Ohio Health Policy Review

Weekly update on federal reform

Congress returns from recess to mull 5 reform plans
Congress returned from its weeklong Independence Day recess on Monday with five separate health reform plans to consider (Source: “Congress back to wrestle with healthcare reform,” Washington Post, July 6, 2009).

As legislators begin to weigh provisions from each plan with an eye toward melding them into a single bill, financing of the plan has become hotly debated, particularly whether taxing benefits will be required. At the same time, revised Congressional Budget Office estimates for health reform dropped the price tag from $1.6 trillion to $1 trillion, renewing optimism by some in Congress that a financing strategy could be achieved.

"The issue is going to be getting a bill that looks affordable without a substantial increase in taxes," said Bob Blendon, a health policy and political analysis professor at Harvard University. "The lower the total cost, the less you are going to have to find the financing to do this."

Federal insurance czar concept floated
Congressional Democrats are floating a proposal to create a presidentially appointed “health choices commissioner,” to oversee an independent agency charged with regulating the insurance marketplace (Source: “Need for federal insurance czar is questioned,” Associated Press, via Google, July 7, 2009).

House Democrats have released an 800-page draft bill outlining the establishment of the Health Choices Administration. Among the responsibilities of the commissioner and the new agency would be to run a national purchasing pool through which individuals and small businesses could pick medical coverage from among private and government-sponsored plans. The agency also would decide at what point the pool would be opened to all employers and who would qualify for federal subsidies for buying coverage.

State regulators say the federal commissioner would duplicate efforts now being done at the state level.
"We have concerns that a federal commissioner would not provide adequate protection for our consumers, and that the bill as drafted duplicates functions that exist in states across the nation," said Oklahoma Insurance Commissioner Kim Holland, speaking on behalf of the National Association of Insurance Commissioners.

Proponents of having a federal commissioner, however, say a national health insurance purchasing pool needs a regulator at the federal level. "If we're going to have a national insurance exchange, you can't have it run by 50 regulators in the states," said William Vaughan, a senior policy analyst with Consumers Union, publisher of Consumer Reports.

White House, hospitals agree to $155 billion savings plan 
Vice President Joe Biden announced today that hospital officials have agreed to a deal that would create $155 billion in savings to the national health system (Source: “White House, hospitals reach deal on health care,” Associated Press, via Google, July 8, 2009).

Among the cost savings would be a $50 billion reduction in payments currently paid through Medicare and Medicaid to hospitals for treatment uninsured and low-income patients. That move is being criticized by the National Association of Public Hospitals and Health Systems and the National Association of Childen’s Hospitals, which were not directly involved in talks with the administration.

As support for tax wanes, Congress eyes other financing options
With several new polls showing strong opposition to taxing employer-provided health insurance, Congressional Democrats have begun exploring other means of financing health reform legislation (Source: “Congressional Dems eye health care funding options,” CNN, July 7, 2009).

According to a New York Times/CBS News poll, 70 percent of respondents oppose the tax and only 20 percent said they would support it. A Kaiser Family Foundation survey found 54 percent of respondents opposed the tax.

"When you get numbers like that, it certainly causes you to look for alternatives," said Sen. Kent Conrad, D-North Dakota, who chairs the Senate Budget Committee.

Conrad said a House Democratic proposal to tax sugary drinks is no longer being considered because of strong opposition in Congress, but a move, favored by President Obama, to lower tax deductions for Americans with annual incomes greater than $250,000 is still on the table. Another option being considered is increasing the Medicare payroll tax.

House Majority Leader Steny Hoyer, D-Maryland, told reporters the House committees are planning to finalize health care legislation next week. A vote on the House floor is expected at the end of the month.

Group of Congressional Democrats opposes abortion inclusion in federal plan
Although none of the five reform proposals being considered by Congress specifically mentions abortion, 19 anti-abortion Democrats, including two from Ohio, are voicing concern that tax dollars could be used to fund abortions (Source: “Anti-abortion Democrats in Congress vow to oppose health care packages that don't exclude procedure,” Cleveland Plain Dealer, July 8, 2009).

Ohio representatives Marcy Kaptur and Steve Driehaus are among a group of legislators that sent a letter to House Speaker Nancy Pelosi late last month stating that they would oppose any reform package that included spending tax dollars on abortions.

"We cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan," says the letter. "By ensuring that any health care package will not fund or require funding for abortions, we will take this controversial issue off the table so that Congress can focus on crafting a broadly supported reform package."

Both Sen. George Voinovich and Sen. Sherrod Brown, though differing in their overall views on abortion, said through their offices that they oppose including abortion coverage in any new federal health plan. Although Brown supports abortion rights in general, he said that any future federally funded health plan should follow the lead of current federal programs  and only pay for abortions in cases of rape, incest or to save the life of the mother.

