Ohio Health Policy Review

Study: Ohio, other states to see Medicaid long-term care costs skyrocket

As the U.S. population ages in the next two decades, Medicaid spending on long-term care is expected to rise dramatically, according to a report released by America’s Health Insurance Plan, the trade association of the health care industry (Source: “Medicaid long-term health care costs to soar,” Reuters, Sept. 29, 2008).
The report predicts that long-term care for elderly and disabled Medicaid recipients would total $3.7 trillion over the next 20 years, with $1.6 trillion of that total being paid by states.

The report, State Medicaid Expenditures for Long-Term Care, 2008-2027, predicts that state Medicaid spending for long-term care should more than double in Ohio, from $2.4 billion this year to $5.4 billion in 2027. Ohio currently pays the third most in state Medicaid contributions for long-term care, behind only New York, California and Pennsylvania.

"Medicaid's position as the payer of last resort for long-term care -- despite the presence of long-term care insurance available in the marketplace today -- will continue to create budgetary difficulties for states and the federal government over the next two decades," the report.

Report chronicles states’ efforts to cover low-income, childless adults

A report from the National Academy of State Health Policy found that 23 states, plus the  District of Columbia, have attempted to create affordable coverage options for the low-income, childless adults, a group that makes up about one-third of the uninsured population (Source: "State Efforts to Cover Low-Income Adults Without Children," State Health Policy Monitor, Sept. 2008).

The primary reason that the low-income adults with no children composes such a large percentage of the uninsured population is that unless they are elderly or disabled, they do not qualify for Medicaid.

Although Ohio currently has no program to address coverage for low-income adults without children, the issue was raised in the State Coverage Initiative’s report to Gov. Ted Strickland. The SCI report found that there are about 182,000 uninsured Ohioans living below 100 percent of the federal poverty level. The report proposes addressing the issue by enrolling low-income, childless adults in plans offered by Medicaid managed care organizations.

Study: Dental care lacking for children covered by Medicaid

A new study by the Government Accountability Office estimates that 6.5 million children covered by Medicaid have untreated tooth decay (Source: “Kids in Medicaid have more tooth decay: study,” Reuters, Sept. 23, 2008).

Of the 20 million children in the United State who covered by Medicaid, only a third had any dental care in the past year, according to the study. About half of all children on private insurance had dental care in the past year.

"Children in Medicaid remain at higher risk of dental disease compared to children with private health insurance; children in Medicaid were almost twice as likely to have untreated tooth decay," the GAO report found.

One problem, the report found is that many parents have tried and failed to find care for their children. According to the report, "We estimate that 724,000 children aged 2 through 18 in Medicaid could not obtain needed care."

Senators quietly working on bipartisan universal coverage plan

A group of 16 Senators -- eight Democrats and eight Republicans --  have been working quietly for the past two years to craft legislation to enact universal coverage (Source: “Can 16 senators solve the health care crisis?” MSNBC.com, Sept. 22, 2008).

In what the co-sponsors Sen. Ron Wyden, D-Ore., and Sen. Robert Bennet, R-Utah, call a “philosophical truce,” the bill includes a coverage mandate, an idea long fought by Republicans, and a larger role for private insurers, something Democrats have consistently opposed. While Medicare would remain intact under the plan, the bill calls for the elimination of SCHIP and Medicaid.

Among the many obstacles facing the bill are a provision that all insurance be purchased by individuals directly from government-regulated private insurers. That means all  Americans who have health insurance -- most of them through their employer -- would have to change their plan.

Another concern with eliminating employers from the process is that individuals would be left on their own to choose plans and negotiate rates and would not have the benefit of a pooling mechanism to reduce costs.

The sponsors of the bill say they know there is still much to be worked out and their hope is that the legislation can be used as a framework for whomever wins the presidential election in November. "This thing isn't written in concrete," Wyden said. "We think we've got a good start here. We think we've got something to work with."

Medicare Part D premiums to go up 24 percent next year

The Centers for Medicare and Medicaid Services announced Thursday that more than three-fourths of Medicare Part D prescription plans will be raising their premiums next year and that the average premium will increase by 24 percent (Source: “Medicare drug-plan premiums to climb in 2009,” Akron Beacon-Journal, Sept. 26, 2008).

