Connecting State and Local Government: Collaboration through Trust and Leadership

Source: National Association of State Chief Information Officers

Citizen demand for efficient government often drives state agencies to seek out opportunities to deliver traditional services in non-traditional ways. Engaging in cross-boundary collaboration can be a way for states to leverage costs while providing citizens with streamlined services. Such collaboration is inevitable for state CIOs and this brief (PDF; 211 KB), a product of NASCIO’s Cross-Boundary Collaboration Committee, explores the unique challenges and opportunities of cross-boundary collaboration between state and local government entities. Highlighting successful examples of state-local collaborations already underway, this brief features the governance and financial models that were utilized for these collaborations. In addition, this brief examines the unique challenges facing state-local challenges and explores the ways in which states and localities can work together to achieve success and to lay the groundwork for future collaborative efforts.

Tax Cuts: Myths and Realities

Source: Center on Budget and Policy Priorities

Since 2001, the Administration and Congress have enacted a wide array of tax cuts, including reductions in individual income tax rates, repeal of the estate tax, and reductions in capital gains and dividend taxes. Nearly all of these tax cuts are scheduled to expire by the end of 2010. Making them permanent would cost about $3.5 trillion over the next decade (when the cost of additional interest on the federal debt is included). Because important decisions about these tax policies must be made in the next few years, it is essential to understand their effects on deficits, the economy, and the distribution of income. Supporters of the tax cuts have sometimes sought to bolster their case by understating the tax cuts’ costs, overstating their economic effects, or minimizing their regressivity. Here, we address some of the myths heard most frequently in recent tax-cut debates.

U.S. employers’ health benefit cost continues to rise at twice inflation rate, Mercer survey finds

Source: Mercer

Total U.S. health benefit cost rose by 6.1 percent in 2007, the same pace as last year, to an average of US$7,983 per employee, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer and released today.

The good news is that cost increases have held steady for three years (after spiking to nearly 15 percent in 2002) and are likely to slow a bit further in 2008. The bad news is that’s still more than twice the rate of inflation. Health cost growth is outpacing wages and material costs and eroding business profitability.

There are consequences for working Americans as well: In the absence of a mandate to provide coverage, some small employers are simply dropping their plans, adding their employees to the growing rolls of the uninsured. Among employers with fewer than 200 employees, health coverage prevalence fell from 63 percent to 61 percent in 2007 – and that’s down from 66 percent five years ago. This drop-off is continuing despite the new availability of relatively low-cost consumer-directed health plans (CDHPs), which may be a concern for state and federal policymakers currently debating the future of US health insurance.

Survey highlights include extensive data, graphs, charts. Full report available for purchase.

Snapshot: California’s Uninsured 2007

Source: California Healthcare Foundation

The number of uninsured Californians under age 65 continues to rise as employer-sponsored health insurance declines. Some who lose insurance at their workplace are buying individual policies; others become eligible for coverage through public programs like Medi-Cal. But more than 20% of Californians remain uninsured. The problem, though national, is more prominent in California, which has a lower percentage of individuals with employer-sponsored coverage and a higher proportion of uninsured. And because of California’s large population, the number of people without insurance — 6.6 million — is the highest of any state.

Reacting to inaction at the federal level, California is pursuing solutions closer to home. In 2006, California enacted legislation (SB 1448) that provides $540 million in new federal funds for local efforts to expand health coverage and care to uninsured individuals. And, in 2007, coverage expansion and health reform are high on the Sacramento policy agenda.

Some findings from this year’s snapshot include:
* Workers at private-sector businesses of all sizes are experiencing an increased likelihood of being uninsured;
* More than a third of the uninsured have family incomes of more than $50,000 per year;
* Nearly 70% of uninsured children are in families where the head of the household has a full-time job; and
* Nearly 60% of the state’s uninsured are Latino.

Full Report (PDF; 538 KB)

The Hispanic Family in Flux

Source: The Brookings Institution

By virtue of its size, growth, and relative youth, the Hispanic population will have a growing impact on all policy matters related to the family according to a new report. This impact will be large and distinctive. The growth of the Hispanic population has already slowed the decline of the two-parent parent family in the United States as immigration produces a steady flow of young adults with a higher propensity to marry than their native-born peers, both Latino and non-Latino. But, immigration, particularly under current policies, is also producing a disproportionate number of Hispanics who are geographically separated from their spouses. The dynamics shaping the Hispanic family are both complex and fluid. Within the Hispanic population there are notable differences in the prevalence of some key behaviors. Of greatest concern is the finding that births to women who are unmarried are more common among native-born Latinos than foreign born Latinos. Such differences are especially significant for the long term because a large and growing share of the youth population is made up of the native-born children of immigrants. Survey data shows that a powerful process of acculturation is taking place among immigrants and their offspring which produces an erosion of the strong sense of family evident among recent immigrants in favor of attitudes similar to those of non-Latinos in the U.S. population.

