MN2020: Health Care

Accretive is the Symptom to a Bigger Problem

Mon, 21 May 2012 11:00:32 +0000

By Lucas Smith, Undergraduate Research Fellow

If you have been reading the news lately, you probably noticed that the State Attorney General is suing Chicago-based, company Accretive. The AG’s office released a six-volume report detailing the exploits of Accretive’s employees in the Fairview hospital system. Accretive is accused of, amongst other things, attempting to coerce patients into settling outstanding debts before receiving medical care.

While many patients and medical professionals qustion Accretive’s ethics, their tactics are an unfortunate and inevitable consequence of the medical debt problem. Hospitals, nationally, provided a total of $39.3 billion in uncompensated medical care in 2010. And to deal with this problem hospital networks like Fairview turn to companies like Accretive to recoup losses. Without, getting at the core problem of medical debt more Accretive-like incidents are inevitable.

According to a study published in 2009, approximately 54.4% of bankruptcies in the United States are the result of the increasingly high cost of medical care. In addition to listing illness or medical bills as causes of their bankruptcy, respondents also listed “aggressive collection efforts.” Not only due medical bills swallow a substantial amount, but the illness often forces the primary breadwinner to stay home and care for a sick family member instead of working. Illness functions like a parasite on a household’s income, a survey from the Commonwealth Fund reported that 44% of families with medical debt had to use all of their savings to pay their bills.

But bankruptcy is only the beginning, as a 2006 article points out, “[w]hatever the level of medical bankruptcy, the actual problem is much greater because medical debt… is pervasive and damaging not only to personal finances but to health care access as well.” While the risks posed by medical debt are greater on those without health insurance, it is not exclusively so. Some 15% of those who had insurance in the last year had medical debt. Even more surprising, 70% of all those with debt reported having insurance at the time they incurred the debt.

An important, non-fiscal, consequence of this trend is that people with medical debt have inadequate access to medical care. According to the same 2006 article, a national survey found that even people with insurance that had medical debt reported just as high of a barrier to care as people that had no insurance. While surprising, the trend does make sense. A person with medical debt is unlikely to want to add to it so they forgo filling a prescription or going to the doctor.

That is the truly devastating aspect of Accretive behavior. Their aggressive debt collection practices are likely to deter Minnesotans from seeking care. According to one survey, over two thirds of people whose medical debt had been referred to collection agencies reported that it caused them to change their care-seeking behavior. Often this involved going to different providers or delaying, and even avoiding, medical treatments.

A recent Star Tribune piece provides a detailed summary of Accretive’s effort to pressure hospital employers into collecting more money. Andrew Cook said in an email to Fairview executives; “We've started firing people that aren't getting with the program." According the AG’s report, hospital employees were told to tell emergency room patients they would wait while the patient went and got their checkbook from their car. If this happened every time you need a doctor, would you keep going? Probably not.

But policymakers are in a bind. The only way to truly deal with this probably is through a comprehensive reform effort that lowers cost for consumers that likely involves transitioning away from an insurance-based health system. But given the polarized nature of government, such reform is unlikely. That only leaves them with the option of treating the symptom. Attorney General Lori Swanson’s law suit is exactly that. It punishes Accretive for what they have done, but does not doing anything to deal with the broader systemic problem that lies beneath the surface. Which unfortunately makes it inevitable.

Accretive, in what I imagine is a PR move, has announced they are funding a panel of health care policy "all-stars," including Tom Daschle, to put together national standards for medical debt collection. While not a bad idea in theory, the credibility of the panel's report depends on its ability to maintain its independence from Accretive. But, even if they can, the end result still only treats the symptom, not the problem.

VIDEO: Bringing Back the Housecall

Mon, 21 May 2012 11:00:04 +0000

By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist

Mankato-based Open Door Health Clinic recently launched a set of mobile clinics to bring affordable preventative care to rural towns with limited medical access.

These rolling health facilities offer a variety of medical screenings, dental work and treatment on a sliding-scale fee accessible to low-income and uninsured Minnesotans.

What’s in Ramsey County’s Wind?

Wed, 16 May 2012 11:00:03 +0000

By Will Nissen, Fellow

Back in April, Ramsey County received an F for particulate matter (PM) pollution on the American Lung Association's (ALA) 2012 State of the Air report. Hennepin, Dakota and Scott Counties all received a C grade for PM pollution. As the apparent metro black sheep, what is Ramsey County doing wrong?

