A Roadmap to Health Insurance for All: Principles for Reform

Source: Commonwealth Fund

From press release:
Health insurance reform plans that build on a mix of private and public health insurance, where costs are shared among government, employers, and enrollees would have great potential to move the system to high performance and would be the most practical to implement according to a new report released today by The Commonwealth Fund Commission on a High Performance Health System. Commissioners are a diverse group of leading health policy experts from government, private industry, health care delivery organizations, academia, and professional associations.

Affordable, comprehensive health insurance coverage for all Americans is essential to achieving a high performance health system, say the report authors, because coverage helps to ensure access to essential preventive services; improve overall health; cut down on inefficiencies like duplicate medical tests; reduce administrative costs; and eliminate costly uncompensated care for uninsured and underinsured families.

However, the way coverage reform plans are designed will be critical to their success and ability to offer all participants access to high-quality, efficient, and equitable health care, according to the analysis, A Roadmap to Health Insurance for All: Principles for Reform, prepared for the Commission by Sara Collins, Assistant Vice President at The Commonwealth Fund and colleagues. The report is the first of three major policy reports the Commission will issue this Fall.

Full Report (PDF; 487 KB)

Grading State Disclosure 2007

Source: Campaign Finance Institute

From press release:
Access to state-level candidate campaign disclosure data continued to improve in states across the country, according to Grading State Disclosure 2007, a comprehensive evaluation of campaign finance disclosure laws and programs in the 50 states. The 2007 study, released today by the California Voter Foundation, found that Washington State ranks first in the nation in campaign disclosure, while Oregon ranked as the most improved state in 2007.

The assessment was conducted by the Campaign Disclosure Project, which seeks to bring greater transparency and accountability to money in state politics. The project is a collaboration of the California Voter Foundation, the Center for Governmental Studies and the UCLA School of Law and is supported by The Pew Charitable Trusts.

Executive Summary
Full Report (PDF; 943 KB)
State by State Summaries and Rankings

Vaccine Prioritization During an Influenza Pandemic

Source: Critical Infrastructure Protection Program, George Mason University School of Law

Preparing for an influenza pandemic is a monumental challenge and requires participation from federal, state and local governments as well as the private sector. It is with great pleasure that the George Mason University School of Law’s Critical Infrastructure Protection (CIP) Program publishes a collection of essays (PDF; 737 KB) on vaccine prioritization during an influenza pandemic. The United States government is spending a significant amount of time and resources examining and preparing for the possible threat of an influenza pandemic. A major challenge in preparing for an influenza pandemic encompasses vaccine prioritization. Specifically, if a pandemic were to occur and vaccines needed to be distributed, who should be first to receive vaccines? Should first responders or critical infrastructure employees have priority to receive the vaccines?

The CIP Program invited leading scholars to address this important issue. The essays focus on different concerns about vaccine prioritization. The first essay, submitted by Dr. Colleen Hardy, of the George Mason University School of Law’s Critical Infrastructure Protection Program, provides an overview of current federal response plans to an influenza pandemic. Specifically, it summarizes the Department of Health and Human Services’ (HHS) influenza plan concerning vaccine prioritization. In addition, the essay describes the National Infrastructure Advisory Council’s (NIAC) Working Group on Pandemics’ recommendations to the Department of Homeland Security and HHS.

Dept. of Labor Launches New Website on Retirement Laws

Source: U.S. Department of Labor, Employee Benefits Security Administration

The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) today announced a new interactive Web tool to serve as a resource for employers in complying with federal employee benefit laws. The ERISA Fiduciary Advisor is designed to help employers and others who provide services to private sector retirement plans understand their responsibilities. The advisor provides an overview of the Employee Retirement Income Security Act (ERISA), including the most common mistakes EBSA finds in its investigations, and provides links to additional information as well as tools to assist plan officials. Strong fiduciary oversight and compliance assistance are both high priorities for EBSA.

Family Values at Work: It’s About Time! Why We Need Minimum Standards to Ensure a Family-Friendly Workplace

Source: Multistate Working Families Consortium

“Family Values at Work” documents the consequences on workers, families, businesses and the nation when family values end at the workplace door. The document details the wrenching stories of workers suffering from the lack of family-friendly work rules, summarizes key research, and lays out a policy agenda modest compared to that of other advanced nations yet urgently needed by U.S. workers and their families. These policies include a minimum number of paid sick days for routine illnesses as well as a family leave insurance fund to provide income during longer-term leaves for a new baby or serious health condition.

The report is being released by the MultiState Working Families Consortium, a network of state coalitions working for policies that value families. Joining them are ten national organizations, including 9to5, National Association of Working Women, ACORN, the AFL-CIO, Moms Rising, and Service Employees International Union. Together these groups and others are building a movement to win changes at the local, state and national level. Funding for the report was provided by the Annie E. Casey Foundation.

Private Medicare Drug Plans: Seniors and Taxpayers Hurt by High Expenses, Low Rebates

Source: U.S. House of Representatives, Committee on Oversight and Government Reform

The report has five principal findings:

The Part D insurers have high administrative expenses. The administrative expenses, sales costs, and profits of the private insurers offering Medicare Part D coverage will cost taxpayers and beneficiaries $180 per beneficiary in 2007. Taking into account the costs to the government of monitoring the private insurers, total administrative expenses, sales costs, and profits will reach $4.6 billion in 2007, with the profits of the Part D insurers alone accounting for $1 billion. The administrative expenses, sales costs, and profits of the privatized Part D program are almost six times higher than the administrative expenses of traditional Medicare. These high expenses do not appear to be due to one-time “start-up” costs because the total expenses increased from 2006 to 2007.

