chip

It's October. What's Congress doing about healthcare?

lborkowski — Wed, 04 Oct 2017 17:53:31 +0000

It's October. What's Congress doing about healthcare?

We made it to October without letting Congressional Republicans ravage our healthcare system, so that's a relief. However, the fact that it's October also means funding for the Children's Health Insurance Program and federally qualified health centers has expired ... and Congress has been putting so much energy into trying to gut Medicaid and further restricting women's access to abortions that they neglected to renew funding for these two immensely popular bipartisan programs.

Instead of funding these programs because they're crucial sources of coverage and care for large portions of our population, House Republicans are trying to use them as leverage to weaken other aspects of public health. Vox's Dylan Scott reports:

Republicans want to pay for CHIP and health center funding by cutting Obamacare and cutting entitlement spending.

The House GOP plan would:

Cut Obamacare's public health fund by $6.4 billion over 10 years
Cut the grace period for Obamacare enrollees who fail to make premium payments. Under current law, enrollees can miss three months of payments without losing their coverage. The House bill would shorten that grace period to one month or allow states to set their own.
Repeal Obamacare's Independent Payment Advisory Board, the controversial panel created by the law tasked with reducing Medicare's costs if the program's spending grows at too fast a rate.
Increase Medicare premiums for high earners (individuals making $500,000 annually)
Aim to cut Medicaid payments for prenatal care and preventive services for children in circumstances when another insurer could instead be liable for the costs

Let's all remember what this says about the values of current members of Congress when the next election arrives.

lborkowski Wed, 10/04/2017 - 13:53

Tags

Affordable Care Act

abortion

chip

FQHCs

Affordable Care Act

CHIP provides health insurance to nearly 9 million kids. Its funding expires on Sept. 30.

kkrisberg — Fri, 15 Sep 2017 16:15:51 +0000

CHIP provides health insurance to nearly 9 million kids. Its funding expires on Sept. 30.

Earlier this week, members of the Senate Finance Committee announced an agreement to extend funding for the Children’s Health Insurance Program. The announcement had been anxiously awaited by families and advocates across the nation, as the program’s federal funding expires in about two weeks. The agreement is good news, but coverage for CHIP’s 8.9 million children isn’t safe just yet.

According to reports, the agreement would extend CHIP’s funding for five years — a win for advocates worried that lawmakers might propose another two-year extension as it did in 2015. The agreement would also maintain the Affordable Care Act’s enhanced CHIP matching rate — a measure that boosted the federal share by 23 percent — for another two years and then begin a phase-down to pre-ACA matching rates. CHIP currently provides nearly 9 million U.S. children with timely access to medical care, covering kids whose families make too much to qualify for Medicaid but not enough to access affordable coverage in the private sector.

While news of the Senate CHIP agreement is encouraging, there are still big questions and concerns. Senate Finance Committee leaders — Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Ore. — haven’t yet identified how they’ll offset the cost of re-funding CHIP, which is between $5 billion and $10 billion. That omission has some worried that CHIP funding could come at the expense of other critical health funding. Two other big questions: Will members of the House agree to a five-year CHIP extension? And will lawmakers attempt to attach CHIP funding to more divisive measures that could hinder its quick passage?

And quickness is key. Most states set their CHIP budgets months ago, and most made those budgets assuming federal lawmakers would reauthorize CHIP funding at its enhanced rate, according to a recent Kaiser Family Foundation survey of state Medicaid officials. That means if Congress doesn’t follow through on CHIP funding, states will face serious funding shortfalls and officials will be forced to find ways to make up the money gap (not likely) or reduce costs (such as cutting back on services and eligibility). The Kaiser survey found that of the 42 states that provided information on when they will exhaust their current CHIP funds, 10 states said funding will likely run out by the end of 2017. Some states, the survey noted, have statutes on the book that require officials to shut down their CHIP programs if federal lawmakers stop funding CHIP.

Just the fact that lawmakers have allowed CHIP’s funding reauthorization to come down to the wire is unprecedented, said Carrie Fitzgerald, vice president for Children’s Health Programs at First Focus.

“We were hoping and working hard to try to get CHIP done early in the year, but the larger health care debate took precedent and it was impossible to get this going,” Fitzgerald told me. “But it does seem that (lawmakers) know this has to get done and that it will get done. …Still, it’s tough on states. They’re doing the best they can to keep things moving smoothly, but everyone needs to see this done.”

