May 2009 Archives

Last November, excitement over the prospects for real change swept a new President into office and gave hope to many who had long since lost hope that things could get better and that government could do good.  We all have our own criteria for what constitutes "real" or "good" change, but whatever change may mean, the majority of Americans soundly embraced it, even though we all know that change can sometimes be hard. 

For us at CCF, the promise of change has just taken on a new reality.  I am truly honored to have been selected by this Secretary, by this Administration, to lead the Centers for Medicaid and State Operations, otherwise known as "Medicaid" (though it also encompasses CHIP).  It is a great privilege to serve as a public servant in this Administration. The opportunity presented is enormously exciting and more than a little daunting.  Collectively, we have the chance of a lifetime to ensure that every person in America has access to affordable, quality coverage and to make Medicaid and CHIP the best programs they can be.  How can we do anything less?

My colleagues at CCF aren't skipping a beat as they bid me farewell.  Today, co-authors Dawn Horner, Jocelyn Guyer and Martha Heberlein are releasing a major report on what children need from health reform.  On Monday, CCFer Tricia Brooks is presenting at a Brookings Institution forum on ways to get rid of red tape in Medicaid and CHIP and pursue automatic enrollment in health reform.  Liz Arjun, Tricia and our Spitfire Strategies partner, Colleen Chapman, are in Washington state helping the Children's Alliance work through their plans to ensure that Washington's new Apple Health for Kids program (Medicaid and CHIP) succeeds in covering all kids.  Joe Touschner is working closely with Arkansas partners to help support the state's implementation of its recently enacted CHIP coverage expansion.  (The groups in both Arkansas and Washington are part of the David and Lucile Packard Foundation Finish Line project.) Joan Alker is providing analyses to Hill staff on premium assistance, and Cathy Hope and Phil Zorn are busy keeping all of you up-to-date, and hopefully engaged, through this blog.
 
CCF will continue to do this enormously important work- and so much more- now under the leadership of Joan Alker and Jocelyn Guyer, who will take the reins as CCF's co directors.  You all know them--they are the ones you turn to to understand the intricacies of CHIP financing, or the do's and dont's of waiver policies, or the ways to help integrate Medicaid and CHIP into a broader health reform solution.  They have led this organization with me since it began 4 years ago and have shaped and contributed to every aspect of its work, its vision, and success.  CCF could be in no better hands.

This is all good change.  Not necessarily easy or simple, but good.   As for me, I don't want to make too much out of all this change talk. It's true that I may have to change cars as I try to figure out an economical and environmentally friendly way to commute to Baltimore, but I'm not leaving CCF's vision or its partners.  We are all working to improve our nation's health care system, each in our different ways.  And one thing that most certainly will never change is the value I place on all that I have learned from you over the years.  I thank you deeply for that; please keep it coming.

You can't pick up a paper (some of us do still read them) or read a blog today without hearing about health reform. In fact, you have read on our blog about the flurry of activity on the Hill. The good news is that no longer is the argument focused on whether health reform is needed, but on how it should be done.

At the top of the agenda is how to provide the millions of people who are uninsured with high-quality coverage that is affordable. Children have a large stake in this debate--both because of its implications for their families and the work that still is needed to ensure all children have coverage that addresses their unique needs. In CCF's new report released today "The Last Piece of the Puzzle: Providing High-Quality, Affordable Health Coverage to All Children through National Health Reform," we attempt to bring these issues to the forefront of the much larger debate by providing a blueprint of what children need from health reform.

The truth is that we have made significant strides in providing children have health coverage, and the new CHIP law took us even further. But CHIP reauthorization was never intended to be the panacea, nor a substitute for broader health reform. Even if the new CHIP law works exactly as intended, millions of children will remain uninsured and even those children who have health insurance will not necessarily get the child-specific care they need. Particularly troubling is that whether a child has health insurance is truly a game of chance-- depending on such arbitrary distinctions on whether the child lives in Kansas City, Kansas or Kansas City, Missouri or whether the child's parent works for a school district or a chain retail store.