There are 1.8 million Ohioans enrolled in Medicare Part D.

Medicare beneficiaries also will have just 49 drug plans to chose from, down from 58 last year. Enrollees in 37 of the available plans may also be faced with paying significant amounts of money out of pocket for prescription drugs because of a so-called “doughnut hole” in coverage. After drug costs reach $2,700 (an increase from $2,510 last year), beneficiaries are responsible for potentially paying more than $3,000 out of pocket until catastrophic coverage starts.

That potential gap is part of all of the plans in Ohio that pay for brand-name drugs. A dozen Medicare drug plans will provide at least some generic medicines without a gap in coverage (down from 17 last year). However, those plans are the most expensive, ranging from $50.10 a month to $97.50 a month.

Study critical of medical licensing

An new analysis by the Cato Institute casts doubt on the benefits of licensing medical professionals (Source: “New Cato Study Advocates Eliminating Medical Licensing,” Cato Institute news release, Sept. 16, 2008.

The analysis, Medical Licensing: An Obstacle to Affordable, Quality Care, concluded that medical licensing by health care professionals significantly reduces access and does little to improve quality of care.

"Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions to the private sector and other courts," wrote Cato adjunct scholar Shirley Svorny in the analysis.

Medicaid funds spared in latest state budget cuts

The Ohio Department of Child and Family Services announced Wednesday that an additional $80 million will be trimmed from its budget, but the cuts will not affect Medicaid benefits (Source: "Ohio poor face $80 million loss,” Columbus Dispatch, Sept. 25, 2008).

Almost half of the cuts, $36 million, will come from money that was set aside for Medicare Part D payments but is not needed, according to state officials. No senior currently using the program is expected to lose benefits.

Gov. Ted Stickland specified that the cuts not affect the $9.3 billion that the state sets aside to fund Medicaid until it is reimbursed with federal funds. However, money used to detect Medicaid fraud will be cut.

The cuts are part of Strickland’s request for 4.75 percent budget cuts at all state agencies to close a $545 million budget deficit. It is the second time this year that state department have been asked to make significant cuts to address budget shortfalls.

Alliance calls on states to take lead on HIT

A group of governors and state health officials is asking that states support e-prescribing and address medical privacy and security issues as a means to boost healthcare IT (Source: “State Alliance calls for state action on healthcare IT,” Healthcare IT News, Sept. 23, 2008).

The State Alliance for e-Health released a 60-page report called “Accelerating Progress – Using Health Information Technology and Electronic Health Information Exchange to Improve Care.”

Recommendations in the report for states include:
• Providing leadership and support for e-health efforts, especially on e-prescribing
• Promoting the use of standards-based, interoperable technology
• Streamline the licensure process to enable cross-state e-health
• Engaging consumers to use HIT in managing their health and healthcare
• Developing workforce capacity to support electronic HIE efforts

WebMD soliciting health-related questions for presidential debate

WebMD has announced that it is partnering with the nonpartisan Commission on Presidential Debates to gather questions for the second presidential debate.

Tom Brokaw will be moderating the town-hall-style debate and will ask questions from audience members and online submissions. WebMD is planning to use its election message board to allow users to submit health-related questions.

The first debate between Sen. John McCain and Sen. Barack Obama will take place on Friday (Sept. 26) and will focus on foreign affairs and national security. The town-hall-style second debate will take place on Tuesday, Oct.7. The final debate, to focus on the economy and domestic policy, is set for Wednesday, Oct. 15. All debates are scheduled to begin at 9 p.m.

School soft-drink bans have little health benefit, study finds

There is no significant difference in soft-drink consumption between students who go to elementary schools that ban sodas and those that do not, according to a new study.

Appearing in the September issue of The Journal of the American Dietetic Association, the study found that only about 4 percent fewer children in no-soda schools said they did not drink soft drinks (Source: “Nutrition: Soda Ban in Schools Has Little Impact,” New York Times, Sept. 23, 2008).

In recent years, more school districts have considered banning high-calorie soft drinks to address increasing rates of childhood obesity. While researchers concluded that restrictions do have some benefit, they also suggest that policymakers consider strategies that focus on broader dietary habits in the home and at school.

The study analyzed 2004 surveys of 10,000 fifth graders in 40 states.