Echoing the Kaiser findings, Fitzgerald said she hadn’t heard from any state officials worried about running out of CHIP funds on Oct. 1 — as far as she knew, none were planning to shut down their CHIP programs or scale back either. In fact, she said state CHIP officials are “trying to walk a fine line” — they want to raise awareness about CHIP’s importance, but they don’t want to worry families during CHIP’s crucial fall enrollment period. But if Congress doesn’t act by the Sept. 30 expiration date, she said it would force states to start considering their options, none of which bode well for children’s health coverage.

“There isn’t another option that’s as affordable and child-specific as CHIP,” Fitzgerald said.

The consequences of Congress’ inaction vary depending on how a state organizes its CHIP program. According to the National Academy for State Health Policy, the ACA requires that Medicaid expansion CHIP programs maintain eligibility levels for kids through 2019, regardless of federal funding. However, the 42 states that run separate CHIP programs can scale back enrollment if federal funds cease.

Eva Marie Stahl, director of the Children’s Health Initiative at Community Catalyst, said if children did begin to lose CHIP coverage, some might find coverage in Medicaid and some may be able to access employer-sponsored insurance (though employer coverage is generally more expensive than CHIP for many working families). Families who lose CHIP could turn to the ACA marketplace, but Stahl said many would face another hurdle known as the “family glitch.” The way the ACA was written, part of eligibility for marketplace subsidies is whether a family has access to affordable employer-based coverage. However, the ACA’s definition of “affordable” employer coverage is based on the cost of covering the individual, not the whole family — hence, the family glitch.

“There’s no question that Congress should move swiftly to refund CHIP and they should cleanly extend it for five years at a minimum — especially with so much uncertainty around other forms of health coverage” Stahl told me. “This program is 20 years old, enjoys bipartisan support and works well. It’s good for keeping children healthy and it’s a really important program for helping working families.”

Across the U.S., more than one in three children are covered by either Medicaid or CHIP — in fact, the two programs have helped drive the children’s uninsured rate to record lows. (The newest Census data puts the 2016 children’s uninsured rate at 5.4 percent.) Medicaid and CHIP typically offer more comprehensive children’s coverage than private insurance, such as covering dental care and myriad services for children with special health care needs. Research finds that children with Medicaid or CHIP coverage have better access to primary care and preventive care than uninsured children and fare just as well as on those two indicators as privately insured kids.

Dennis Cooley, a general pediatrician in Topeka, Kansas, for 37 years, said about 30 percent of his patients get coverage through the state’s combined Medicaid/CHIP program, KanCare. Statewide, more than 73,000 Kansas children get their coverage thanks to CHIP. For many low- and moderate-income Kansas families, CHIP provides affordable care that’s also high-quality care, said Cooley, who chairs the American Academy of Pediatrics’ Subcommittee on Access. For example, CHIP follows Early and Periodic Screening, Diagnostic and Treatment guidelines, which ensure children get appropriate medical and preventive care. In other words, CHIP is designed specifically to support the needs of children, whereas private insurance is typically designed for a more general population.

Cooley said he’s been traveling to Washington, D.C., and talking with legislators about the importance of CHIP for years now — and he agrees that CHIP does enjoy bipartisan support. But he’s still worried.

“Each time, legislators say ‘no one’s against CHIP’ or ‘don’t worry,’” he told me. “But then politics gets involved.”

CHIP’s federal funding officially expires on Sept. 30. For more on CHIP, visit First Focus.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 09/15/2017 - 12:15

Tags

Affordable Care Act

government

healthcare

Public Health - General

ACA

Child health

Children's Health Insurance Program

We’re close to universal insurance coverage for kids. The GOP health care bills would reverse that.

kkrisberg — Fri, 23 Jun 2017 18:43:00 +0000

We’re close to universal insurance coverage for kids. The GOP health care bills would reverse that.

The House and Senate health care bills are overflowing with proposals that will strip Americans of access to quality, affordable health care. But perhaps the cruelest part is what they do to children — the most vulnerable and powerless among us. Children can’t show up at the ballot box to protect their health and so it truly is up to the rest of us.

