40 years and is expected to continue to grow. While private funding covered about 75 percent of national health costs in 1965, public funding is expected to account for half of it by 2014, according to the Centers for Medicare and Medicaid Services. "How to manage that ever-increasing share of the health costs is emerging as a major battle between Washington and the states that only gets tougher as the baby boomers begin to retire," according to the Christian Science Monitor. President George Bush's proposed $60 billion cut in federal funds over the next 10 years is "central to meeting his promise" to halve the federal deficit, according to the Monitor. The Economist deems Bush's proposals, which "trim a mere two percent" from the federal Medicaid contribution, "extremely modest" when "set against [the] trajectory" of Medicaid costs that have increased 63 percent in five years. Other programs that provide health care to the poor are expected to increase by $15 billion, "so the net loss to the states would be even smaller." But the governors are opposed to Bush's proposal, which they consider "a simple shift from the federal budget, which can run deficits, to state budgets, which cannot," reports the Monitor. (March 3, 2005) More Companies Join Pool Offering Coverage to Part-Time Workers Source(s): Diane E. Lewis, The Boston Globe (Mar. 3). U.S. employers have increased the number of contract and part-time workers on their payroll, but many do not offer them health insurance, reports the Boston Globe. National Health Access is "the brainchild of 60 Fortune 500 companies that joined forces to attract insurers who would be willing to cover the firms' uninsured workers and their families." These " | |||||