Well, it may not be that simple. One cause for the polluted air, says the Minnesota Lung Association’s Robert Moffitt, is simply a combination of weather patterns and geographic location. We’re always polluting somewhere, says Moffitt, and with Minnesota’s flat open spaces and high winds air pollution can blow in from some areas (even from outside the state) and settle in others. During the three-year span that data was gathered for the 2012 State of the Air report, this may be what happened to Ramsey County.

Zach Hansen, Manager at the Environmental Health Section of the St Paul-Ramsey County Department of Public Health, seconds this opinion, stating that air pollution is much more of a regional problem. Air pollution is such a tough issue because it doesn’t adhere to political or sometimes even natural boundaries, and depending on its source air pollution is regulated by a variety of different government agencies.

For example, point pollution sources such as factories and power plants are generally regulated by the state or federal governments, whereas area pollution sources such as backyard wood stoves and fires are regulated by cities. In fact, most counties in Minnesota often have very little regulatory power when it comes to land-use and pollution issues.

The ALA recommends the standard drive less, use less electricity and avoid outdoor fires and mowing the lawn on air quality alert days.

But Ramsey County residents already pride themselves on being environmentally conscious and have seen their grade slip from a B in 2009 to this year’s F, while the other metro counties have maintained a C or higher in the same time period. What's the deal then?

There are point-source polluters in Ramsey County that may be contributing to this problem as well. The Rock Tenn paper recycling plant off University and Cretin Avenues in St Paul lost its supply of steam in 2008 when the High Bridge Coal Plant near downtown converted to natural gas. A neighborhood group protested the plant's proposed garbage incinerators to compensate for the lost steam, so for the last three years it's been burning fuel oil #6 (not a pleasant substance).

District Energy, St Paul’s wood-fired combined heat and power plant downtown, burns unused wood waste, and though it has received numerous leadership awards for renewable energy and achieved some impressive cost and energy-saving accomplishments, the Minnesota Pollution Control Agency (MPCA) fined the District $55,000 last year for “alleged violations of [its] air quality permit.”

Across the river and upwind in Hennepin County lies the Hennepin County Energy Recovery Center (HERC), which burns 1,000 tons of refuse-derived fuel (read: garbage) every day to generate electricity and heat for Minneapolis. Although waste wood and refuse-derived fuel are considered renewable energy sources in Minnesota, these sources may be contributing to particulate matter pollution in Ramsey County.

But David Thornton, Assistant Commissioner at the MPCA responsible for air quality issues, does not think we can point specifically to these point-source polluters as the main culprits for Ramsey County’s F grade. Thornton says it is a combination of “literally thousands of sources” that are contributing to this problem. And as to why Ramsey has experienced falling grades in recent years while other metro counties have maintained a C or better, Thornton says we just don’t know for sure. The location of air monitors (see monitor locations across the state here), weather inversions during winter months when PM pollution is particularly bad, or geographical characteristics may all have had an impact.

Regardless of the source, the implications for not fixing this problem are serious. The EPA is expected to lower its standards for PM pollution in the coming months, and the costs could be high if Ramsey County and the state of Minnesota do not comply. Back in 1999, the state faced a similar crisis when ozone levels were reaching dangerous highs. A Minnesota Chamber of Commerce report issued then estimated that it would cost between $189 and $266 million to bring just the Twin Cities down to EPA requirements if the state hit nonattainment status. That cost would have hit government agencies like the MPCA and extended to businesses and citizens forced to comply with tighter regulations.

As convoluted as this issue is, Ramsey County has made efforts to green its diesel vehicle fleet and make its buildings more energy efficient. The County (and the numerous other stakeholders involved) is also talking to and working with as many people as possible. Current work with neighboring counties and states, other government agencies, Twin Cities businesses, and citizens (being facilitated by the Environmental Initiative) is the only way Minnesota will stay ahead of deteriorating air quality.

Defend Women’s Health

Mon, 12 Mar 2012 10:59:59 +0000

By Meg Reid, Undergraduate Research Fellow

The “contraception controversy” has exploded this month, as the government decides whether or not religiously affiliated organizations should have to cover contraception to their female employees without co-pays. It’s a complex debate and an important question, but the struggle for women’s reproductive health and reproductive rights goes far beyond this one ruling. Family planning services, contraception, and abortion rights are threatened, and if women’s rights are not protected, we’ll see huge public health and economic impacts.