Right now, after decades of hard work, the U.S. has achieved near-universal insurance coverage of its littlest residents. About 95 percent of U.S. kids have health insurance. Unfortunately, the House and Senate proposals to replace the Affordable Care Act and gut Medicaid, in combination with Trump’s federal budget proposal, could send the children’s insurance rate tumbling downward. It’s particularly cruel because while there’s no official policy on the books that explicitly guarantees a child’s right to health care, our collective policymaking over the years has tended toward ensuring that children don’t go without timely and necessary medical attention. It’s one of those issues we used to describe as “bipartisan.” (Remember those days?) Today, the health of America’s children sits squarely on the budgetary chopping block, as if their health and well-being aren’t intrinsically connected to all of our future prosperity.

According to a recent report from the Urban Institute, children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased nearly one-third between 2008 and 2015, pushing down the child uninsured rate by nearly half. During that time period, children in Medicaid and CHIP experienced improved access to providers and received more routine health care services, while their families faced lower financial burdens related to their children’s medical care. Also in that time span, fewer children went without needed medical care because their families couldn’t afford it, fewer children had to delay care because of cost, and fewer families had problems paying their medical bills. Currently, about 35 million children get their care through Medicaid and CHIP.

However, all that could change if Republican proposals to massively cut and cap federal Medicaid funding as well as cut CHIP become law (more on the Medicaid cuts here). On those GOP policy proposals, Urban Institute researchers Emily Johnston, Jason Gates, and Genevieve Kenney write:

Altogether, these policy changes raise the risk that Medicaid/CHIP eligibility will decline among children, reversing the downward trend in uninsurance that has prevailed over the last several decades. Even if policy changes do not directly target children, changes that reduce Medicaid coverage among parents could still cause a decline in Medicaid and CHIP coverage among children; earlier research has shown that children are more likely to enroll in Medicaid/CHIP when their parents also qualify for public coverage. With less federal funding for Medicaid and CHIP, states may reduce benefits and/or provider payments, which in turn could adversely affect access to care among children covered by these programs. Monitoring is critical to ensure that children, particularly those from low- and moderate-income families, continue to have adequate access to health care.

On CHIP, Trump’s fiscal year 2018 budget proposal “fundamentally restructures” the program, according to First Focus, a nonpartisan children’s advocacy group. In particular, Trump’s budget extends CHIP’s funding through 2019 (its funding officially expires this September), but cuts allotments by $5.8 billion — that’s a cut of 21 percent. That 21 percent cut is achieved through a number of policy changes, including ending the ACA’s increased CHIP matching rates and capping CHIP’s income eligibility. Trump’s budget proposal also calls for cutting Medicaid funding by $610 billion — and keep in mind, that’s separate from the House and Senate health care bills that also cut Medicaid funding by the billions. Just exactly how all these proposals to slash and burn people’s health care will come together remains to be seen, but none of it looks good for kids.

That’s why earlier this month, more than 1,200 organizations from around the country sent a letter to leaders in Congress asking them to save CHIP. They wrote: “It is worth noting that the children who stand to lose CHIP would likely have no other affordable coverage option available to them. The resulting increase in the rate of uninsured children would be an enormous step backwards.”

The most recent health care bill out of the Senate, released just yesterday, would end the ACA’s Medicaid expansion and radically restructure and cap its federal funding. Bruce Lesley, president of First Focus, said of the Senate bill (which is nearly tauntingly titled the “Better Care Reconciliation Act):

There is no way to shield our nation’s most vulnerable children from Medicaid cuts of this magnitude. In fact, contrary to the President’s promise not to cut Medicaid and eliminate onerous regulations, the bill slashes Medicaid by hundreds of billions of dollars out of health coverage and gives states incentives to impose new bureaucracy and red tape barriers to coverage.

For cover, the “Better” Care draft bill attempts to include a few provisions to make the draconian bill appear less harmful to children and families. But, under scrutiny, they will do nothing to prevent the oncoming disaster this legislation would unleash.

Lesley wasn’t the only one opposing the proposal’s treatment of children. Here’s what the American Academy of Pediatrics had to say about the Senate’s supposed carve-outs to protect children:

The bill includes misleading 'protections' for children by proposing to exempt them from certain Medicaid cuts. A 'carve-out' for some children determined to be 'disabled' does little to protect their coverage when the base program providing the coverage is stripped of its funding. Doing so forces states to chip away coverage in other ways, by not covering children living in poverty who do not have complex health conditions, or by scaling back the benefits that children and their families depend on. This bill would make a child's access to health care dependent on his or her ZIP code and force states to make decisions about which vulnerable population gets services. Put simply, this bill is bad policy for children.