Cleveland health access program struggles to get off the ground

The Cuyahoga Health Access Partnership, conceived two years ago to improve access and coordinate care for the poor and uninsured in Cleveland, is struggling to raise enough money to get the program off the ground (Source: “Cuyahoga Health Access Partnership threatened by hospitals' reluctance to commit funds, resources,”Cleveland Plain Dealer,  June 29, 2009).

The program, modeled after ones in San Francisco and Detroit, would pair major hospitals with free clinics and health plans, create a network that allows more uninsured people to get consistent care with primary-care physicians and specialists and would eventually reduce the need for emergency room visits.

The Partnership, which was convened by the county two years ago, agreed to set up a one-year operation with an executive director, board, grant writers and a medical-records system to track patients. The program will operate with a $350,000 budget with the goal of helping up to 3,600 uninsured in the first year, eventually reaching up to 21,700 within a few years.

The initial deadline for area hospital systems, free clinics and health plans to say specifically what they are willing to contribute passed last week. Organizers said all responses had not been received and deadline for a plan to be formed has been extended to July 6.

Report offers recommendations to states setting up medical homes

A new report from the National Academy for State Health Policy compiles information from Medicaid and Children’s Health Insurance Programs in 10 states to formulate a list of recommendations for other states considering implementing the medical home model (Source: “Medical home recommendations for states,” Modern Healthcare, June 28, 2009).

Information from Colorado, Idaho, Louisiana, Minnesota, New Hampshire, Oklahoma, Oregon, Washington —in addition to North Carolina and Rhode Island which have well-developed medical home initiatives—led to five major strategies for other states to consider in developing their own plans:

• Forming partnerships with key players (including patients, providers and private sector payers) whose practices the state seeks to change.
• Defining medical homes to help establish provider expectations and implementing processes to recognize primary care practices that meet those expectations.
• Aligning reimbursement and purchasing to support and reward practices that meet performance expectations.
• Supporting practices to help advance patient-centered care.
• Measuring results to assess whether their efforts are succeeding in containing costs, improving quality and patient experience. Forming key partnerships.

The Commonwealth Fund-sponsored report, titled “Building Medical Homes in State Medicaid and CHIP Programs,” (pdf, 68 pages) is available on the Commonwealth Fund’s Web site.

Promoting the development of patient-centered medical homes is one of four ““Core collaborative transformational strategies” identified in the recently released Ohio Health Quality Improvement Plan (pdf, 45 pages).

Feds delay release of EHR ‘meaningful use’ definition

David Blumenthal, the Obama Administration’s point man on health information technology, has asked the federal Health IT Policy Committee’s meaningful use working group to amend recommendations on what defines “meaningful use,” a definition critical to determining who will receive a share of $19 billion in federal EHR money (Source: “First draft of EHR ‘meaningful use’ definition unveiled,” American Medical News, June 29, 2009).

"We had a lively discussion, and it was decided after considerable input on the topic of meaningful use that we would take it back to discussion to work on it a little bit longer," Dr. Blumenthal said. He said the committee expects to unveil revised recommendations by July 16, the date of its next scheduled meeting. The definition was originally expected to be released by late June.

In other health information technology news, the Agency for Healthcare Research and Quality is requestion information from small- and medium-sized practices on tools for analyzing and redesigning workflow before and after HIT implementation (Source: “AHRQ Seeks I.T. Workflow Options,” Health Data Management, June 25, 2009).

According to a notice (pdf, 3 pages) published in the Federal Registry, responses to questions will be incorporated into a toolkit used to assist small- and medium-sized practices in analyzing or redesigning workflow, either before or after health IT implementation. Comments should be submitted on or before August 24. Electronic responses should be addressed to WorkflowRFI@ahrq.hhs.gov. 

Franklin Co. mental health board sues state over funding formula

The Alcohol, Drug and Mental Health Board of Franklin County is filing suit against the state, claiming that it was deprived of its share of funding for as long as a 10 years (Source: “ADAMH board to sue state over mental health funding,” Columbus Dispatch, June 29, 2009).

While the state acknowledges that its previous funding formula, which was based heavily on hospital use, was unfair to the county because ADAMH was successful at providing treatment that kept residents out of state mental hospitals.

The state is proposing that the formula fix be phased in over 10 years to avoid cutting payments to other counties. However, the county is asking for a temporary restraining order that would force the state to pay up sooner.

ADAMH officials estimate that if they are awarded the money earlier, 2,000 additional county residents would start or continue treatment in the coming year.

Ohio health clinics get $4 million in federal funds

U.S. Representatives Tim Ryan (D-Niles) and Charlie Wilson (D-Marrietta) announced that several Ohio health clinics were awarded a total of more than $4 million in federal Recovery Act Capital Improvement grants (Source: “Valley health clinics receive more than $4 million,” WFMJ TV, June 30, 2009).