Family planning services, which include not only access to contraception but also pregnancy testing, screenings for breast and cervical cancer, gynecological exams, and treatment for STIs, are being cut across the country. Montana, New Jersey, New Hampshire, and Texas have all made recent, significant cuts to these services. Some states are targeting specific institutions that provide these services; Wisconsin, North Carolina, Tennessee, Indiana, and Texas have all moved to block Planned Parenthood from funding because it also provides abortions, even though state dollars don’t go towards abortions. More states are moving forward on similar measures.

Take the example of Texas. The state cut family planning by two thirds in October. Shortly after, half of state-supported family planning clinics had closed. Now conservatives want to cut the Women’s Health Program, which covers over 100,000 low-income Texas women. They would rather sacrifice the health of these women than fund Planned Parenthood.

At the same time, reproductive-age women are more and more likely to be uninsured. Research from the University of Minnesota found that a quarter of women between the ages of 18 and 49 had gaps in insurance, and 10 percent of pregnant women were uninsured. In 2009, the Guttmacher Institute found that 23 percent of mid- to low-income women had difficulty paying for birth control, and 24 percent put off a visit to the gynecologist. A lot of women aren’t receiving the help they need to afford contraception and prenatal care—and their children could face poor birth outcomes. And yet across the nation, conservatives are making it more difficult for these women to access care.

That’s not all. There’s lots of evidence showing that contraception saves women and taxpayers money. Contraception allows women to delay childbearing, so they can invest in their education and careers. Historically, this not only helped individual women but also resulted in a huge economic impact as more women joined the workforce. One study showed that the pill alone accounted for 30 percent of the convergence of men’s and women’s salaries between 1990 and 2000. And according to the Atlantic, the rise of women in the workplace contributed almost 2 percent per year to GDP growth. Contraceptives are saving money today, too. A study from the Brookings Center on Children and Families found that expanding family planning through Medicaid—a $235 million investment possible through the Affordable Care Act—would save taxpayers a whopping $1.32 billion. Why are we fighting family planning?

The right to choose is also facing great challenges. Last month’s controversy in Virginia over requiring women who seek abortions to undergo a transvaginal ultrasound was only the beginning: similar noninvasive bills are pending in several states and Texas has been enforcing transvaginal ultrasounds since last year. Florida wants to instate a 24-hour waiting period after ultrasound, Utah is pushing a 72-hour waiting period, Oklahoma wants to require women to listen to the sounds of the fetus’ heartbeat, and South Dakota wants to mandate counseling at crisis-pregnancy centers.

Two proposed bills in Minnesota would require new, expensive licensing and inspections for all clinics that provide 10 or more abortions per month, and would require a doctor’s presence for the administration of abortion-inducing drugs. This effectively shuts down a program started by Planned Parenthood to give patients in rural areas easier access to medication abortions, which use a pill to induce early abortion. The program allows a trained health care professional to administer the drug if a doctor is present via videoconferencing. The drugs in question are associated with fewer deaths than Tylenol or Viagra, and yet these proposed bills make it ever harder for patients to access them. “Make no mistake, this bill is not about protecting women or saving lives,” said Karen Law, executive director of Pro-Choice Resources in Minneapolis, “This is a whittling away at abortion access for women.”

Even as they try to strip services and rights, conservatives attack woman. We’ve had Rush Limbaugh on one side label Sandra Fluke a “slut,” Bob Morris of Indiana call the Girl Scouts of America “a tactical arm of Planned Parenthood,” and Foster Freiss tell us “gals” to put aspirin between our knees. Don’t even get me started on Rick Santorum.

Something needs to change, and we can make it happen here. Minnesota does not need to follow in the footsteps of the states mentioned here. We can take Minnesota in a different direction. Instead of cutting family planning services, let’s bolster funding and pass contraceptive equity. Instead of threatening a woman’s right to choose, let’s support organizations like Planned Parenthood and secure the right of a woman to seek an abortion if she chooses. We need to stand by our commitment to women’s health and reproductive rights.