The Children’s Hospital Association panned the Senate bill too:

Compared to the (House bill), the new Senate bill calls for even steeper cuts to the Medicaid program by restricting Medicaid’s funding to a slower growth rate. An Avalere Health analysis of the (House bill) concluded that cuts to Medicaid funding for children would be at least $43 billion over 10 years. Ultimately, Medicaid coverage and benefits for the over 30 million children who rely on Medicaid would be threatened in both the House and Senate bills. Congress should not consider any legislation undermining health care for tens of millions of children.

Children’s hospitals across the country call on senators to reject this bill, a bad bill for kids.

The nation’s experts in child health and well-being are trying to warn us: children will suffer if Republicans succeed at defunding Medicaid and CHIP. Adults should listen to them.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 06/23/2017 - 14:43

Tags

Public Health - General

ACA

budget cuts

Child health

children's health care

Children's Health Insurance Program

California, the Golden Liberal State, is close to universal care. Sort of.
http://www.sacbee.com/news/politics-government/capitol-alert/article157…

Study: Kids with chronic health problems will face greater financial burdens if forced out of CHIP

kkrisberg — Tue, 25 Apr 2017 21:04:14 +0000

Study: Kids with chronic health problems will face greater financial burdens if forced out of CHIP

More than 8 million U.S. children depend on the Children’s Health Insurance Program for access to timely medical care. The program is authorized through 2019, but its federal funding expires in September and it’s unclear what Congress will do.

That uncertainty stresses all the systems and families that depend on CHIP, but it may be especially risky for the 2 million chronically ill children who get care through the program, which was originally designed for families falling in the gap between market affordability and Medicaid eligibility. In a study published this month in Health Affairs, researchers found that low-income children with chronic conditions would face higher out-of-pocket costs if forced to move from CHIP to the individual marketplace.

With the future of CHIP funding unclear, researchers simulated two scenarios: one in which CHIP funding is extended, and another in which CHIP children are enrolled in the Affordable Care Act insurance markets. After analyzing health plan data from CHIP and the marketplace, they found that CHIP enrollees may face thousands of dollars in additional costs on the individual market, with families of children with diabetes, epilepsy or mood disorders facing the highest additional costs.

Study co-author Alon Peltz, a physician who cares for children with special health care needs, noted that about one in every four kids in CHIP has a chronic health condition.

“We’re coming up on the 20^th year of CHIP and there are concerns about how to maintain coverage for these children,” Peltz, also a postdoctoral fellow in the Robert Wood Johnson Foundation’s Clinical Scholars Program at Yale School of Medicine, told me. “We wanted to think more critically about different avenues policymakers could take as they think about the future of health insurance coverage.”

In conducting the study, which included more than 7,000 children with one or more chronic conditions, Peltz and colleagues assumed that ACA subsidies would still be available to help former CHIP families buy coverage on the marketplace. (Unfortunately, the future of those subsidies is also unclear.) They found that at every income level, children with chronic health problems would pay more for coverage in the marketplace than they would have in CHIP. For example, a family living at 100-150 percent of the federal poverty level (that’s about $30,000 for a family of three) would spend about $233 more in the marketplace annually, while a family at 251-400 percent of poverty (or between $51,000-$81,000 a year) would pay $1,078 more in the marketplace.

Researchers also found that marketplace costs were higher for all six of the chronic conditions studied: asthma, ADHD, developmental disorders, diabetes, epilepsy and mood disorders. Children with epilepsy experienced the biggest spending increase in shifting to the marketplace, with the difference ranging from about $400 to nearly $2,500 depending on household income. The study attributed a majority of the out-of-pocket differences to spending on prescription drugs and inpatient hospitalizations. For instance, among children with asthma or ADHD, higher prescription expenses accounted for much of difference in CHIP and marketplace spending. For kids with diabetes, epilepsy and mood disorders, higher spending was typically associated with hospitalization costs.