In a country where there is remarkably strong public consensus that all children should have the health care coverage that they need to grow and thrive, it is clear that health reform must tackle these remaining gaps in coverage for children. We have come far, but now is the time to put the last pieces of the puzzle in place by:

• Building affordable pathways to coverage for all of America's children;
  

• Taking further steps to ensure that every insurance card translates into children receiving the care that they need to develop and grow properly;
  

• Creating a unified, "no wrong door" enrollment and renewal process to ensure all families can easily access coverage; and
  

• Strengthening the financing of public programs, which serve as the backbone of the current coverage system for low-income children.
  

I encourage you to read the report for our specific policy recommendations within each of these puzzle pieces (if you have limited time the Executive Summary provides a good synopsis). In the coming weeks and months, we will continue to post on how to address the needs of children in health reform, which we hope will further the dialogue on this critical issue. And, as always, we welcome your comments and thoughts.

The Center for Children and Families staff is scurrying as fast as a NASCAR pit crew as two of our top issues are building momentum. We are participating in back-to-back Capitol Hill forums on addressing children's unique health needs in health reform and removing bureaucratic hurdles to enrollment in Medicaid and CHIP. For those of you in town, please join us for the forums. The rest of you will have to wait for us to blog about them.

Tomorrow morning, CCF will release a new report at the "How Can Health Reform Help Kids?" forum sponsored by the Center for American Progress Fund and the Children's Partnership. The event will be held Friday, May 29 from10 a.m. to 11:30 a.m. in the Capitol Visitors Center Room SVC 200/201. The event is free and open to the public, but you must RSVP in order to get through security. Here's the invitation.

Monday morning, CCF Senior Fellow Tricia Brooks will participate in a forum on "Effortless Enrollment" sponsored by the Roosevelt Institution. The event is being organized by Roosevelt Institution Senior Fellow Robert Nelb and should provide a lively discussion of enrollment issues that both Tricia and Robert have discussed on this blog. The Urban Institute, Brookings Institution and Heritage Foundation and others will join in the discussion. The forum is Monday, June 1 from 10:30 to 12 (noon) in the Capitol Visitor's Center Room SVC 202/203 but you must RSVP for security purposes. Here's the invitation.

If technology were not so prolific, there would be no reason to write this blog.  My kids grew up using computers and cannot remember a time when technology was not a focal point of everyday life.  From researching homework (or health policy) to balancing your checkbook and paying bills, from shopping for hard-to-find sizes to socializing with friends, the internet is our connection to people and resources near and far. It's fast, friendly and convenient.

Unfortunately, applying for public health coverage programs online is not the norm.  Believe it or not, many states still do not have an online application for families to apply for coverage. Some of those that do merely provide an electronic version of a paper application that allows someone to type a response on a blank line.  And then, it's not uncommon that the applicant is required to print the application or a signature page, then sign the form and use snail mail to get it to an office where an eligibility worker has to input the data.  I know you must be shaking your head by now, but trust me, it's true!

One state in particular - Wisconsin - has made great gains in the use of technology for people to apply to a number of public programs, get information about their benefits and report changes.  Wisconsin's ACCESS program is a great example of how technology can be used to simplify the process of applying for children's health coverage.

I recently had a Q & A session with Angela Dombrowicki from the Wisconsin Division of Health Care Access and Accountability about ACCESS.  We were so excited we sent an e-postcard to all of our friends.  You can check it out here.  We'd love to hear about your state's innovations in technology.  

Shopping at the mall is never a favorite pastime of mine but it does provide some comic relief to what I see happening in health reform.  As I watch teenagers frantically searching for the latest fashion trend, I am reminded that this tendency to grab onto the latest and greatest new fad is at play in the health reform debate.

The fairly new concept of "health insurance exchanges" is grabbing all the attention while barely any attention is being paid to the good old blue jeans of health care - Medicaid.  Now Medicaid has outlasted love beads, pet rocks and leisure suits and will probably outlast exchanges, but it is painful to see such a staple of the health care system endure yet another snub.  Instead of throwing it by the wayside to grab onto the next new fad, policymakers should spiff it up a bit and put it proudly at the center of the health reform debate.

