Entries in States (5)


Most States Underprepared for Public Health Emergencies

Comstock/Thinkstock(NEW YORK) -- There are persistent gaps in the nation’s ability to respond to public health emergencies, according to a new study from the Robert Wood Johnson Foundation and Trust for America’s Health, despite a series of recent tragic events like 9/11, anthrax threats and Hurricane Katrina.

One of the most notable findings is that 20 U.S. states do not currently mandate written evacuation plans for all licensed child care facilities, should the need arise.

“Most school systems have plans in place, but we also need to recognize that child care facilities need plans as well,” said Dr. Jeffrey Levi, executive director of Trust for America’s Health.

Planning to care for the 67 million children in American schools and childcare settings presents complex considerations and challenges, the study authors wrote.  And while 42 states require all K-12 schools to have a disaster plan in place for emergency events including gun violence, only 23 states mandate these plans for facilities caring for infants, toddlers, or special needs children.

“That’s surprising,” says Lynsey Barkoff, a public school nurse working in New York City.  “All levels of education, including preschool, should have emergency plans in place.”

The report scored states on a scale of one to 10, with one point assigned for each public health marker the state achieved.  These markers included level of public health funding, community response time to public health incidents, percent of vaccination goals met, and climate change adaptation plans.

The states with the highest scores -- eight out of 10 points -- were Maryland, Mississippi, North Carolina, Vermont and Wisconsin.

“This is only a snapshot of preparedness,” said Levi.  “But [these states have] made a long term commitment to protecting public health through their leadership.”

Ranking lowest in public health emergency preparedness were Kansas and Montana, with only three out of 10 points.

These rankings are in large part due to lasting effects of the economic crisis.  From the 2010-2011 to 2011-2012 fiscal year alone, 29 states cut public health funding.  This was the second year in a row of budget cuts for 23 of these states and the third year in a row for 14 states.

Copyright 2012 ABC News Radio


Meningitis Outbreak: 331 Cases, 25 Deaths, 7 Joint Infections

Hemera/Thinkstock(ATLANTA) -- Another person has died from fungal meningitis in an outbreak linked to tainted steroid injections, bringing the total to 25 deaths, health officials reported Friday.

The U.S. Centers for Disease Control and Prevention has increased the tally of cases to 338: 331 cases of fungal meningitis and seven cases of joint infections. South Carolina became the 18th state affected by the outbreak on Sunday.

For a map of cases by state, click here.

The outbreak has been linked to contaminated vials of methylprednisolone acetate, an injectable steroid used to treat back and joint pain. Sealed vials of the steroid, made by the New England Compounding Center in Framingham, Mass., contained exserohilum rostratum, a fungus found in soil and plants. It's unclear how the fungus landed in the sealed vials.

The New England Compounding Center has recalled all its products and shut down operations. Calls to the owners were not immediately returned.

As many as 14,000 patients are thought to have received injections of the suspect steroid.

Seventy-six clinics in 23 states that received methylprednisolone acetate from the recalled lots have been instructed to notify all affected patients. The "potentially contaminated injections were given starting May 21, 2012," according to the CDC.

For a full list of clinics receiving the recalled lots of spinal steroid injections, click here.

Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis -- including headache, fever, dizziness, nausea, sensitivity to light, stiff neck, weakness or numbness, slurred speech and pain, and redness or swelling at the injection site -- can take more than a month to appear.

The longest duration from the time of injection to the onset of symptoms in the current outbreak is 42 days, according to the CDC's Dr. Benjamin Park.

"But we want to emphasize that we don't know what the longest will be," he added, stressing that patients who received injections of the recalled drug should stay attuned to the subtle symptoms "for months."

Fungal meningitis is diagnosed through a spinal tap, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.

Unlike bacterial meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.

Copyright 2012 ABC News Radio


'Obamacare' Ruling Puts New Emphasis on State Governments

(WASHINGTON) -- There are very few certainties in politics, but the Supreme Court's ruling on the Affordable Care Act, the controversial health care law colloquially referred to as "Obamacare," resulted in one of those rare sure things: It assured that the debate surrounding the law will rage on for the foreseeable future.

Almost immediately after the Supreme Court announced its ruling, Mitt Romney vowed to repeal the law if elected in the fall. Republicans in the House and Senate got a new talking point -- Republican control of both chambers will greatly improve their ability to facilitate this repeal.

And several Republican governors, including Bobby Jindal of Louisiana and Scott Walker of Wisconsin, said that they would wait until November to take any sort of action to begin actually to implement the law.

Democrats need to maintain control in only one of the following three places -- the White House, the Senate, or the House of Representatives -- to, at the very least, seriously hinder Republicans' ability to repeal the law entirely. If Romney is elected president, there are a handful of legal options he can take unilaterally, without the help of Congress, to go after the law, but he'll be greatly limited. And Republicans will face a time crunch, given that the law will take full effect in 2014.

If the Affordable Care Act continues to be the law of the land, however, state governors will have the job of implementing several requirements outlined by the reform. For example, under the law, each state is required to set up state exchanges where residents can, if they choose, select a healthcare plan (residents can also go through employer if that is an option for them). The exchanges do not need to be up and running until 2014, but states are required to demonstrate by Jan. 1, 2013, that their exchanges are in progress, and will be operational by the 2014 deadline. If they fall behind, the Department of Health and Human Services would then come in and set up the exchanges.

"If the state decides not to establish an exchange, then the federal government establishes the exchange for them. So it's kind of a pick-your-poison scenario, if you will," said Renee M. Landers, a professor of law at Suffolk University Law School in Boston. Presumably, governors who are resistant to setting up exchanges would be more resistant to the federal government establishing the exchanges for them.

