SHARE Grantee Newsletter - April 16, 2010

Federal Reform
A View from the Hill
From the Desk of SHARE Director Lynn Blewett:

I had the opportunity to witness the Senate vote on the Health Care and Education
Reconciliation Act of 2010 last Thursday afternoon, thanks to Lauren Gilchrist who is
Senator Franken’s health Legislative aide. Lauren is an MPH graduate of the University of
Minnesota and one of my former students. I literally raced to the hill, she grabbed a pass
for me and off we went! Two different groups of people asked me, “Do you know what bill
they are voting on?” Ah, yes, I do!

It was an historic moment but much more subdued than the raucous House vote which I
watched on CSPAN, which included loud roars and cheers for Nancy Pelosi. The Senate
kept its decorum – no shouting or cheering. Only a small applause and then all was done.

I worked for the US Senate in the early 1980s, and being there brought back a lot of
memories of working around the clock during the early implementation of DRGs, PSROs,
and Social HMOs. One of my cherished moments was watching a debate on Medicare
between Senator Durenberger and Senator Kennedy on the Senate floor. I met many
colleagues during that time who have devoted their careers to improving health and health
care. I guess we have a few more years of work to do!

Now we face the process of figuring out what is in the bill, and waiting for direction from the
many federal agencies responsible for implementation. SHARE and SHADAC will be doing
the best we can to help states think about next steps in reform and how best to monitor
and evaluate expansions. Stay tuned for more updates.

Lynn
News from Grantees

SHARE Webinar: Joel Cantor to Discuss New Dependent Coverage

Findings from Issue Brief Update
Joel Cantor has released a new issue brief titled, "The Impact of State Dependent Coverage
Expansions on Young Adult Insurance Status: Further Analysis." In the brief, Dr. Cantor
and co-authors use data from the Current Population Survey to evaluate the impact of
dependent coverage expansion initiatives in 19 states on health insurance coverage of
young adults between 2003 and 2008. The authors also examine the variation in impact
among population subgroups over time. This report is a companion to the authors’ January
2010 technical brief on the same topic.

Dr. Cantor will discuss his new findings in the second of SHARE's Great Research
Conversations webinars, which will take place on Wednesday, April 21st, at 12:00 p.m.
Eastern (11:00 a.m. Central). He will be joined by Troy Oechsner, J.D., who will serve as
the discussant. Mr. Oechsner is Deputy Superintendent of Health for the State of New York
and Adjunct Professor at Albany law school, and he will speak from a state perspective
about dependent coverage expansion initiatives. SHARE Director Lynn Blewett will moderate
the webinar.

Read Dr. Cantor's new report.

Register for the webinar.

SHARE and SHADAC News

Lynn Blewett, Julie Sonier, Testify to Minnesota Legislature about How

Federal Reform Will Affect the State
SHARE Director Lynn Blewett and SHADAC Deputy Director Julie Sonier testified last week
at two informational hearings before various committees of the Minnesota House and
Senate. The hearings were held in order to clarify the immediate and pending effects of
federal Patient Protection and Affordable Care Act on Minnesota's health care system. The
committees also hoped to identify what the legislature and state agencies will need to do to
both ensure compliance with new regulations and take advantage of optional provisions that
might benefit Minnesota.
Dr. Blewett and Ms. Sonier spoke to the committees about public program expansion and
eligibility changes under the new federal legislation, along with new regulations for
Minnesota's private insurance market and employers. They also addressed the implications
of reform for Minnesota's high-risk pool and discussed issues related to operationalizing an
insurance exchange in Minnesota. Finally, they addressed delivery system and payment
reform under the federal legislation, pointing out that the federal reforms are generally
quite similar to those in Minnesota's 2008 health reform bill.

Elizabeth Lukanen Quoted about Multi-Share Initiatives in USA Today

SHARE Deputy Director Elizabeth Lukanen was quoted in a March 15th USA Todayarticle
about small-employer multi-share programs. The article discusses the benefits and
limitations of such programs, noting that such programs do help some people who would
otherwise be uninsured, but they often struggle with low enrollment and may offer only
limited benefits. Ms. Lukanen confirmed that multi-shares are "not the perfect solution,"
but she pointed out that, for small employers and low-income workers, "it's what they can
afford."