In 1965, the most vulnerable in society had little access to affordable health care. The nation embraced a new program called Medicaid and it became an important lifeline to those most in need.  Since that time, private health insurance has eroded, health care costs have skyrocketed and more families and individuals have found themselves in need of affordable health care options.  Policymakers should look to lessons learned through the forty-four year history of Medicaid in their efforts to figure out how to best meet the needs of the uninsured.  

One place to look is the state that has had the most experience with health reform - Massachusetts.  What we hear from folks up there is that a strong Medicaid program is as fundamental to the success of health reform as a pair of jeans is to your wardrobe.  Nancy Turnbull should know - she serves on the board of the Commonwealth Health Insurance Connector Authority, which is an "exchange".  During a recent panel discussion hosted by the Alliance for Health Reform and The Commonwealth Fund, Turnbull emphasized that Medicaid provides the foundation of coverage necessary in order for the exchange to work.

 "In particular, our coverage expansions come on a very strong base of Medicaid coverage and there are about 800,000 people in Massachusetts, non-Medicare, non-dually eligible who are covered on the Medicaid program," she said.  "This created a very important foundation of coverage on our state on which the Connector has built."  

According to Turnbull,  the health care program in Massachusetts relies on the expertise and experience of the Commonwealth's Medicaid program.

Turnbull went on to say:

"Most people who are on Commonwealth Care are very similar to Medicaid people and the program has been designed deliberately to recognize that -- the needs and the challenges of people who are low- and moderate-income,"

A strong Medicaid program is fundamental to the success of health reform and the exchange can't function properly without it.  In other words, while "exchanges" are pretty cool, they'll look a lot better with a good pair of jeans (aka revived Medicaid program).

When my third child was born just 20 months after our twins, I was briefly the mom of three kids under the age of two.  Not as tough as the challenge facing Jon and Kate plus Eight or the octuplet mom, but enough to make me think that my life would never be quite as chaotic again.  And, so far, it hasn't been, but the recent flurry of activity on health reform has created a similar feeling of not quite knowing which set of priorities is most important to turn to first.  So, to try to sort it out, we thought it would be worth reviewing some of the more important developments we've heard, seen or read about in recent weeks and to do a look ahead.  

Yesterday, the Senate Finance Committee released a set of health reform coverage options, offering some important insight into the direction this crucial committee may take as it tackles the goal of covering all Americans.  

• A strong and affordable benefit package would be available to children and parents through Medicaid, potentially up to 150 percent of the federal poverty line.  

• Families above that income level would be covered through what seems to be a coordinated package consisting of CHIP (for kids) and coverage on the exchange with a tax credit (for parents).  

• CHIP would be brought up to 275 percent of the federal poverty line, and CHIP benefits would be strengthened to cover all recommended preventive care and the full range of medical services a child might need. 

• In addition to the coverage improvements, the Finance Committee document advances the notion that it should be much easier for people to enroll in coverage.  It recommends a simplified, unified system for figuring out whether people should be enrolled in Medicaid, CHIP, or the Exchange that relies on a web-based portal, among other approaches. 

At the same time, some of the options still under consideration fall short of the goal of guaranteeing access to high quality care for everyone.  For example:

• There is no limit on out-of-pocket costs for people covered through the exchange, which means many Americans will still face the prospect that a serious health crisis can also quickly become a financial crisis.

• There could be a waiting period -- a state option -- before immigrants lawfully residing in the country can be covered under Medicaid or CHIP.  

• Benefits on the Exchange don't require a pediatric care package, and 

• States could be required to rely on commercial insurance products to serve Medicaid beneficiaries, disrupting other successful models of care that are often better suited to the needs of low-income people, such as the medical home model now in use in North Carolina and other states. 

The Center for Children and Families came into being four years ago today to develop effective, practical strategies to improve access to quality health care for children and families.  As we spend our birthday watching the Senate Roundtable Discussion, "Increasing Access to Health Care Coverage," we wanted to celebrate with you online (fewer calories that way). 

One of the most common questions we get at CCF is, "What are states doing to cover kids?" Since CHIP was reauthorized in February, this question has taken on a new twist: "Are states doing more to cover children since the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 was signed by President Obama?"  The answer is an unequivocal, "Yes," which, given the current status of state budgets, may come as a surprise to many; it was to me.   

Nothing! (If I were cooler, I could have twittered this response in.)