1. Hawaii: Mom-and-Pops Could Be In Line for Tax Credits Via Health Care Reform Natalie Brown-Aiwohi, owner of Headshots Hawaii, might be eligible to receive several thousand dollars in federal tax credits this year under the new health care reform law, and even more in the upcoming years. "Anything for small businesses I think is great because for us we suffer the most," said Brown-Aiwohi, who has 14 part-time workers. Approximately 16,300, or 81 percent, of Hawaii businesses with fewer than 25 workers and average annual wages of less than $50,000 will qualify for the federal tax credit, according to a report released yesterday by Families USA, a national consumer health advocacy group based in Washington, D.C. Of those, the report showed that 4,900 local companies with 10 or fewer workers earning an average annual wage of less than $25,000 qualify for the maximum tax credit of 35 percent this year. That increases to 50 percent of the premium by 2014. "This should help small-business owners to make coverage more affordable," said Ron Pollack, executive director of Families USA. The amount of the subsidies small businesses receive will vary based on the number of employees and the average compensation. The tax credit was added to the health care reform law to lower the cost of offering health benefits to employees. Small businesses in many states are not required to offer health insurance. In Hawaii the Prepaid Health Care Act of 1974 mandates that employers provide health insurance to employees who work 20 hours or more a week. "For Hawaii, small businesses are finally going to get some federal relief from doing something they've already been doing all along--that's a big difference from the rest of the country," said Jennifer Diesman, vice president of government relations at the Hawaii Medical Service Association, the state's largest health insurer. "I would call it sort of a double-edged sword," said Tim Lyons, executive director of Hawaii Business League, a small-business advocacy group comprising 1,200 members. "It's an expense you already have that you may be able to offset with the tax credit. The other side of that sword is the amount of time and effort it takes to figure out, apply for and receive the credit." Nationally, more than 4 million small businesses--or 83.7 percent--could qualify for the credit this year, according to the report. The Congressional Budget Office estimates the tax credit will save small businesses $40 billion by 2019. Families USA calculated the number of small businesses eligible for the tax credit by sampling about 39,000 businesses from the U.S. Census Bureau's Business Register. To calculate estimated tax credits, go to Health Insurance Premium Tax Credit. [Kristen Consillio, Honolulu Star-Advertiser, 07/16/10] 2. National: Many Children Lose Health Insurance When Parents Lose Jobs Dr. Fairbrother and her colleagues at Cincinnati Children's hospital have just come out with an excellent new study that takes a clear-eyed look at how often children end up losing health coverage after a parent loses a job. The results are powerful, but not pretty--between 2000 and 2004, almost one in three kids lost coverage when their parents lost a job (311 out of every 1,000). And, the rate is much higher for low-income children (456 low-income children out of every 1,000 lost their coverage when a parent lost a job). With the latest government data indicating that in 2009, there were 9.4 million families with at least one unemployed member, these are alarming findings. As bad as this news seems, one bright spot is that this is a problem we can fix by helping these children secure affordable coverage options through Medicaid and CHIP as their parents get back on their feet. And, I'm willing to bet that we've actually already made some significant progress since 2004, the latest year for which data were available for the new study. Thanks to the hard work of Governors, state-based advocates, and political leaders in Washington who have made a strong commitment to covering children, many of the children in families losing jobs now are eligible for Medicaid or CHIP and, increasingly, they are facing easier, more family-friendly enrollment procedures. Especially before their budget situations deteriorated, states across the country were getting rid of red-tape barriers to coverage and extending Medicaid and CHIP eligibility to additional children. Since the downturn, states have largely held onto the gains in coverage (although concerns are increasing about cuts to provider reimbursement rates) and some are continuing to push forward. This ability to "weather the storm" has been due in large part to a short-term, temporary increase in the help that the federal government provides states in financing Medicaid. Now, however, we are coming up on a critical moment that brings the importance of Dr. Fairbrother's research into sharp focus. At the end of this year, the extra help the federal government has given states is slated to expire even though state budgets continue to be battered by rising demand for services. Without a short-term continuation of the extra help, states will be under enormous pressure to scale back Medicaid and CHIP, including children's coverage. (They can't do it directly because the new health law requires a maintenance-of-effort when it comes to Medicaid and CHIP eligibility rules and procedures but there are indirect ways to cut back on coverage that states may be forced to consider such as slashing the number of state workers who can process applications or cutting reimbursement rates so deeply that children cannot secure needed care.) If this happens, the reality documented by Dr. Fairbrother that children often lose their private coverage when their parents lose a job will translate into more and more uninsured children. We will have a much harder time "catching" them in Medicaid and CHIP, and offering their families the peace of mind that comes with knowing that at least their children can still get health care. On a more global scale, we could end up with a deeply disturbing result--more children becoming uninsured even as the country moves forward on implementation of broader health reform in 2014. At Georgetown, we work closely with state officials and advocates who are addressing these issues in the states and the sense of urgency is palpable. If leaders in Washington don't come through quickly with an extension of federal fiscal relief, it may threaten a lifeline that can help millions of families stay afloat in the midst of unprecedented job loss. [Jocelyn Guyer, Say AHHH! Policy Blog, 07/13/10] 3. Oregon: The Real Winners in Health Care Reform--Kids In March, America made history by passing the Affordable Care Act. As the summer heats up, so does the ongoing debate around the country about what the new health reform law actually means for all Americans. Not everyone is convinced that the law is good for the country. But there is one constituency group that clearly came out as winners in the fight, one group that--although literally necessary for the future survival of our country--can't speak up for itself and often is ignored. They are our nation's most important, yet most vulnerable resource: our children. The reality is, when it comes to the well-being of our children, there are areas--including our high rates of childhood obesity and infant mortality--where the U.S. falls painfully short. With the passage of health reform, we got it right. We made an essential investment to improve our children's health. We should all celebrate that. The Affordable Care Act includes significant reforms that will not only help improve our nation's health care system, but also benefit children and families right here in Oregon. The law will offer health insurance coverage to nearly 32 million more Americans and also will ensure health care coverage for all children in the United States. Children no longer will be denied care because of pre-existing health conditions, and young people up to age 26 can remain on their parents' health insurance. This will bring much-needed relief to roughly 15,000 individuals in Oregon who now can have quality, affordable health insurance through their parents. Recognizing that children are not just little adults, the law funds demonstration projects for a model of care called the medical home. As pediatricians, we know that this model of care works for families. It establishes partnerships between the child receiving care, the health professionals who provide the care, and the family who facilitates the care. Devoting new attention to the medical home through health care reform will help many more children receive age-appropriate health services. Additionally, the new law allows for pediatric preventive care services to be offered to families with no co-pay, no matter what type of insurance they have. Placing an emphasis on prevention will help keep our children healthier and allow pediatricians to monitor and diagnose health problems earlier. The new law also greatly improves children's access to health care by providing incentives for more pediatric specialists to enter the work force. This means that more doctors will be available to care for children with complex health conditions. The law also devotes funding to help more doctors treat Medicaid patients. Before the law was signed, when doctors saw Medicaid patients, their payments often were insufficient to cover the overhead expenses of maintaining their practice. Now, the Affordable Care Act will allow many of Oregon's most vulnerable children to get the care they need. Health reform is good for the country and good for Oregon. As the leadership of the Oregon Chapter of the American Academy of Pediatrics, we're grateful that its passage will be a significant investment in the health and future of all our children. Now the real work begins as the federal government works to implement the law in the coming months. We look forward to working with state and federal officials, and the child health community in Oregon to continue to make our children's health our highest national priority. [Mary Brown, David Willis and Arthur Jaffe, OregonLive.com, 07/20/10]