The Part D insurers have not negotiated significant drug manufacturer rebates. The rebates negotiated from drug manufacturers by the private Part D insurers will reduce Medicare drug spending by 8.1% in 2007. In contrast, the Medicaid program receives rebates from drug manufacturers that reduce drug spending by 26%, over three times as much. The small size of the Medicare rebates and the transfer of low-income dual-eligible beneficiaries from Medicaid drug coverage to Medicare drug coverage will provide a $2.8 billion windfall to pharmaceutical manufacturers in 2007.

The Part D insurers receive rebates on drug purchases made by beneficiaries in coverage gaps. The Medicare Modernization Act requires that private insurers give Medicare beneficiaries “access to their negotiated prices,” including “all discounts, … rebates, [or] other price concessions.” When the Part D insurers obtain rebates, however, they do not pass them through to beneficiaries by reducing drug prices in coverage gaps like the “donut hole.” Instead, the dollars flow in the opposite direction: the private insurers receive rebates from the drug manufacturers on purchases paid out-of-pocket by beneficiaries. In 2007, the Part D insurers are expected to receive $1.0 billion in drug rebates from transactions in which beneficiaries in coverage gaps pay 100% of the drug costs.

The Part D insurers have established drug pricing formulas that leave beneficiaries and taxpayers vulnerable to price increases. In almost all cases, the private insurers use pricing formulas that pay pharmacies the drug manufacturers’ full list prices minus a fixed percentage and a small dispensing fee. These formulas have resulted in drug prices that are generally no lower than those already available through discount pharmacies and on-line drugstores, while leaving beneficiaries and taxpayers vulnerable to repeated increases in list prices by the drug manufacturers.

The Part D insurers have a mixed record in promoting the use of generic drugs. In 2007, 59% of prescriptions filled by Medicare Part D will be filled with generic drugs. This level of use of generic drugs compares favorably with Medicaid, which fills 54% of prescriptions with generic drugs. It does not compare favorably with the experience of the Department of Veterans Affairs, which fills 68% of prescriptions with generic drugs.

CDC estimates 94,000 invasive drug-resistant staph infections occurred in the U.S. in 2005

Source: Centers for Disease Control and Prevention (CDC)

Methicillin-resistant staph aureus (MRSA) caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005, most of them associated with health care settings, according to the most thorough study of life-threatening infections caused by these bacteria, experts with the Centers for Disease Control and Prevention (CDC) report.

The study in the Oct. 17 edition of the Journal of American Medical Association (JAMA) establishes the first national baseline by which to assess future trends in invasive MRSA infections. MRSA infections can range from mild skin infections to more severe infections of the bloodstream, lungs and at surgical sites. The study found about 85 percent of all invasive MRSA infections were associated with health care settings, of which two-thirds surfaced in the community among people who were hospitalized, underwent a medical procedure or resided in a long-term care facility within the previous year. In contrast, about 15 percent of reported infections were considered to be community-associated, which means that the infection occurred in people without documented health care risk factors. The 2005 rates of invasive infection were highest among people 65 years of age or older. Black people were affected at twice the rate of whites, which could be due to higher rates of chronic illness among blacks.

CCH Survey Finds Most Employees Call in “Sick” for Reasons Other Than Illness

Source: CCH/Wolters Kluwer

Two-thirds of U.S. workers who call in sick at the last minute do so for reasons other than physical illness, according to the findings of the 17th annual CCH Unscheduled Absence Survey. The 2007 CCH Survey found that while 34 percent of people call in sick to work at the last minute due to “personal illness,” 66 percent are taking time off to deal with personal or family issues. “Most people today are juggling the demands of busy personal and professional lives, and are trying to do their very best in both places,” said CCH Employment Law Analyst Pamela Wolf, JD. “Organizations need to stop the tug of war with people for their time, and become a partner to employees to help them, and the business overall, be more successful.” Employers, however, have failed to make significant headway against the costly absenteeism problem that takes billions of dollars off the bottom line for U.S. businesses. The nation’s largest employers estimate that unscheduled absenteeism costs their businesses more than $760,000 per year in direct payroll costs, and even more when lower productivity, lost revenue and the effects of poor morale are considered.

The US Economic Impacts of Climate Change and the Costs of Inaction

Source: Center for Integrative Environmental Research, University of Maryland

The range of climatic changes anticipated in the United States – from rising sea levels to stronger and more frequent storms and extreme temperature events – will have real impacts on the natural environment as well as human-made infrastructures and their ability to contribute to economic activity and quality of life. These impacts will vary across regions and sectors of the economy, leaving future governments, the private sector and citizens to face the full spectrum of direct and indirect costs accrued from increasing environmental damage and disruption.

Executive Summary (PDF; 1.7 MB)
Full Report (PDF; 5.2 MB)
Regional Summaries (PDFs)

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

Source: Congressional Research Service

Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient.

Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care.

Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement.

Recognizing family caregivers as an important part of the nation’s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support.

Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits.