1. Hawaii: Health Care Reform Briefing
The Keiki Caucus and Kupuna Caucus are hosting a national health care reform briefing on 09/18/09 at 9:30 AM in the State Capitol Auditorium.
2. National: America's Children Top Stakeholders in Health Reform
As the health debate moves forward, there's been a lot of discussion about stakeholders, and possible winners and losers. The insurers? The hospitals? The drug companies? But there's one group of stakeholders who no one seems to be talking about, even though for them and for all of us the stakes are the highest: America's children.
For the last several months, we've been working through the Bipartisan Policy Center to find areas for bipartisan consensus on health care reform. And one thing that is clear is that unless Congress makes children's health care affordable, comprehensive, and simple, children will be the big losers in the health care debate. Many members of Congress--and many members of the public--think that Congress "took care of children'' earlier this year when they passed the expansion of the Children's Health Insurance Program (CHIP). However, even with the CHIP expansion, five to six million children will remain uninsured, and millions more will remain underinsured.
Uninsured and underinsured children cost our communities. A 2007 study in Pediatrics found that communities save $2,100 for every child they insure or keep insured. Uninsured children are eight times more likely to have delayed medical care and too often end up in the emergency room where treatment can be much more expensive than in the doctor's office. One out of every nine children in America does not have health insurance. In the coming weeks, we can change that. The president and Congress have a chance to do the right thing. With just three essential targeted investments, we can level the health playing field and guarantee real reform that works for every child in America.
First, all children should be able to afford health care, no matter where they live. Right now, different states have wildly different rules for eligibility for Medicaid and CHIP. For children, it's like playing the lottery--where you're born can determine whether you get to grow up healthy. Congress must fix that. In our recently released report "Crossing our Lines: Working Together to Reform the US Health System,'' we recommend that Americans making under 400 percent of the federal poverty level receive enhanced protections.
To make sure that children aren't worse off after health reform than they are now, families that make less than 300 percent of the federal poverty level, about $66,000 a year for a family of four, should not have to pay more out-of-pocket expenses and have weaker benefits for their children than they currently do in Medicaid. Second, Congress needs to make sure children's health insurance includes all essential services. All children need immunizations, regular vision, dental, and other developmental screenings, and greater access to primary care and mental-health services.
And third, Congress needs to make enrollment in children's health insurance programs simple. Currently, about two-thirds of uninsured children are actually eligible for coverage, but in part because of needlessly complicated state-by-state barriers, they never get the care they need. In some states, like Mississippi, children have to interview for their health care. In others, they face long waiting periods. Congress needs to put an end to this by automatically enrolling children in health insurance. Part of the reason Medicare covers nearly every senior citizen is because when you turn 65 you are in--unless you opt out. Why shouldn't the same be true for children's health care?
We also believe that as important as it is to expand coverage for children, it is essential to reduce the cost of health care. Any expansion of health insurance must be accompanied by effective measures to reduce the costs for the system overall. In the days to come, Democrats and Republicans are going to decide how they will respond to this historic opportunity to provide a level health playing field for children. We're willing to bet that each of them has stood up at a fund-raiser or a rally and uttered the words "Our children are our future." It's true, economically and morally. Now it's time to make sure that future is a healthy one. [Tom Daschle and John C. Danforth, Boston Globe, 09/07/09]
3. Oregon: Becomes 1 of 12 States to Cover All Kids
But Babcock, 27, filled out a new application last week with a promise that this time the Oregon Health Plan will find a way to cover her 8-year-old daughter, Keeley Lingley. The assurance comes from Gov. Ted Kulongoski signing a bill extending health insurance to about 80,000 uninsured children.
Oregon children no longer will be denied health insurance because their parents can't afford it or don't qualify for the Oregon Health Plan. Oregon joins 11 states committed to providing universal health insurance for their children, a goal Kulongoski has pushed for since he was elected in 2002. "It is one of those great events," Kulongoski said. Spending on health care, Head Start preschool, and other programs for children, he said, means kids "are going to be healthier and smarter, and we are all going to benefit from it." By insuring all kids, Oregon should see better health outcomes for its children, including improvements in vaccination rates, dental decay, asthma management, and early detection of autism and other developmental issues," said Dr. James Lace, a Salem pediatrician. Better health means children will be better prepared for school, said Lace, who founded Childhood Health Associates of Salem, a team of eleven pediatricians who run a clinic twelve hours a day, seven days a week, serving 36,000 children a year.
Under the new law, Oregon will tax hospitals and most commercial insurers to expand state health insurance to 80,000 uninsured children. A one percent tax on health insurance premiums will pay for the additional children. Pediatricians are gearing up for an influx of patients over the next two years. The Children's Health Alliance, which includes 110 pediatricians in the Portland area, expects up to 60,000 more children. Marion and Polk counties expect another 14,000 children, Lace said. Providers must adopt a "whole new mind-set" to steer any child who shows up without health insurance into a program, said Lace, who told Babcock about Oregon's new law.
Babcock, a single stay-at-home mother in Salem, said the state rejected her daughter years ago after concluding the girl's father was capable of providing her health insurance, though he didn't. The two aren't married. The state health plan provides health insurance to low-income and disabled residents through Medicaid, which operates with a combination of state and federal money. Keeley has remained healthy over the past five years and Babcock has racked up only $500 in debt for her daughter's routine care, dodging the bigger expenses that would come from more serious needs such as a broken tooth or bone. She was relieved to hear about Oregon's new law. "Every child should have health insurance no matter what," she said. "They are our future."
The state Department of Human Services has created the Office of Healthy Kids and about 100 new positions to handle the expansion, which begins by enrolling thousands of children who qualified for the Oregon Health Plan even before the new law. Those children live in families with incomes up to 185 percent of poverty. The federal poverty level is $22,050 for a family of four. The plan doesn't cover children who are illegal immigrants.
The state soon will launch a publicity campaign to enroll the children who already qualify, said Cathy Kaufmann, manager for the Healthy Kids office. In October, children in families with incomes up to 200 percent of poverty become eligible for the program. In January, the state will begin subsidizing on a sliding scale private employer health insurance for children in families earning between 201 percent and 300 percent of poverty. Children from families in that income bracket without employer insurance can buy into a new state-sponsored insurance option, which also will be available to all other Oregon children.
Health providers say the expansion may hit obstacles. Children new to the Oregon Health Plan, for example, may run into problems finding doctors in the Portland area. Most metro pediatricians have stopped taking any more state plan children because the health plan's Medicaid payments do not cover the doctors' costs. That is not a problem elsewhere in the state where Medicaid managed-care companies are structured to pay doctors more, said Dr. Robert Mendelson, board member for the Children's Health Alliance. "We (in Portland) are getting paid 58 percent of the commercial (insurance) rate where other plans are paying 85 percent of commercial rates," he said. "We are all for universal care, but we have to remain in business."
Kulongoski said the state is committed to having 95 to 98 percent of Oregon children insured within the next two years. That is about as many as any state has been able to insure because some children live with families that avoid authorities or move frequently. The governor said Oregon is blazing a path President Barack Obama should consider as he wrestles with national health care reform. "I would tell him, 'Start with children,'" Kulongoski said. "Make sure every child in this country has access to health care. It is not only a health issue. There is a great equality issue in this." [Bill Graves, The Oregonian, 08/05/09]
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