2003-09-22 -- Why We All Need to be in the Same Plan


Four recent articles demonstrating we need not only universal health
coverage and a single payer funding mechanism, but also a single
health plan where everyone receives the same benefits.

**  57,000 preventable deaths yearly from differences in health plans

**  National Survery: States Cutting Medicaid Benefits

**  Survey: Minorities Feel Cheated in Health Care

**  Alabama Blue Cross offers low-cost plan to cover uninsured


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Wall Street Journal, September 18, 2003

'Quality Gap' in Health Care Kills 57,000 Each Year in U.S.

New Study Cites Failings in Treatment, Prevention of Some Chronic
Conditions

By RHONDA L. RUNDLE  Staff Reporter of THE WALL STREET JOURNAL

 For the fourth straight year, quality of care improved in managed
health plans whose performance is measured by national standards, but
there is a growing "quality gap" that prevents millions of Americans
from receiving the best care, according to a new study.

More than 57,000 Americans die needlessly every year because they
don't receive the appropriate health care that is routinely provided
by some health plans, according to the National Committee for Quality
Assurance, a nonprofit organization in Washington. Those estimates
reflect the U.S. health-care system's poor performance on such
measures as controlling heart patients' high blood pressure and
diabetics' blood-sugar levels. (See the study.)
http://www.ncqa.org/Communications/State%20Of%20Managed%20Care/SOHCREP
ORT2003.pdf

 "It's not a question of knowing how to treat heart disease, diabetes
or mental illness," said Margaret E. O'Kane, president of the quality
organization. "We know how. We're just not doing it." Many Americans
do not receive the care that medical science has shown to be effective
in controlling existing conditions, as well as preventing others, such
as smoking-related heart disease.

The study shines a light on a troubling problem for physicians, health
experts and government policy makers: It takes much too long for
information about the best ways to detect and treat disease to become
part of the standard practice of medicine. The NCQA, which collects
data submitted by health plans, hopes to improve overall medical
practice by making the plans more accountable for their performance.

Missed health-care opportunities cost the nation more than $1 billion
a year in avoidable hospital bills, according to the study. The
health-care system's failure to provide the best treatment for just
five conditions -- asthma, depression, diabetes, heart disease and
high blood pressure -- is blamed in the report for nearly 41 million
sick days a year, resulting in the loss of $11.5 billion annually by
American businesses.

The NCQA study is its first to put a price tag on the system's
failures and missed opportunities. "People will always question those
kinds of numbers, but it's a way of trying to get people's attention
on the issue," said Ms. O'Kane. Some researchers have criticized a
1999 National Academies' Institute of Medicine study that attributed
98,000 deaths a year to medical errors, but several years later the
report continues to be widely cited and has become part of the
national debate about health-care quality.

The "quality gap" leads to enormous variations in the rates at which
certain important therapies or services are delivered, the NCQA report
said. For example, nationwide only about 40% of people with diagnosed
high blood pressure have their pressure adequately controlled. An
increase to 68% -- the level already achieved by the nation's top
health plans -- would save an estimated 28,000 lives next year,
according to the report.

For the second consecutive year, Touchpoint Health Plan in Appleton,
Wis., was the nation's strongest overall performer in terms of quality
of care. Regional differences in medical practice and clinical quality
persist, the study found. Health plans in the Northeast, including
Massachusetts and Connecticut, outperformed those in other regions, as
they have consistently in recent years.

Data used in the study were submitted by 513 health plans that
collectively cover more than 71 million people, or about a third of
the insured population.

Write to Rhonda L. Rundle at rhonda.rundle@wsj.com



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Associated Press, Mon Sep 22, 2003

 States Cutting Medicaid Benefits

 By MARY DALRYMPLE, Associated Press Writer

WASHINGTON - States cut Medicaid benefits and increased copayments in
2003 to slow spending growth in the low-income health insurance
program for the first time in seven years, according to a survey
released Monday.

Average Medicaid spending growth in the 50 states and the District of
Columbia was 9.3 percent, down from 12.8 percent a year ago, said the
Kaiser Commission on Medicaid and the Uninsured. Enrollment in the
program over the same period increased 7.8 percent.

By comparison, premiums for employer-sponsored private health
insurance increased 13.9 percent over the year.

Diane Rowland, the commission's executive director, said the trends
portend uninsured parents and children finding themselves shut out of
the program and the elderly and disabled seeing their coverage erode.

"Many will get less care and others will lose it altogether," she
said.

The commission is an arm of the Henry J. Kaiser Family Foundation,
which supports health research. It has conducted the Medicaid survey
annually for three years.

All 50 states and the District of Columbia took some cost-containment
actions as they grappled with declining revenue and budget deficits,
the survey found. All also said they plan to impose more spending
constraints next year.

Most often, states froze or reduced payments to physicians, hospitals,
nursing homes and other health care providers. Another popular
cost-control strategy curbed payments for prescription drugs with
preferred drug lists or copayments. A few states required Medicaid
users to buy generic drugs or limited the number of prescriptions that
could be filled each month.