The study’s findings also assume that children shifted to the marketplace would continue to get all the services they need. However, researchers cautioned that “in reality, families could encounter networks that are inadequate to meet their children’s specialty care needs and (that could) lead to even higher out-of-pocket expenses.” In addition, about 2 million children now covered by CHIP don’t currently qualify for ACA subsidies due to a loophole known as the “family glitch,” which would certainly impact their ability to afford coverage outside of CHIP. (Right now, families can get ACA subsidies as long as they don’t have access to affordable employer-sponsored coverage. However, that affordability determination is based on coverage for the individual employee, not the employee and her or his family. Hence, the “family glitch.”)

The study offered three strategies for leveling affordability between CHIP and marketplace plans: enhancing cost-sharing reductions in the ACA marketplace; re-examining cost-sharing for the two big drivers — drugs and hospitalization — of CHIP-marketplace spending differences; and monitoring whether marketplace deductibles negatively impact a child’s ability to access timely care. (CHIP plans rarely include deductibles.) However, all those strategies are based on an assumption that the ACA isn’t repealed and any changes to the law are relatively small. With that in mind, the researchers concluded that keeping CHIP funded is the best option for kids who need reliable access to care.

“Given concerns about the viability of the marketplace, the legal battles regarding the cost-sharing reduction payments and the efforts to repeal the ACA, reauthorizing funding for CHIP is most likely the least disruptive strategy moving forward,” researchers wrote.

Peltz said that if federal CHIP funding did disappear, many states would likely continue the program in some form. But with only state funds — and no matching federal funds — CHIP families may see reductions in services or higher cost-sharing requirements. He also noted that the ACA increased federal CHIP reimbursement to states. If Congress eliminated that enhanced reimbursement that could negatively affect state CHIP plans as well.

Still, Peltz said he’s hopeful that policymakers can find a solution that ensures care for the 8 million children who depend on CHIP.

“With some uncertainty right now in the political landscape, the CHIP program seems to be the best option for making sure that children, particularly those with chronic conditions, can continue accessing affordable care,” he told me. “We have a strong history of providing services to this vulnerable group of children…and as both a researcher and clinician, I hope we’ll continue the tradition of caring for these children.”

For a copy of the CHIP study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 04/25/2017 - 17:04

Spread the word: Affordable Care Act enrollment open until Jan. 31

kkrisberg — Fri, 27 Jan 2017 16:54:14 +0000

Spread the word: Affordable Care Act enrollment open until Jan. 31

We’re just a humble little public health blog. But we can still do our part. If you or someone you know need help getting health insurance coverage before next week’s enrollment deadline on Jan. 31, here are some good resources.

First, why do this? Because this week, the Trump administration abruptly canceled advertising and outreach scheduled to run during this final week of Affordable Care Act enrollment. Apparently, he even pulled ads that were already paid for. But, you can still enroll. According to Paul Demko at Politico:

(The Trump administration) is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

“You can’t take comments by the Trump administration about trying to help people gain coverage seriously," Pollack said. "It is not a heavy lift to tell people about the opportunities for getting enrolled. It is not a heavy lift to continue ads that have already been paid for.”

The last five days of the open enrollment season are seen as critical because many individuals procrastinate and then join a last-minute sign-up surge. That’s particularly true for younger and healthier customers who are crucial to making insurance markets work.

The enrollment deadline is looming, but here are some resources you can spread the word about:

Shop for insurance and enroll today at HealthCare.gov.

At HealthCare.gov, you can enter your ZIP code and locate people and groups in your community that can help you find and purchase health coverage.

Curious if you qualify for Medicaid or the Children’s Health Insurance Program? Find out here.

Find more free enrollment assistance through Get Covered America. They also have a calculator you can use to determine if you qualify for financial assistance.

Find it easier to locate enrollment resources using a map of America? Check out this tool from the American Hospital Association.

Unsure what all that insurance jargon means? Here’s a handy glossary.

The American College of Physicians offers state-specific enrollment resources for providers and patients.

Find resources to help enroll special populations, such as people who are homeless or face language barriers, at the Council on Social Work Education.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Fri, 01/27/2017 - 11:54

Tags

Affordable Care Act

government

healthcare

Public Health - General

Study: Medicaid, CHIP score higher than private insurance on access to kids’ preventive care

kkrisberg — Wed, 25 Nov 2015 18:28:20 +0000

Study: Medicaid, CHIP score higher than private insurance on access to kids’ preventive care

Public health insurance programs often get a bad rap, despite a growing positive evidence base on their patient care, quality and outcomes. Earlier this month, another study emerged that found Medicaid and the Children’s Health Insurance Program not only outperform private insurance when it comes to children’s preventive care, they can serve as a model of comprehensive children’s coverage.