Under the law, as it was written, governors would also oversee an expansion of Medicaid within their states. However, the Supreme Court ruled that states could opt out of this expansion. The legal procedure for deciding whether to go forward with the expansion will differ by state. It would be paid for entirely by the federal government for the first several years, and afterward states would only be required to chip in 10 percent of the cost.

The governors might not be acting alone.

"States might need to have legislation to be able to take advantage of the expansion," said Landers. "It's really impossible to generalize accurately because each state situation is so different. A governor can possibly make some kind of administrative changes, but certainly if it's going to take more money than they would need to go through the legislature."

It's not known what the governors in these states might do about the expansion of Medicaid, but many states that joined the suit against the law have Republican-controlled legislatures, and that's unlikely to change.

In Louisiana, for example, members in both the state house and senate have four-year terms, and are currently serving out their 2012-2016 term. In Michigan, no state senators are up for re-election this year, and house Republicans have a 16-seat majority.

In Virginia, the state senate has 20 Republicans and 20 Democrats, but the state's Republican lieutenant governor serves as the tie-breaking vote. The Virginia state legislature won't hold elections again until fall 2013, when there will also be a gubernatorial race in the state.

Several states could end up opting out of the Medicaid expansion -- and in that case, Landers says, the ACA would not meet all of its goals.

"It will mean that the Affordable Care Act will fall short of achieving some of its goals, because the Medicaid expansion was supposed to address low income people," Landers said.

Low-income residents of a state that opts out of the expansion will likely not be required to pay the fee for not having insurance.

"Their incomes will be too low to pay the tax. Unless a person has an income that meets the federal threshold for filing a tax return, they don't have to meet the individual mandate requirements" said Landers. "And even if you have the income that's above that level, if there are hardship requirements or you can show that there is no affordable product on the market for you to pay that's not less than 8 percent of your income, also can get an exemption."

The federal threshold for filing a tax return is an income of at least $9,350 annually for a single filer, $18,700 for a married couple with no dependents, and $22,350 for a couple with one dependent. After that it increases by an amount of $3,650 per dependent.

The National Journal estimates that the 26 states that opposed the health care law represent a majority -- 55 percent -- of Americans who have no medical insurance.

Copyright 2012 ABC News Radio


What Drives Variation in Medicaid Spending?

Comstock/Thinkstock(SAN DIEGO) -- Although there’ve been many studies assessing the geographic variability of Medicare coverage costs, only a few have looked at inter-state variability in Medicaid spending and the factors contributing to the differences.  For example, in 2007 the average cost per beneficiary in the U.S. was $5,163, but New York spent almost $8,500 while California only $3,186.  Researchers at the University of California-San Diego sought to find out what is contributing to these differences?
The authors found that the states in the mid-Atlantic region -- New Jersey, New York and Pennsylvania -- have the most expensive regional care, while states in the South central region -- Alabama, Arkansas, Lousiana, Mississippi, Oklahoma, Tennessee and Texas have the least expensive.  The top 10 highest-spending states spent $1,650 above the national average per beneficiary compared to the 10 lowest-spending states which spent $1,161 below the national average, according to the study's findings reported in Health Affairs.

Turns out that the biggest contributing factor to the differences in expenditures is the volume of services delivered.  But other factors mattered as well.  The authors found that higher numbers of hospital beds and specialists increased hospital admissions (and therefore costs), while higher numbers of primary care physicians reduced admissions and thereby lowered costs.  

The lead author states that this finding “suggests that there s a great deal of room for innovation in Medicaid.  By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

Copyright 2011 ABC News Radio


States Battle with Federal Government on Health Care

Photo Courtesy - Getty Images(WASHINGTON) -- At a time when Medicaid enrollment is on a steady rise and the economy remains weak, health care has also unearthed old tensions between states and the federal government that lie at the heart of the health care debate.

The expansion of the Medicaid program under the new health care law, and additional measures like the requirement that every American must carry health insurance and states must set up health insurance exchanges -- where the uninsured would be able to shop for coverage and compare rates -- have aroused rebellion from states.

Twenty states have filed a joint lawsuit against the Department of Health and Human Services, challenging the constitutionality of the provision that requires all Americans to purchase health insurance by 2014.

The feud over health care between states and Washington is not new. It has existed since the program was created in 1965, but the current partisan climate in which political jockeying is on the rise just further exacerbates that tension.

"This is not exactly a new issue when states feel fiscally pressed," said Gail Wilensky, an economist and a senior fellow at Project Hope, an international health education foundation.

Medicaid has been particularly hard hit by the budget crisis and the weak economy. Spending on Medicaid rose an average of 8.8 percent this year, the highest rate of growth in eight years, according to the Kaiser Family Foundation. The federal stimulus program gave some relief to states, providing roughly $87 billion in October 2008.

Under the new health care law, the federal government will provide funding to expand Medicaid to Americans whose incomes are at or below 133 percent of the federal poverty line.

But that has done little to appease states, many of which say the new law will increase their costs in the long-term even though it expands coverage to more citizens.

The blame game is likely to continue in an issue that is growing increasingly complex, experts say.

"There's not an easy villain," said William Roper, dean of the school of public health at University of North Carolina, Chapel Hill. "We as Americans want people to be covered by health insurance and get health services that they need, but we have a much greater appetite for public services than we have an appetite for the taxes that pay for them and that has produced over years -- and more recently over the last few years -- a gigantic budget deficit."

"The greater challenge for states right now is how can we give people everything and stay solvent and do what the federal government wants," said Sreedhar Potarazu, an ophthalmologist and chief executive of Vital Spring Technologies. "States are on the verge of going over the cliff and health care is the last straw."

Copyright 2010 ABC News Radio

ABC News Radio