Eighteen states responded to the fiscal pressure by reducing benefits,
and 20 states plan similar actions next year. Most of the changes
involved dropping optional benefits, including some geared toward
children. Eliminated coverages included visits to chiropractors,
podiatrists, speech therapists and psychologists. Some states imposed
limits on hospital stays and annual hospital visits.

Half the states limited eligibility for Medicaid. The changes
typically affected few people. Six states tried to drop large numbers
of people from the program, but each case they had to delay or cancel
the action. About 400,000 people would have lost coverage if the
states had carried out their plans, according to the survey.

Seventeen states increased their copayments, and 21 states plan
increases for next year.

The problem promises to get worse in 2005 when states exhaust a $10
billion federal windfall that temporarily increased the federal
Medicaid matching rate. The survey found states do not expect their
fiscal woes to be over when the federal aid runs out.

The nation's economic downturn pressured Medicaid from two directions.

As people lost their jobs or private health coverage, they became
eligible for Medicaid benefits. A slow economy also deprived states of
the revenues they needed to keep the program running.

"The biggest source of blame here is the economy," Rowland said. "They
really get put under much more pressure from Medicaid when the economy
tanks. At the same time, when the economy goes negative, states'
revenues drop off."



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 Reuters, Monday, September 22, 2003

Survey: Minorities Feel Cheated in Health Care



WASHINGTON (Reuters) - U.S. blacks and Hispanics feel they get worse
health care than their white compatriots, according to a study
published on Monday -- a feeling supported by scientific evidence.

The study, published in the journal Health Affairs, finds that blacks
and Hispanics are up to three times more likely than whites to feel
that minorities receive a lower level of care.

Just one in five whites felt minorities got shortchanged, the survey,
done by the Harvard University Forums on Health, Health Affairs, The
New America Foundation, and other groups, found.

"The poll findings show a persistent feeling among minorities that the
care they are getting is not equal to that of whites," Dr. David
Blumenthal, director of Harvard's Interfaculty Program on Health
Systems Improvement, said in a statement.

"Inequality in medical access and treatment is a problem for many
Americans that can no longer be ignored."

In 2002 the Institute of Medicine (news - web sites) reported that
members of racial and ethnic minorities are given lower quality health
care than whites even when make as much money and carry the same
insurance.

The Institute, an independent body that advises Congress and the
federal government, suggested that deliberate or unconscious bias by
doctors and other health care providers may worsen the problem.

The survey by Lake Snell Perry & Associates involved 806 adults and
was weighted to include extra numbers of blacks and Hispanics.

Those surveyed felt that cultural and language barriers were most to
blame for the disparities while more than half felt doctors and nurses
treat minority patients differently than white patients.

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Birmingham News, September 16, 2003


Health insurance offered for uninsured


ANNA VELASCO  News staff writer

Uninsured Alabamians can get private health insurance through Blue
Cross and Blue Shield of Alabama if they sign up by Nov. 30, the state
Insurance Department announced Monday.

The coverage is guaranteed for Alabama residents under 65 years old,
regardless of their health, although pre-existing medical conditions
will not be covered for 12 months. Applicants must be uninsured.

The plan, approved by the Alabama Department of Insurance last week,
is a product of a task force the department set up last spring to
address health insurance concerns. Assistant Insurance Commissioner
Ragan Ingram said he hopes the plan will help many of the 500,000
people in the state without health insurance.

"The rates appear to be very competitive," he said.

Under the policy, monthly premiums are $145 for individuals and $320
for family coverage. Also, before co-payments kick in, there's a
per-person deductible of $1,000 for major medical expenses such as
doctors' visits, with a $3,000 per family out-of-pocket cap. Drug
coverage starts after paying the $250 per person deductible.

Coverage will begin Oct. 1, Nov. 1 or Dec. 1, depending on when
applicants enroll.

Blue Cross spokesman Jim Brown said the company tried to keep rates
affordable for people who otherwise have no access to health care
coverage.

"There is an obvious need and really an increased need because of the
economy and the large number of people laid off from their jobs," he
said.

Health insurance for people who don't have coverage through their
employers is not easy to find or guarantee. The coverage is usually
more expensive than what Blue Cross is offering under this plan and
often requires joining an association.

"With this, you don't have to join an association," Ingram said. "You
call Blue Cross directly to have this program."

To get Blue Cross coverage through Alfa Insurance, in contrast, people
have to join the Alabama Farmers Federation, and they pay higher
premiums the older they get. The coverage through Alfa is for "healthy
individuals," according to the company's Web site.

A survey conducted this year by the Alabama Department of Public
Health estimates that 500,000 Alabamians are without health insurance.

Dr. Don Williamson, state health officer, said the new plan offered by
Blue Cross is a "wonderful opportunity."

"It sounds like it has the potential to fill a gap that we
identified," he said.

Interested applicants may contact Blue Cross at 888-215-1832 or by
email at SpecialOpenEnrollment@bcbsal.org. for more