Published in JAMA Pediatrics, the study is based on data from the U.S. National Surveys of Children’s Health between 2003 and 2012 — a sample of more than 80,000 children up to age 17 living in households with incomes between 100 percent and 300 percent of the federal poverty level (low to moderate income). The researchers compared health care access, quality and cost outcomes in four categories: Medicaid, CHIP, private insurance and no insurance. They found that for kids in Medicaid and CHIP, 88 percent had access to preventive medical care, compared to 83 percent among children with private insurance. There was a similar trend regarding preventive dental care. The study also reported that 78 percent of caregivers of kids enrolled in Medicaid and CHIP reported a perception that their insurance always met their needs, versus 73 percent of parents with private insurance.

Study author Amanda Kreider, who helped conduct the study during her time as a research associate at PolicyLab at Children’s Hospital of Philadelphia, said the findings are particularly relevant as some decision-makers have questioned the need for robust public health insurance programs now that the Affordable Care Act (ACA) is law. Indeed, earlier this year, many child health advocates were concerned that members of Congress wouldn’t act fast enough to reauthorize CHIP’s funding, which was set to expire in September. Fortunately, the funding was reauthorized, but only through 2017. Throughout that debate, advocates noted that due to some eligibility glitches in the ACA, if CHIP disappeared, many children would simply be left without any insurance. And many of those who switched to private insurance would likely experience a worse quality of care.

“Any measure to move low- and moderate-income kids to (health insurance) exchange plans would need to address access and cost and not be too hasty in devaluing these public plans,” Kreider, now a PhD student in health policy at Harvard, told me. “We might consider the outcomes in Medicaid a benchmark for other plans.”

The JAMA Pediatrics study found that families with privately insured children were much more likely to experience out-of-pocket costs, at 77 percent, than caregivers of children in Medicaid, at 26 percent, and CHIP, at 38 percent. About 20 percent of caregivers with kids in Medicaid reported frustration in receiving health care services, compared to 23 percent for privately insured children and 26 percent for kids in CHIP.

About 70 percent of study participants in all three insurance plans experienced care coordination. Caregivers of kids across all three insurance types reported similar rates of satisfaction with the ability to see needed health care providers as well. Difficulties in accessing specialty pediatric care popped up across the plans, however such challenges were more pronounced among kids with private insurance and those in CHIP. Not surprisingly, children with no insurance were much less likely than insured children to receive preventive care or have a usual source care.

Kreider said that the specialty care findings were somewhat of a surprise, adding that future research is needed to tease out the contributors to specialty care barriers. Kreider and co-authors Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen Noonan and David Rubin write:

The high reported rates of preventive care receipt and perception of Medicaid and CHIP coverage meeting children’s needs, together with concerns about limited access and increased cost sharing in private plans, might caution against calls for expanded private coverage for children and substantiate advocacy for extending CHIP coverage beyond 2017. However, this study uncovered some challenges in access to services and specialty care for both children with CHIP coverage and privately insured children with special health care needs. Although the etiology of these challenges is not well understood, these findings suggest that Medicaid might serve children in families with low to moderate incomes better than other coverage types.

Kreider said while her study doesn’t reveal the exact mechanisms that led to Medicaid’s positive reviews — for example, what exactly made access to preventive care easier for children with Medicaid — she noted that unlike marketplace plans, pediatric benefits under Medicaid are extremely well defined. In fact, while insurers participating in the new health insurance exchanges are required to offer certain essential health benefits, such as pediatric care, such benefits are not consistently defined across the country. The study cited a recent review of state benchmark plans that found no plan had a definition of pediatric services.

“What we’re seeing is that Medicaid does a great job for kids,” Kreider told me. “These programs are really providing high value for kids and I think that’s something people can get behind.”

Combined, Medicaid and CHIP provide care to more than 43 million children, including half of all low-income children in the U.S. To request a full copy of the study, visit JAMA Pediatrics.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

kkrisberg Wed, 11/25/2015 - 13:28

Excellent article. Thank you.