View the full USA Today article.

SHADAC Welcomes New Senior Research Fellow, Joanna Turner

SHARE is pleased to announce that Joanna Turner has joined the SHADAC staff as a Senior
Research Fellow. Joanna joins SHADAC from the U.S. Census Bureau, where she spent nine
years as a statistician working with federal population surveys. During her tenure at the
Census Bureau she evaluated the new health insurance question on the American
Community Survey as well as working with the Current Population Survey and the Small
Area Health Insurance Estimates Program. Ms. Turner holds a master’s degree in statistics
from the University of Wisconsin-Madison.

State Reform News

Arizona Eliminates Its CHIP Program

On March 18th, Arizona became the first state to drop its CHIP program. The move will
leave almost 38,000 low-income children in the state without health insurance coverage as
of June 15, 2010. Lawmakers also passed a 25 percent reduction in Medicaid coverage--a
reduction which will drop about 310,000 people from the program in January 2011 if federal
ARRA funding for Medicaid programs is not extended.
Lawmakers who supported the cuts say they made the reductions to CHIP and Medicaid
because Arizona is facing its largest budget deficit in history, with a $2.6 billion projected
shortfall next year. However, opponents point out that the cuts violate the Medicaid
maintenance-of-effort clause in the newly-passed federal health reform legislation, thereby
jeopardizing the state's eligibility for federal Medicaid funding.

While other states (California and Tennessee) have placed enrollment caps on their CHIP
programs, none besides Arizona has eliminated the program altogether, and California and
Tennessee have both rescinded their caps.

Ohio Is First State to Accept Sebelius’s CHIP Enrollment Challenge

Ohio has joined a national challenge to sign up uninsured children who are eligible for
Medicaid/CHIP but not enrolled. The challenge was issued by U.S. Health and Human
Services Secretary Kathleen Sebelius on February 4th--the first anniversary of President
Obama's CHIPRA signing--and Ohio is the first state to respond.

Ohio's CHIP program currently covers children with family incomes at or below 200 percent
of the federal poverty level. The state estimates that two-thirds of its uninsured children
(or approximately 77,000 kids) meet these income guidelines but are not enrolled.

In accepting the Secretary's challenge, Ohio Governor Ted Strickland has authorized three
initiatives to make it easier to enroll and retain eligible children. The state will:

1. Adopt 12-month continuous eligibility rules;

2. Permit hospitals and community clinics to grant presumptive eligibility to apparently
eligible children so they can have immediate access to care; and
3. Establish express-lane eligibility (ELE) for children already deemed eligible for other
government programs, such as food stamps.

Adoption of these initiatives puts the Ohio in the running for federal performance bonuses
that average about $5 million.

New Report on Minnesota's 2008 Reforms Released

The National Academy for State Health Policy and the Commonwealth Fund have released a
report exploring Minnesota's efforts to transform its health care delivery system. The
report-"Reforming Health Care Delivery through Payment Change and Transparency:
Minnesota's Innovations"-analyzes the state's landmark health reform legislation (passed in
2008) along with the many public and private initiatives that preceded its passage. In
particular, the report focuses on the legislation's provisions related to the collection and
reporting of data to achieve price and quality transparency and on the provisions that
 support care redesign and payment reform.

The authors of the report point out that, while Minnesota has a unique health care
environment-with a small uninsured population, a strong base of employer-sponsored
insurance, and a history of public-private partnership-the state's experiences with payment
and delivery system reform illustrate successes and challenges that are applicable to other
states struggling with rising health care costs. Additionally, with federal reform focusing
more on questions of coverage and access, mechanisms for payment and delivery system
reform need further exploration.

Link to a PDF of the full report.

Send Us Your News!

If you have news items that you would like SHARE to highlight, please send them to
Caroline Au-Yeung at butle180@umn.edu.

SHARE is a National Program Office funded by the Robert Wood Johnson Foundation to fund, synthesize and
disseminate evaluations of state health reform. Periodically, SHARE will send a newsletter outlining upcoming
events, grantee activities and updates on our funded projects. For more information, visit SHARE's web site,
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