New on the Web 1: July 2001
We've collected information on several new reports and other resources available on the Web that we hope you'll find interesting and useful. Descriptions and links appear below.
Health Insurance Accessibility for Those in Less Than Perfect Health
A study conducted by researchers at Georgetown University's Institute for Health Care Research and Policy for the Kaiser Family Foundation found that consumers with various health conditions can often get coverage of some kind in the individual insurance market, but that coverage often comes with limits on benefits and may be priced out of their reach. This study created seven hypothetical applicants and asked 19 insurance companies and HMOs in eight markets around the country to consider them as actual consumers. Sixty applications for coverage for each of the hypothetical consumers resulted in "clean offers" (where applicants were offered coverage without restrictions on covered benefits) just 10% of the time, rejections 37% of the time, and coverage with benefit limits and/or premium increases 53% of the time.
Medicare + Choice Report Card
Mathematica Policy Research has released an interim report card on Medicare + Choice and has given it a D. This grade was based on the finding that the program has failed in several of its important goals, and that choices available to Medicare beneficiaries have actually diminished since its inception: some plans have withdrawn from the program, few new plans have entered the program, greater choice has not developed in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-income areas of the country have widened.
Medicare Spending on the Chronically Ill
The Alliance for Health Reform has published an issue brief examining the extent and cost of care for the chronically ill in the American health system. The brief lists the most common chronic conditions, examines how the health care costs for such conditions are paid for, and discusses the need for reforming the way the medical system is structured to be more responsive to those living with chronic conditions.
Moving Beyond CHIP Enrollment
In this report designed for advocates, the Children's Defense Fund emphasizes how important it is for families to enroll their eligible children in a health insurance program before they become sick or injured, as well as the importance of using health services once enrolled. It provides tools for reaching out to families and enrolling children in CHIP and Medicaid, as well as resources for assisting families once they are enrolled.
New Urban Institute Findings on Uninsured Children
The Urban Institute has released three new reports as part of their CHIP evaluation. Two of the reports look at parents' reasons for not enrolling their eligible children in Medicaid or CHIP, finding that insufficient knowledge about the programs, confusion about who can enroll in the programs, and administrative hassles associated with enrollment are key reasons. The researchers point out that knowing why families don't enroll their children in Medicaid and CHIP can help inform ongoing outreach efforts. The third report examines how states are dealing with the issue of crowd out, the extent to which crowd out is occurring, and how policies to limit crowd out affect enrollment. All the three studies can be found by following the link below.
Medicaid Managed Care Appeals Process, State Oversight Inconsistent
This report, put out by the Office of Inspector General of the Department of Health and Human Services, summarizes an evaluation of the dispute resolution process for Medicaid beneficiaries enrolled in managed care plans and how well states have implemented federal due process requirements. The Inspector General's office found that, while the dispute resolution systems in the nine states studied appeared to be working as intended, there were still a number of problems: states conduct few managed care hearings, and managed care organizations receive relatively few complaints and grievances; member materials and notices are often inadequate; regulations governing fair hearing time frames can be ambiguous; states have different interpretations of the plan's role, as well as their own, in fair hearings; and oversight of dispute resolution is inconsistent.
State Managed Care Organization Liability Laws
The Kaiser Family Foundation recently released a study of currently enacted managed care liability provisions in state law. The report describes the key features of such laws in the eight states that have enacted them (beginning with Texas), legal challenges that have been made to some of them, and early experiences in states whose laws have gone into effect. It makes the case that, up to this point, courts have held that ERISA (Employee Retirement Income Security Act of 1974) preempts many types of lawsuits filed on behalf of health plan consumers.
Ambulatory Care for the Urban Poor
For this report, the Urban Institute examined the organization and financing of ambulatory care for the poor in three urban communities - Denver, Houston, and Los Angeles - and the challenges posed to those systems by ongoing changes in the health care sector. The study describes each community's ambulatory care safety net, the challenges each community faces, their responses to those challenges, and possible determinants of the level of success each has achieved in meeting the ambulatory care needs of their vulnerable populations.
Mental Health Care Policy
Community Voices: Health Care for the Underserved has published a report that provides overviews of barriers to access and use of behavioral health services, the financing of mental health services, and the coordination of such services. It also presents new policy solutions aimed at expanding access to care and providing early intervention services.
State Health Information
The Kaiser Family Foundation has launched a new Web resource called State Health Facts Online that offers comprehensive health policy information for all 50 states, the District of Columbia, and all U.S. territories. It offers information on a broad range of more than 200 topics, including population demographics, managed care, the uninsured, Medicaid, Medicare, minority health, and women's health. This free resource allows users to view information for a single state or to compare and rank data across multiple states and compare it to U.S. totals.
State Legislative Health Care Issues
The Blue Cross and Blue Shield Association has released its 9th annual survey of state legislative activity focused on health insurance access and regulation. The three legislative trends consisted of increasing health plan regulation, expanding access for the uninsured, and reining in the cost of prescription drugs. Of the three trends, the most popular initiative was expanding health insurance access for certain populations, including children in low-income families and seniors lacking drug coverage.
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