Insurance for children: Medicaid, CHIP, and the "family glitch"

lborkowski — Mon, 15 Dec 2014 12:04:49 +0000

Insurance for children: Medicaid, CHIP, and the "family glitch"

The latest issue of the journal Health Affairs focuses on children's health, and one of the major topics is health insurance for children. A look at the Kaiser Family Foundation's coverage statistics shows that in 2013, 49% of children ages 0 - 18 had employer-sponsored coverage, 39% were covered by Medicaid or another public program, 5% had other private coverage, and 8% were uninsured. There are three main ways US children get health insurance coverage:

Medicaid: The federal government pays a portion of healthcare costs for Medicaid beneficiaries, and in exchange requires that states extend coverage to certain populations, including children living below the poverty level. (In 2014, the FPL is $11,670 for a one-person household, $23,850 for a household of four.) KFF reports on the state income cutoffs for 2014, which include:

Ages 0 - 1: All states cover children ages 0 - 1 whose family incomes are at or below 144% of the FPL; seven states and the District of Columbia set the limit at various points above 300% FPL. Utah has the lowest limit, at 144% FPL; five other states have it below 150%; Iowa's limit is the highest, at 380%.
Ages 1 - 5: All states cover children ages 1 - 5 whose family incomes are at or below 138% FPL; five states and DC set the limit at various points above 300% FPL. Oregon has a limit of 138% FPL, while 15 other states have limits below 150%; Hawaii's limit is 359%.
Ages 6 - 18: All states cover children ages 6 - 18 whose family incomes are at or below 138% FPL (with 17 states using that as the limit); four states and DC set the limit at various points above 300% FPL, including Hawaii at 359%.

CHIP: The Children's Health Insurance Program, which Congress established with 1997 legislation and reauthorized with a 2009 law, allows states to use federal funding to provide or purchase coverage for children whose family incomes are above the Medicaid eligibility limits but still too low to afford private insurance. Unlike federal Medicaid funding, which is available for as many eligible beneficiaries enroll in the program, federal CHIP funds come in fixed amounts, and states can cap the number of CHIP beneficiaries. CHIP coverage also does not need to include all of the benefits specified for Medicaid-covered children, and allows beneficiaries to be charged for premiums and cost-sharing (although these charges are still lower than those in most private plans). Income cutoffs for CHIP coverage range from 175% FPL in North Dakota to 405% FPL in New York.

Private coverage: Families can get coverage through an employer-sponsored plan, or they can buy coverage from an exchange (marketplace). Those who are eligible for subsidies under the Affordable Care Act can get financial assistance with premiums for exchange-purchased plans. The basic rule is that people with household incomes between 100% and 400% FPL are eligible for premium subsidies. However, there are important exceptions. If an employee is offered employer-sponsored coverage and that coverage qualifies as affordable, that employee's family is not eligible for subsidies. The determination of an "affordable" plan -- one whose premiums cost no more than 9.5% of the person's income -- is based on what is affordable for the employee as an individual, not what is affordable for the employee's family. NPR's John Ydstie recently offered an illustration of how this rule can leave lower-income families without affordable insurance options:

Suzanne Shugart and her family face a similar situation in McPherson, Kan. Her husband works for a cabinetmaker, earning around $32,000 a year. He can get health insurance through his employer for a little more than $50 a month, just for himself.

That's also affordable coverage, according to Obamacare rules, so Shugart's family isn't eligible for subsidies in the online marketplace. But the employer's family coverage is too expensive for them, says Shugart.

"If he were to increase it to a family plan, which would include me, it goes up to about $380 a month, which is nearly our mortgage payment," Shugart says.

She and her husband can't afford that, she says. Luckily, their children qualify for insurance through a state plan.

"That's how we've lived for the last eight years," Shugart says. "He has insurance through work and the kids have state insurance, and I just live on hope and a prayer that nothing bad will happen."

If Shugart's family could get subsidized coverage on the Obamacare exchange, the premium for a benchmark plan would be a little more than $200 a month, making coverage for her much more affordable.