Full Paper (PDF; 449 KB)

How Much Value Do Workers Place on Health Benefits?

Source: Employee Benefits Research Institute

What value do workers place on employment-based health benefits? Would workers be willing to exchange their health benefits for an additional $7,500 in taxable income? Among employers that provide health benefits, that was about the average per-employee cost of health benefits for active workers and their dependents in 2006 (and it’s not counted as taxable income to employees).

The 2007 Health Confidence Survey, released recently by the nonpartisan Employee Benefit Research Institute (EBRI), asked several questions that sought to determine the value workers place on employer-based health benefits. Here are some of the findings:

• Perhaps because of the increased costs that many are experiencing, most Americans with employment-based health benefits value them above the actual dollar amount that employers pay toward the coverage.

• When employed Americans with health coverage were asked whether they would prefer $7,500 in employment-based health insurance coverage or an additional $7,500 in taxable income, three-quarters (76 percent) chose the employer-provided health coverage. Of those, about one-quarter each said their employer would have to give them an additional $10,000¬$14,999 (22 percent) or $15,000 or more (25 percent) in taxable income for them to willingly give up their coverage.

• Fifteen percent stated no amount of taxable income would be enough. Six percent said they would accept less than $10,000, while 3 in 10 (31 percent) were unsure of the amount. These results are consistent with the results of similar questions asked in previous years.

• Most of those with employment-based coverage would prefer to continue receiving their current level of health benefits from their employer even if some of the premium were taxed (62 percent). About one-quarter (27 percent) would choose to reduce the level of health benefits they receive from their employer so that they paid no taxes on the premium. About 1 in 10 (9 percent) were not sure which they would prefer.

Most Americans with employment-based health benefits are confident that their employer or union will continue to offer health insurance for its workers. Almost 3 in 10 (28 percent) in the survey were extremely confident that this will continue to be the case. This represents a decrease from the 35 percent extremely confident in 2004, but is statistically equivalent to the levels measured in 2000 and 2002. About 3 in 10 each in the 2007 survey were very (30 percent) or somewhat (28 percent) confident.

MRSA Toolkit for Middle & High Schools

Source: Tacoma-Pierce County Health Department

This toolkit has been designed to help prevent and stop or reduce the spread of Methicillin resistant Staphylococcus aureus (MRSA) skin infections in middle and high schools. It contains educational materials targeted to the school health team, athletic directors/coaches, custodians, athletes/students and parents.

See also: MRSA Toolkit for Elementary Schools

MRSA Toolkit for Childcare Centers

MRSA Toolkit for Outpatient Clinics/Offices

The Long-Term Outlook for Health Care Spending

Source: Congressional Budget Office

Spending on health care has been growing faster than the economy for many years, representing a challenge both for the government’s two major health insurance programs, Medicare and Medicaid, and for the private sector. A prologue to the Congressional Budget Office’s (CBO’s) upcoming long-term budget outlook, to be released next month, this study (PDF; 832 KB) presents the agency’s projections of federal spending on Medicare and Medicaid and national spending on health care over the next 75 years. The goal of the projections is to examine the implications of a continuation of current federal law, rather than to make a prediction of the future. In reality, federal law will change; nevertheless, the projections provide a useful measure of the scope of the problem facing the nation under current law.

The Joint Commission Annual Report Shows Further Improvement in Health Care Quality in Nation’s Hospitals

Source: Joint Commission

From the news release:

American hospitals are making measurable strides in the quality of care provided for patients with heart attacks, heart failure, pneumonia and surgical conditions, according to the Joint Commission’s second annual report on health care quality and patient safety in the nation’s hospitals. The detailed report portrays the aggregate performance of accredited hospitals against the Joint Commission’s standardized national performance measures and its National Patient Safety Goals.

Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2007 also shows, however, that whether or not patients receive proven treatments for these common reasons for hospitalization often depends on where they live. For example, statewide performance of hospitals on the measure of providing discharge instructions to patients with heart failure ranges from 49 percent to 91 percent.

The Joint Commission issues this annual report as part of its on-going efforts to emphasize the health importance of accountability and continuous improvement for hospitals, and to empower consumers with information that will make them more active participants in their health care. This report examines how America’s accredited hospitals performed against quality-related performance measures and safety goals during 2006 and in previous years.

Direct to Full Text, 2007 Annual Report