Capitol Comments

Strengthening State Medicaid Programs Becomes Central Issue

The number of uninsured Americans is the highest on record. There’s been a serious decline in the amount of privately available coverage, especially for low-income Americans.

Those two facts, according to Vikki Wachino, mean “the need for Medicaid coverage now is as great or greater as it’s ever been.”

Wachino, an independent consultant with the Strengthening Medicaid Initiative at Georgetown University’s Center for Children and Families, said Medicaid plays a large role in states’ health care systems and that role is only going to grow.

Federal Government Still Bans Funding for Syringe Exchange

State syringe exchange programs that provide clean needles to drug users and others to stop the spread of HIV are not allowed to use federal funds. Since 1988, the federal government has prohibited Centers for Disease Control and Prevention funding to be used for syringe exchange programs.

And because of that, states that allow the syringe exchange programs—and states that even fund them—are struggling with funding in some cases with the absence of federal dollars and also federal policy support for the idea.

“It has a chilling effect, when you have the federal government saying that the science is not all there—it gives people an excuse not to do it or they actually believe what the government says,” Allan Clear, executive director of the California-based Harm Reduction Coalition, said of the federal ban on syringe exchange funding.

Rescuing Lost Seniors

Every year, hundreds of seniors and others with dementia wander away, on foot or driving, and if not found within 24 hours, at least half suffer serious injury or death, according to the Alzheimer’s Association.  As baby boomers age, the toll is expected to multiply.

Eight states offer a program called Silver Alert, which aims to help family members and providers deal with that problem. The program is patterned after a national program for missing children known as Amber Alert and has resulted in the safe return of a majority of those reported.

Breakthrough in Stem-Cell Research

Groundbreaking new stem-cell research that uses ordinary skin cells instead of human embryos has done little to quell the moral quandary over stem-cell research.

President Bush in his State of the Union address Jan. 28 said the new research “has the potential to move us beyond the divisive debates of the past.”

That hasn’t happened since the breakthrough last November.

Instead, scientists around the world quickly cautioned that years of work remained to perfect the technique, and continuing work on embryonic stem cells is an essential part of that process. And, scientists said, they also need money to continue embryonic studies.

Several states—California, Connecticut, Illinois, Maryland, New Jersey, New York and Wisconsin—have continued to lead the world in financial and political support for stem-cell research. Three states—Iowa, Massachusetts and Missouri—have made the research legal, but not offered state funding, while six states—Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota—have taken the path of most developed countries and restricted the studies.

For more information, visit Stateline.org.

CSG Releases Report on State Medicaid Programs

Many state Medicaid programs spend almost 80 percent of their budgets treating individuals with chronic illness.

Some states are turning to disease management programs as a strategy to address cost and quality concerns, according to "Rural Medicaid Disease Management: Afterthought or Strategic Aim," a new report from The Council of State Governments. Disease management, which covers a range of activities designed to treat individuals with chronic illnesses, has been used in commercially insured populations to improve the quality of care and reduce costs associated with chronic disease.

CSG staff conducted a national survey of state programs to assess whether state Medicaid officials made any distinction in services provided to rural and urban residents, and whether the different needs of rural residents were addressed in program development and implementation.

Who Controls Cigarette Sales?

The U.S. Supreme Court today will hear a challenge to a Maine law that requires tobacco retailers who sell their products online to register with the state, use only authorized carriers to deliver their goods and clearly mark packages containing tobacco.

The court's decision could affect 40 state laws regulating Internet sales and shipment of everything from tobacco products to dangerous products such as explosives and wild animals. States believe their police powers - their ability to protect the public's healthy, safety and general welfare -- allow them to restrict how tobacco products are shipped and sold.

Delivery companies like UPS and FedEx say federal law puts the federal government in charge of package carriers. In fact, they say, the Federal Aviation Administration Authorization Act of 1994 prohibits states from placing extra requirements on their services.

Find out more about this story at Stateline.org.

Candidates on Health Care Reform

Is health care an issue important to your selection of a presidential candidate?

Several presidential candidates have participated in the Health Care 2008 Presidential Candidate Forums hosted by the Kaiser Family Foundation at the Barbara Jordan Conference Center in Washington, D.C.

The events are organized by Families USA and the Federation of American Hospitals. Candidates discuss in detail his or her vision about health reform with a panel of leading health journalists.

So far, Sen. John McCain, Sen. Joseph Biden, Rep. Dennis Kucinich, Sen. Hillary Rodham Clinton and former Sen. John Edwards have shared their views.

Gov. Bill Richardson will discuss his vision Nov. 19.

Forums for Sen. Christopher Dodd, former Gov. Mike Huckabee, Rep. Ron Paul and former Gov. Mitt Romney will be announced.

Most Support SCHIP Renewal

The State Children’s Health Insurance Program is widely popular among people of all political stripes.

That’s according to a new survey by NPR, the Kaiser Family Foundation and the Harvard School of Public Health. The survey, conducted in October, found strong majority support for the reauthorization and expansion of SCHIP. In fact, seven in 10 Americans said they back plans for expansion.

Democrats overwhelming support reauthorization – 82 percent before hearing the pro and con arguments and 80 percent after hearing them. Sixty-nine percent of Independents support the bill; that number of supporters dropped only 3 percent after hearing the arguments. And a majority of Republicans, 54 percent, said they support expansion; that support dropped to 47 percent after hearing the pro and con arguments.

Two in three people oppose President’s Bush’s veto of the reauthorization, although 56 percent of Republicans approved of Bush’s veto. Two-thirds of the people surveyed supported SCHIP eligibility for families of four who make $40,000 per year, roughly two times the poverty level. Support dropped to 32 percent for those families who make $60,000 a year.

Read the Public Views on SCHIP Reauthorization and see a breakdown of the answers to survey questions.

States Tell Smokers: Butts Out

Notice to smokers: If you want to light up after a meal at a restaurant, you should check state laws.

Half the states have adopted smokefree laws in public places. The increase in statewide smoking bans has been spawned by a 2006 Surgeon General's report that says, basically, there is no safe level of secondhand smoke.

Annie Tegan, senior program manager for Americans for Nonsmokers' Rights, said the social norms are changing. "When people go to work they expect to breathe smokefree air. People are understanding the dangers of secondhand smoke," she said.

The Surgeon General's report, coupled with a growing number of smoking bans in local communities, is prompting many state legislatures, even those in tobacco country, to adopt the statewide bans.

Find out more in the August State News.

Governors Want SCHIP Renewed

Governors want Congress to renew the State Children's Health Insurance Program this year.

They were unanimous in their support for the program during the National Governors Association meeting last weekend. The 33 governors in attendance also want the Bush administration to do more to help states develop clean, affordable energy.

NGA held its 99th annual meeting in Traverse City, Mich., July 20-23.

Find out more about the governors' efforts on SCHIP and energy at stateline.org.