Recently in Cathy Hope Category

I'm really bad at keeping up with all these national days, weeks and months of recognition.  I somehow missed the opportunity to indulge on National Potato Chip Day (March 14).  I didn't even notice that Ohio Governor Kasich signed a proclamation earlier this year designating February 6 as National Pork Rind Day.  But today I found a national celebration I can really rally behind - National Nurses Week (May 6 - 12).

What a great idea -- celebrating the people who immunize our kids, listen to our concerns and advise us on important preventive health care for our families.  Frankly, I can't imagine how anything would get done in a health care setting without nurses. 

My last interaction with a nurse was during my annual exam with my nurse practitioner.  Even though I see her only once a year, she has a major impact on my health. She doesn't let me justify away those extra pounds (hope she doesn't read about my plans to celebrate national potato chip day next year) but she also doesn't make harsh judgments.  I always wonder how she has the ability to take so much time with her patients and really listen.  A nursing student accompanied her during my last visit. When she was out of the room tracking down more information to share with me on vitamins, the student nurse told me she is amazed by how she is able to handle a full caseload while taking the time to be fully engaged with every patient that walks in the door.

When my super-human nurse practitioner came back to the room, I figured it was time to whisk me out of the office but she insisted on catching up on other things.  She asked me about my family and my job.  When she learned that I worked on health care issues, she was curious about the Affordable Care Act.  She really had not heard very much about it.  (I guess she's been too busy spending quality time with patients to spend much time trying to decipher all the misinformation that's been circulating on the new health law.)  She was thrilled with the fact that insurance companies have to spend more on actual health care, that people would no longer be denied coverage based on pre-existing conditions and that women would no longer be charged higher premiums than men. 

Nurses are critically important to our nation's efforts to improve the quality of care and reach more uninsured people through the Affordable Care Act.  The new health law recognizes that fact and includes provisions to make sure that nurses get the support and training they need.  For more on the importance of nurses and what the Administration is doing to support their hard work, please read the statement on National Nurses Week issued by HHS Secretary Kathleen Sebelius and report on how the new health law has benefitted nurses.

Remember, thanking a nurse is good for your health while eating pork rinds and potato chips will only cause you to need a nurse.  Happy Nurses Week!

The U.S. Department of Health and Human Services (HHS) announced a set of final rules on Affordable Insurance Exchanges.  This set of rules generated quite a lot of interest from stakeholders as more than 24,000 comments were submitted to HHS.  Some of the rules announced this week are in interim final status, meaning HHS will accept further comments on them, so we will likely be adding to that total. They will be published in the Federal Register on March 27.

The final rules combine policies from two Notices of Proposed Rulemaking (NPRMs) published last summer. One rule, published on July 15, 2011, outlined a proposed framework to enable states to build Affordable Insurance Exchanges (Exchanges. A second NPRM, published on August 17, 2011, outlined proposed standards for eligibility for enrollment in qualified health plans through the Exchanges and insurance affordability programs, including premium tax credits.

So what do the final rules mean for uninsured children and families?

Well, they are more than 600 pages long so we are wading our way through as expeditiously as possible.  We hope to share our insights with you soon but in the meantime, here's a fact sheet put together by HHS.  

And we hear that more final rules are coming soon, so stay tuned!

Twenty-eight million children no longer have to face lifetime caps imposed on their health insurance benefits thanks to the Affordable Care Act, according to an issue brief released this week by the Department of Health and Human Services.

Our research has shown that lifetime caps on insurance benefits are a major concern for families with children and youth with special health care needs. 

To see how the ACA is helping children and families in your state, you can find the report on lifetime limits here or view additional state data here. 

While many states were hoping for an extension, it could get them into a predicament similar to the one my son found himself in when he took advantage of a deadline extension on the first phase of his science fair project.  He was thrilled when the teacher offered him an extension until he realized that the date of the science fair would not change.  He ended up behind the eight ball trying to get his project completed in time.

This is welcome news for states that just can't get their applications in by the original deadlines, however, it's important to note that the target date for getting their exchanges up and running hasn't changed so it would be a good idea to keep moving forward as diligently as possible despite the extra time.

Hopefully states will follow the old adage "there is no time like the present" when considering whether or not to delay their applications.  After all, "the early bird gets the worm" and the earliest funded exchanges will most likely produce the best results for families and individuals patiently waiting for a more competitive insurance marketplace to help them find more affordable health care coverage.

Editor's Note: For more information on the exchange establishment grants, please read previous Say Ahhh! blog posts on the topic.