CHIP doesn't necessarily fill the gap in such situations, explain Sara Rosenbaum of the George Washington University Milken Institute School of Public Health (where I also work) and Genevieve M. Kenney of Urban Institute's Health Policy Center in the latest issue of Health Affairs:

As a result, workers whose own coverage meets the affordability threshold are barred from securing premium subsidies for their children, no matter how out of reach dependent coverage might be in relation to family income. This problem, termed the “family glitch,” deprives families of help, potentially leaving millions of children without access to affordable insurance in the absence of CHIP. But CHIP alone is no panacea for the family glitch. CHIP covers more than eight million children at some point each year. However, half of the states set income eligibility standards at less than 255 percent of poverty. In these states, children caught in the glitch but with household incomes higher than their state’s relatively low CHIP upper income threshold yet nonetheless below the premium tax credit threshold of 400 percent of poverty cannot receive tax subsidies. Because of the family glitch, children in these states are at increased risk of lacking a pathway to affordable coverage.

Over the past few decades, Congress has been able to reach bipartisan agreement about the need to improve health-insurance coverage for children. Might they act to fix the "family glitch"? John Ydstie talked to the Urban Institute's Linda Blumberg, who was not optimistic:

Blumberg says it's likely that in a more amenable political environment, the family glitch would be fixed, with Congress adding more focus on the affordability of family coverage.

"But I think that because of the political volatility around this law, there was never an opportunity to sit down and say, 'OK, let's make a policy change here that takes this into account,' " she says.

Blumberg says Democrats have been hesitant to open debate on the law at all, because of fear it would be eviscerated during the legislative process. With the Republican takeover in Congress, the chance of eliminating the family glitch seems unlikely to improve anytime soon.

An 8% uninsurance rate for children is lower than it used to be and better than the 19% rate for adults ages 19 - 64, but it's still shameful.

lborkowski Mon, 12/15/2014 - 07:04

Tags

Would you care for a cricket chip?

dr. dolittle — Tue, 27 May 2014 09:48:57 +0000

Would you care for a cricket chip?

Image of cricket chips called "chirps" from Six Foods. (http://www.sixfoods.com/#product)

Crickets are the first insect to now be farmed for human consumption in the United States. I'll admit the thought of snacking on cricket flour-based chips is not exactly appetizing. But the process of farming insects over more traditional livestock seems to be less wasteful. Insect farming is a more efficient way of producing dietary protein as it takes much less feed and water to raise insects as compared to cattle. In addition, greenhouse gas emissions from crickets are much lower than with cattle.

Concern over insect farming for human consumption, besides the obvious "yuck" factor, stems from lack of knowledge surrounding potential parasite and pathogen infections in these insects especially since insect farming for human consumption is not currently regulated and insects are often fed food that would not be considered suitable for humans.

Would you try a cricket chip?

Source:

NewScientist

dr. dolittle Tue, 05/27/2014 - 05:48

Tags

Sure, I've eaten a few, why not. I was keeping leopard geckos and ate a couple of the crickets I fed them, out of curiosity I guess. Crunchy, didn't taste like much. Slight hint of nuts maybe but most just bland crunch.

I've read that here are chefs that buy them live, feed them spirolina and fry them up. They are reported to taste a bit of spriolina and whatever oil they are fried in.

Of course, if you want to put people off crickets show video of a horsehair worm emerging from a cricket.

Just a picture and explanation:
https://en.wikipedia.org/wiki/Nematomorpha

No risk for humans but it raises the ick factor sky high for a lot of people. People are sensitive to such presentations. A video of a slaughterhouse, not even one intended to put people off meat, had a friend unable to look a hamburger in the eye for most of a year.

http://www.nola.com/living/baton-rouge/index.ssf/2013/09/baton_rouge_cr…

This is an interesting article about Flucker Cricket Farns, with some recipes at the end.

Yes, y not,
https://compliancetrainings.com

I've eaten grasshoppers fried in chili oil as a main dish - whole, not processed into "chips", i.e., you have to pull the head and attached gizzard off each one - and they are quite tasty. Of course, packing peanuts fried in chili oil are also quite tasty.

Eat bugs, you know it makes sense..... (think of the size of the farms, for one thing).... The cricket chips look interesting, anyway, even if they don't look particularly appetising....

Since we're not doing so well at curbing our ever-rising population, farming insects sounds like a solution to the problem of how to feed everyone. However, selling the idea will be a major hurdle. I'll stick with my veggies and beans.