Among those receiving a portion of the $851 million in federal stimulus funds that are being distributed to health centers nationally are:

• Ohio North East Health System's Community Health Clinic in Youngstown will get $880,910.
• Akron Community Health Resources Community Health Clinic is in line for $520,060.
• The Community Action Agency of Columbiana will receive $600,105.
• The Ironton Lawrence County Community Action Organization is expecting $665,660.
• Ohio Hills Health Services in Barnesville will get $473,860.
• The largest portion of the money, $1,019,265, will go to Chillicothe-based Family Healthcare to build a new health care center in Meigs County.

"Community Health Clinics have an enormous impact on their communities - they employ physicians, dentists, nurses and medical staff - beyond outstanding services they provide to patients, a good number of whom are the uninsured," Ryan said in a news release.

Federal reform: Week in review

Editor’s Note: As the debate over federal health reform continues to heat up, the Ohio Health Policy Review is going to begin devoting one of its weekly e-mails to providing a round-up of the latest federal legislative developments. While the primary focus of the Review has always been health policy matters in Ohio, it is clear that the legislation being considered at the federal level would have a significant impact on the state. If you have any questions, comments or suggestions, please feel free to contact Review editor Nicholas Wiselogel at nwiselogel@hpio.net or at 614.224.4950 x310.

Poll: Americans worried about reform ramifications
A Washington Post-ABC News poll released last Wednesday found that while a majority of Americans support government playing a role in controlling health costs, most worry about potential ramifications (Source: “Most Want Health Reform But Fear Its Side Effects,” Washington Post, June 24, 2009). 
 
More than 8 in 10 respondents said they are satisfied with the quality of the current care they receive and are relatively satisfied with their personal costs. About six in 10 are at least somewhat worried that reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy.

In the Post-ABC poll, 62 percent support the general concept of a public option, but when respondents were told that meant some insurers would go out of business, support dropped sharply, to 37 percent. Support for an individual mandate ranges from 44 percent to 70 percent depending on the specific provisions.

Obama hosts governors’ group to talk health care
Prior to hosting a health care town hall meeting exclusively aired on ABC last Wednesday, Obama met with five members of a bi-partisan group of governors that recently health roundtable meetings around the country. (Source: “States Assert Place in Health-Care Debate,” Washington Post, June 25, 2009)

"There's no perfect unanimity across the table in terms of every single aspect of reform," the president said in remarks after their meeting. "I think everybody here wants to make sure that governors have flexibility, that they have input into how legislation is being shaped on the Hill."

All of the governors (Republican governors Jim Douglas of Vermont and Mike Rounds of South Dakota, and Democrats Jennifer Granholm of Michigan, Jim Doyle of Wisconsin and Chris Gregoire of Washington) did agree that the additional costs associated with reform should not be shouldered by states. "If we're going to add more population onto the Medicaid rolls, there has to be a way to pay for that," said Gov. Granholm, adding that it is a position Obama supported.

FTC: Ending drug ‘pay-to-delay’ could save $35 billion
Also last Wednesday, the Federal Trade Commission announced that eliminating patent settlements between brand-name and generic drug companies would save consumers $3.5 billion a year (Source: “FTC: end drug patent settlements to save $35B,” Associated Press via Google, June 24, 2009).

FTC Commissioner Jon Leibowitz called on Congress to pass a bill that would ban the settlements. He said the legislation — currently in committees — could save consumers $35 billion over 10 years, about $12 billion of which would go to the government (the federal government pays about one-third of the nation's $235 billion in prescription drug costs through Medicare, Medicaid and other programs). Leibowitz said the so-called “pay-to-delay” issue could be addressed as part of Obama's effort to overhaul the U.S. health care system.

Baucus, Grassley trim costs, continue working on compromise
Senate Finance Chairman Sen. Max Baucus (D-Mont.) announced late last week that a group of three Democrats and four Republican negotiators have found cost-cutting measures that would bring the cost of a reform package down to $1 trillion over 10 years, down from the Congressional Budget Office’s original scoring of $1.6 trillion(Source: “Deal on U.S. healthcare overhaul still uncertain,” Reuters, June 28, 2009).

However, a compromise was not reached before legislators left for this week’s July 4 recess. Sen. Baucus has indicated that his bill should be ready for release next week.

The Finance Committee is one of five in the Senate and House working on health care legislation, and may be in the best position to achieve a bill with bipartisan support.

"As we have been for the last several weeks, we are committed to continuing our work toward a bipartisan bill that will lower costs and ensure quality, affordable care for every American," said the group, which includes Baucus and Senator Charles Grassley, the top Republican on the panel.