NPR reporter Nina Totenberg tells the story of how Supreme Court Justice William J. Brennan briefly met her sister the day she learned she was pregnant.  He got caught up in the excitement and eight months later, remembered the news and asked Nina about her sister's due date.  When he learned that Nina's new niece, Clara, was already two weeks old, he quickly sent off a letter enthusiastically welcoming the newborn to the world adding:  "It's a wonderful world if you will just make it so."

In sending baby gifts to friends and relatives, I have often paraphrased Justice Brennan's quote as it so aptly captures my feelings about all the hope and promise a newborn brings to the world.  We need to welcome children to the world with open arms and help them thrive so they will have every opportunity to reach their full potential and help make the world a better place. 

One very important way we can welcome newborns to the world is to make sure they have the health care they need.  In fact, we should start the welcome wagon even before the "little bundles of joy" arrive through good prenatal care for their mothers to ensure they have the healthiest start in life possible.

That's why I'm so excited about the partnership announced today by the Centers for Medicare and Medicaid Services (CMS) and "Text4Baby".  The goal is to reach out to uninsured mothers-to-be and new mothers to connect them and their children with affordable health care coverage and free texts on important health care topics.  When about two-thirds of uninsured children are eligible but unenrolled in Medicaid or the Children's Health Insurance Plan, it's a strong signal that we need to do more to help connect kids with affordable coverage and this  partnership will help achieve that goal. Mom's Rising is doing it's part by hosting a blog carnival today to help spread the word about affordable coverage options for pregnant women and children.  What a warm welcome to the world for all the babies who will get the healthy start they need because of this initiative. 

In the spirit of Justice Brennan, let's make sure every mother has what she needs to help her children thrive and make the world a better place.

Remember all those claims about how private insurers would be "crowded out" if Children's Health Insurance Program income eligibility guidelines were to be expanded?  Now a report by the National Bureau of Economic Research finds that those fears are likely to be unfounded as there is little evidence of any crowd out in the states that have expanded CHIP eligibility.

CCF's research on this issue has found that when states raise the income eligibility levels, more children enroll but the majority of them turn out to be children who already qualified under the pre-expansion eligibility rules.  My colleagues Jocelyn Guyer and Liz Arjun (now with Community Health Plan of Washington) dubbed that the "welcome mat" effect and it has been documented in many states.

Researchers have not yet tackled in detail the question of why expanding coverage results in many low-income families with already-eligible children securing coverage, but the primary theories that have been posited include: increased awareness of coverage opportunities, simplicity of message, simplification efforts and combating concerns about public coverage.

Undoubtedly you've heard about Super Bowl XLVI , but have you heard of CHIP III which is also taking the field this weekend?

CHIP is short for the Children's Health Insurance Program which was reauthorized three years ago this weekend. To mark the occasion, we're hosting a Super Blog-Off between Patriots fans and Giants fans.  But here's the kicker - they have to compete for kids. That's right, we've taken HHS Secretary Sebelius' "Connecting Kids to Coverage Challenge" quite literally and want the teams to compete based on how much they are doing to help uninsured children.

While we won't likely reach over 110 million people or be able to sell ads for $3.5 million per thirty seconds, our goal is to help reach the 4.3 million uninsured children who are eligible for CHIP or Medicaid coverage but not yet insured.

Last year, the Pittsburgh Steelers won.  That's right.  They might have lost the football game but they won our Super Blog-Off by going to great lengths to reach out to uninsured children.  Pittsburgh fans even swaddled newborn babies in "terrible towels" declaring that no baby should leave the hospital without an insurance card or a terrible towel.

This year, Dayanne Leal of Health Care for All Massachusetts is blogging on behalf of Patriot's fans and a team of health policy experts and advocates from New York are taking the field for Giant's fans. 

So whether you are a Pats' fan, a Giants' fan or wish there were a team from some place west of the Mississippi in the Super Bowl, you can bring home a victory for uninsured kids in your state by supporting efforts to enroll them in Medicaid or CHIP and keeping those programs strong. 

To vote for your favorite team, go to the Patriot's blog or the Giant's blog and post a comment.  Include the words "Go Patriots" or "Go Giants" in the text.

May the best (outreach) team win. 

We haven't heard much about what Politico has dubbed the "sleeper issue" of the Supreme Court case because it is the least likely to be found unconstitutional.   This week, Attorney Paul Clement tried to stoke a little life into the sleeper issue by tying it to the more controversial mandate provision.  In the brief he filed on behalf of the states challenging the constitutionality of the Affordable Care Act, he argued that the Medicaid expansion is possibly more coercive than the mandate (otherwise known as the individual responsibility or minimum-insurance coverage provision).

