Medicaid and SCHIP Coverage: Findings from California and North Carolina

Source: Genevieve M. Kenney, Jamie Rubenstein, Anna S. Sommers, Stephen Zuckerman, Fredric Blavin, Urban Institute, February 1, 2008

This article examines experiences under Medicaid and the State Children’s Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Federal Grants To States And Localities Cut Deeply In Fiscal Year 2009 Federal Budget

Source: Iris Lav and Phil Oliff, Center on Budget and Policy Priorities, February 4, 2008

Grants to state and local governments have long been an important way in which the federal government supports and administers programs efficiently. The new budget, however, continues to significantly erode those grants. This leaves states and localities the option of either curtailing services or increasing their own taxes to compensate for declining federal funds. These cuts would come at a particularly difficult time, when many states already are cutting programs to balance their budgets and half of the states face budget gaps for the upcoming fiscal year of more than $34 billion.

The Dubious Priorities Of The President’s FY 2009 Budget

Source: Robert Greenstein, James R. Horney, and Richard Kogan, Center on Budget and Policy Priorities, February 4, 2008

The President’s budget would provide more tax cuts heavily skewed to the most well-off while cutting vital services for low- and moderate-income Americans, generating large deficits, and increasing the strain on states already confronting budget problems as a result of the economic downturn. The budget reflects misguided priorities that would leave the American people more vulnerable in a number of ways.

Analyzing Affordability In Metropolitan Housing Markets: An Examination Of Affordability For Middle-Income Households

Source: Daniel Melser & Celia Chen, Moody’s, January 28, 2008

As we begin 2008, the U.S. housing and mortgage markets are in the midst of what now accurately can be characterized as a housing bust. Mounting anecdotal reports from metro areas across the country – both recognized housing hot spots and slow-growth markets – indicate that middle-income households are the hardest hit by this ongoing crisis. But it is wrong to assume that the dramatic downturn is easing the housing-cost burden on middle income families either in the short-term or over the long-term. This report shows that these families remain unable to access affordable homes in their communities under current market conditions, and that policy solutions focused on this crisis will only be successful if they are implemented in tandem with a long-term strategy for keeping our communities affordable.

Maloney Bill Targets Credit Card Abuses – Legislation Reining in Unfair Interest Rate Hikes and Unjust Fees a Strong Step Forward

Source: Consumers Union, Press release, February 7, 2008

WASHINGTON, D.C. — New legislation introduced today by House Financial Institutions and Consumer Credit Subcommittee Chairwoman Rep. Carolyn Maloney (D-NY) and Financial Services Committee Chairman Barney Frank (D-MA) curbs some of the most abusive credit card lending practices, consumer groups said.

Among the key provisions of the “Credit Card Bill of Rights Act” are prohibitions on:
• Bait-and-switch interest rate and fee hikes for any or no reason at all during the life of the card;
• Assessing hidden and unfair interest rate charges by charging interest on balances already paid off;
• Unjustifiably maximizing interest charges by requiring consumers to pay off balances with lower interest rates before those with higher rates;
• Charging late fees when consumers mail their payments seven days in advance of the due date; and
• Applying certain unfair interest rate hikes retroactively to balances incurred under the old rate.

See also:
HR 5244 To amend the Truth in Lending Act
S. 1395: Stop Unfair Practices in Credit Cards Act of 2007

OPM Issues Status Report on Performance-Based Pay Systems in the Federal Government

Source: Office of Personnel Management, December 2007

From press release:
The U.S. Office of Personnel Management (OPM) has released a 2007 status report on performance-based pay systems within the federal government, which currently support over 298,000 federal employees. The report, Alternative Personnel Systems in the Federal Government – A Status Report on Demonstration Projects and Other Performance-Based Pay Systems, includes information based on agency data, evaluations and studies, and it demonstrates performance-based pay systems “work.”

“This report shows performance-based pay systems drive improvements in managing performance, recruiting and retaining quality employees, and achieving results-oriented performance cultures,” said OPM Director Linda M. Springer.

The report also includes profiles of demonstration projects currently operating under OPM authority, as well as independent and executive pay systems where employee pay is linked to performance.

New Reports Show Aggressive Efforts by States To Expand Coverage, but Indicate Economy and New Rules May Compromise Progress

Source: Kaiser Family Foundation Commission on Medicaid and the Uninsured, January 28, 2008

From press release:
New reports released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) describe aggressive efforts by states in the past year and a half to expand coverage to low-income children and their families, but the actions may be curtailed as a deteriorating economic climate and new limits on federal assistance take effect.

A downturn in the economy, the federal failure to reauthorize the State Children’s Health Insurance Program (SCHIP) and new federal rules affecting Medicaid and SCHIP eligibility all suggest that the recent period of aggressive expansion of coverage by states may be over. This is the conclusion based on a series of new studies by the KCMU, including a 50-state survey of eligibility and enrollment rules in Medicaid and SCHIP for children and families, interviews with Medicaid directors in ten states representing all regions of the country, and recent studies of enrollment in Medicaid and SCHIP.

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles
Current Issues in Medicaid: A Mid-FY2008 Update Based on a Discussion with Leading Medicaid Directors
SCHIP Enrollment in June 2007: An Update on Current Enrollment and SCHIP Policy Directions
Medicaid Enrollment in 50 States: December 2006 Update
State Children’s Health Insurance Program (SCHIP): Reauthorization History

Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health Reform Plans

Source: Katherine K. Shea, Sara R. Collins, and Karen Davis, Commonwealth Fund, January 2008

From the overview:
The 13th Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey asked a diverse group of experts for their perspective on the health care reform proposals of the 2008 presidential candidates. Survey participants strongly support reform proposals that applied a mixed private-public market approach. Additional favored policy strategies for reform include a requirement for individuals to obtain health insurance, new private market regulations, and a requirement for employers to provide coverage or contribute to a coverage fund. Alternatively, respondents think proposals that focus on tax incentives to purchase individual private health insurance are not an effective method for controlling the rising costs of health care or achieving universal coverage. Health care opinion leaders call for the next president to simultaneously address universal coverage and quality, efficiency, and cost containment policies to move our health care system toward high performance.

Related commentaries:
Reform Is No ‘Either-Or’: We Must Fix the Payment System Along with Access
Darrell Kirch, M.D, president and chief executive officer of the Association of American Medical Colleges
Tough Choices Ahead: Candidates Ignore Pain of Needed Cuts to Health Costs
Dallas L. Salisbury, president and CEO of the Employee Benefit Research Institute and a member of The Commonwealth Fund Commission on a High Performance Health System

Related resources:
Data Brief

Knowing What Works in Health Care: A Roadmap for the Nation

Source: Jill Eden, Ben Wheatley, Barbara McNeil, and Harold Sox, Institute of Medicine/National Academies Press, 2008
(scroll down)

From press release:
Solutions to some of the nation’s most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what the standards for clinical practice should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.

A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.
Report Brief
Report Summary

Employment Numbers as Recession Indicators

Source: U.S House of Representatives, Joint Economic Committee (Republicans), January 2008

This paper investigates the value of employment data as real-time recession indicators. Among popular monthly labor measures, the unemployment rate is the most useful as an indicator of recession, whereas two top measures of employment growth -payroll jobs and civilian employment -have little value. Two other series, the labor force participation rate and the employment-population ratio, also provide little or no value in anticipating a recession. The best pre-recession employment indicator is actually weekly claims for unemployment insurance (UI). The paper reviews a new technique for predicting recessions, and develops an employment recession probability index. The index indicates a 35.5 percent chance that the U.S. economy is in recession, sharply up from 10 percent last month.