HHS site outlines ‘status quo’ in each state
Although Congress is on recess this week, the Obama Administration continues to push for movement on reform legislation. A new report from the Department of Health and Human Services titled “The Health Care Status Quo in Your State,” outlines why each individual state “can’t afford the status quo.” The Ohio section of the report is here.

Podesta, Daschle back health finance plan
As Congress awaits legislation from Baucus and others, a proposal for financing health reform released today by the liberal Center for American Progress also is garnering attention because it is being backed by two close Obama confidants, John Podesta and former Senate majority leader Tom Daschle (source: “Prominent Dems propose pay plan for health overhaul,” USA Today, June 29, 2009).

Podesta led Obama’s transition team last year and Daschle was the president’s first choice for Secretary of Health and Human Services.

The $1.2 trillion plan, outlined in a report authored by David Cutler and Judy Feder and titled “Financing Health Care Reform” (pdf, 17 pages), calls for raising $400 billion over 10 years through Medicare and Medicaid savings, new tax revenues and modernization. The plan also includes what the authors call a “failsafe” trigger that would allow a bipartisan commission to impose cost-savings measures if, after five years, projected health care costs slowdowns were not realized.

Report: Health gains by Cleveland diabetes patients threatened by coverage loss

A new report from Better Health Greater Cleveland shows that while area diabetes patients are showing health improvements, those gains may be threatened as more people lose insurance coverage ("Diabetes patients threatened by loss of coverage,” Cleveland Plain Dealer, June 26, 2009)

The collaborative Better Health Greater Cleveland, which is part of the Robert Wood Johnson-funded Aligning Forces initiative, began examining more than 25,000 diabetes patients’ records in 2007 and is the first large-scale effort in the Cleveland area to report on how patients and doctors are managing diabetes.

Cuyohoga County’s avoidable hospitalization rate for diabetes patients, which resulted in $200 million in spending annually, is substantially higher than the state as a whole.

While the group is encouraged by the fact that about half of patients in 2008 met benchmarks for diabetes control, compared to 39 percent in 2007, the study also found that the number of uninsured patients being monitors increased by 19 percent during the same time period. Because of the high level of medical maintainance required by diabetics, the increased uninured rate is likely to translate into lower rates of compliance with testing and other benchmarks.

"People either scrimp on care - they don't go to visits because they can't make [payments] - or they scrimp on medicines and supplies," said Dr. Randall Cebul, director of Better Health Greater Cleveland. "They won't be checking their sugar, that's all there is to it."

Better Health Greater Cleveland has released both an executive summary (20 pages, pdf) and its full report (111 pages, pdf) titled Community Health Checkup.

AARP Ohio, other groups criticize Strickland’s nursing home spending plan

In a letter to Gov. Ted Strickland, the Ohio Business Roundtable, AARP Ohio and other groups are urging Gov. Ted Strickland and legislators to reduce spending on nursing homes, given the state’s considerable budget shortfall (Source: “AARP and other groups urge governor to stop overspending on nursing homes,” Columbus Dispatch, June 24, 2009).

"Ohio's disproportionate nursing home spending ranks among the 10 worst states in the nation and if major changes are not made to (the budget) before it passes out of conference, that standing is likely to get worse," the groups wrote in the letter.

The letter was also signed by the representatives of the Ohio Association of Area Agencies on Aging and the Cleveland-based Center for Community Solutions.
The groups outlined changes that they said could save the state $100 million in the next biennium,
including:

• Providing long-term care services under a "unified" long-term care budget by combining funds for home and institutional care in a single pot of money to give consumers more choices.
• Increasing the bed tax charged nursing homes.
• Implementing a "price-based" payment system, which allows the state to set the price paid for services. The current "cost-based" system allows nursing homes to tell the state how much they are owed for providing care to Medicaid patients.
• Rejecting a proposal to strip anti-discrimination provisions from state law that prevent nursing homes from denying care to Medicaid patients.

Ohio House passes teen violence bill

A bill allowing juvenile court judges to issue protection order in cases of teen violence was unanimously approved Wednesday by the Ohio House (Source: “Bill to reduce teen violence gets OK,” Toledo Blade, June 25, 2009).

Current state law allows only judges in adult court to issue orders of protection.

"Research shows that over 50 percent of teens report knowing someone involved in a violent relationship, and more and more evidence points to adult domestic-violence victims having a history of violent relationships starting when they were teens," the bill's sponsor, Rep. Edna Brown (D., Toledo), said.

The bill permits someone to seek a protection order in juvenile court against a person under the age of 18 who has committed assault, menacing, stalking, aggravated trespass, and a sexually oriented offense.

The measure now goes to the Senate, where it didn't advance last year despite getting similar overwhelming support in the House. Brown said a few changes have been made to satisfy critics in the Senate, including the addition of language making it easier to have the records of a protection order expunged when the subject reaches the age of 18.