As with most anti-Affordable Care Act arguments, the point that expanding Medicaid would be "coercive" and impose a mandate on the states is based on "more rhetoric than fact".    I would like to take credit for that phrase but I found it in the 11th Circuit Court ruling on the topic. 

"While some individuals are exempt from the penalties designed to enforce the mandate, no state is exempt from the massive penalty -- the loss of the entirety of funding under the single largest grant-in-aid programs for the states -- and so Congress did not even contemplate the possibility of a state opting out of Medicaid," wrote Clement in a brief filed with the court Tuesday.

Hopefully even that super-charged rhetoric can't wake the Rip Van Winkle of sleeper issues. 

For another viewpoint, read the New England Journal of Medicine piece "All Heat, No Light - States' Medicaid Claims Before the Supreme Court" by Sara Rosenbaum and Tim Jost.  They write:

"From a legal perspective, nothing about this latest Medicaid expansion is different from past expansions, other than the fact that it passed as part of a broader health care reform effort. This fact does not change Medicaid's fundamental status as a voluntary program. Were a state to decide that it would rather end its Medicaid program than cover poor adults, it might have to devise a health care alternative for its poorest residents. But that has always been the question states face when Congress expands Medicaid. States may be confronted with a "hard choice," in the words of the 11th Circuit, as to whether to continue participating in Medicaid. But that is not a constitutional matter."

The Department of Justice brief on the Medicaid expansion is due on February 10.  Oral arguments on the topic are scheduled for March 28.  For more information on the Supreme Court timeline and a synopsis of the friend of the court briefs filed in support of the Affordable Care Act so far, visit the Center for Progress.

and Anita Jackson, Mom's Rising

Despite the increase in childhood poverty, our nation has managed to reduce the number of children going without health insurance during these tough economic times thanks to Medicaid and the Children's Health Insurance Program.   This is great news but there is more work to be done as too many of our nation's children are still uninsured.

To highlight the importance of connecting uninsured kids with affordable health care coverage, Moms Rising and Georgetown University's Center for Children and Families Say Ahhh! blogs are hosting a blog carnival.

Why focus on enrolling eligible but uninsured children?  Over 4 million of America's children are going without health insurance right now even though they are eligible for Medicaid or CHIP coverage.  Some have been unable to enroll due to bureaucratic barriers put in their way.  Other families are not aware that their children are eligible. 

There are some incredibly dedicated and talented organizations working to remove roadblocks to coverage and connect children with coverage.  The blog carnival is an opportunity to share with you some of their success stories.  We also hear from some families who rely on Medicaid or CHIP to meet their children's health needs.  As HHS Secretary Kathleen Sebelius points out in her blog: "No child or young person should have to skip a doctor's appointment or go without the medicine they need because their family can't afford it."

We hope the blog carnival will inspire all of us to redouble our efforts to reach eligible but uninsured children.

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Connecting Kids to Coverage: A Message From Secretary Kathleen Sebelius, U.S. Department of Health and Human Services

Children's Health is a National Priority, Patrick McIntyre, United Way

Talking Enrollment in the Windy City, Jennifer Sullivan, Enroll America

Medicaid & CHIP Approval Rating Higher than Employer Coverage Among Parents, Tricia Brooks, Say Ahhh!

Expanding Access to Care for Young Adults Through the Right Outreach and Enrollment Strategies, Brian Burrell, Young Invincibles

Texas Has Highest Rate of Uninsured Kids - Let's Change That Now, Kelli King-Jackson, Children's Defense Fund- Texas

Medicaid a Lifeline for Families, Elena Runiantseva, WA State MomsRising member and Medicaid beneficiary

SC Medicaid Director Seeks to Remove Roadblocks to Medicaid Enrollment, Sue Berkowitz, Say Ahhh!

Using Mobile Phones to Help Families Access Vital Medicaid Coverage, Lisa Han, The Children's Partnership

11 Tips to Help Children Get Enrolled in Medicaid and CHIP, Judy Darnell and Stephanie Hodson, United Ways of CA

Exciting News About ARKids and Medicaid, Elisabeth Wright Burak

Updated Research Gives Fresh Clues to Reaching Uninsured Children, Tricia Brooks, Say Ahhh!

CHIPRA helps to keep Chicago area kids and teens healthy, Marge Dunne, Brittany Ward, Stephanie Gutierrez, Beacon Therapeutic