Creating Better Lives at a Better Value

Thu, 08 Mar 2012 11:00:49 +0000

By Steve Larson, Guest Commentary

The current system of supporting people with disabilities has helped tens of thousands of Minnesotans with disabilities become included, valued, and contributing members of their communities. Our system has been a great move forward in the way we support people with disabilities, who only a few decades ago were warehoused in large, crowded, inhumane institutions.

The system we have created, however, is no longer financially sustainable over time. There will be increasing demands on human services dollars as our population continues to age, and we still must support seniors, children, and people with disabilities who currently receive Medical Assistance and other human services.

This calls for innovations and reforms in the way we support our citizens who need it. Reform has been the buzzword at the Capitol since the beginning of the 2012 Legislative Session. Minnesota House Speaker Kurt Zellers told the St. Paul Pioneer Press before the session started that he would like to see “real structural reform” in the way individuals and programs spend the dollars they receive from the state. Before the Legislature convened, Republican leaders had unveiled a “Reform 2.0” agenda. Gov. Dayton, for his part, began his “Better Government for a Better Minnesota” initiative to change government operations, which so far has included competitive bidding for state health insurance programs.

The Arc Minnesota wants to be part of reform efforts, too. We want to help create a future where Minnesotans are supported by services that enhance their dignity and use our public dollars as cost-effectively as possible. There is already one program underway that is contributing to the solution.

Housing Access Services (HAS) has been in existence for more than two years. A partnership among The Arc Minnesota, local Minnesota chapters of The Arc, and the Minnesota Department of Human Services (DHS), HAS helps people with disabilities who are ready to move to homes of their own as an alternative to more traditional housing options.

In Housing Access Services’ first two years, we have encountered hundreds of Minnesotans with disabilities who need help locating housing; negotiating with landlords; understanding leases and budgets; and finding funds to pay application fees, deposits, and modest furnishings. They may be ready to leave their parents’ home. They may have been in a group home, have become more independent, and no longer need the level of service or 24-hour supervision from group home staff.

Housing Access Services helps individuals with disabilities with any of these needs make the successful transition to a place of their own. So far, HAS has helped hundreds of Minnesotans move – 372 as of this writing. You can hear and see three of those success stories in the Housing Access Services video that DHS produced

Karli Harguth is one of those successes. Before connecting with HAS, Karli lived at home with her parents. Concerns about her seizure disorder and metabolic condition made her mom and dad worry about her living on her own. But Karli, a young woman in her early 20s, wanted more independence. She didn’t need or want to be in a residential facility where she would have people watching her 24 hours a day. “I don’t want to be living where someone is telling me to do this or do that, where someone is checking on me,” she said. “I want to be free.”

Staff at The Arc Southeastern Minnesota in Rochester helped her find an apartment in Eitzen, a small community in Houston County. They helped secure the necessary funding, including energy assistance and support programs to help her live in the community. They were also there when she signed lease and helped her move. “This whole experience has changed my life completely,” Karli said. “Mom still worries about me, but she knows I’m happier now, and she knows it’s the right move.”

Maple Grove resident Adrienne Harper was in a group home for 1½ years, then lived for a short time in an apartment building controlled by a service agency. She was dissatisfied with both options. “The staff felt I had to do whatever they wanted me to do. Whenever they wanted me to eat, I had to eat. Whenever they wanted me to get up, I had to get up. Whenever they wanted me to go to the bathroom, I had to go to the bathroom. I felt that I didn’t have any rights of my own.” Housing Access Services helped her find an apartment in Maple Grove, where personal care attendants come in when needed. Now she lives in her own place, under her own rules.

Besides improving Karli’s and Adrienne’s lives, HAS is helping the state’s bottom line, too. In a report issued by the Minnesota Department of Human Services , the state spends, on average, $35,000 less per year for each person with disabilities who moves to his/her own place from more traditional housing. This adds up to millions of public dollars being used more efficiently and effectively.

Housing Access Services is not for everyone, just like group homes are not for everyone who has a disability. But the service helps people with disabilities who are ready to live more independently to move to a place of their own and make room in the system for those who need a higher level of support and supervision. It is one innovative example of how Minnesota can create even better lives for our citizens at the best value for our tax dollars.

Steve Larson is The Arc Minnesota’s Senior Public Policy Director. The Arc Minnesota is a non-profit organization that promotes and protects the human rights of people with intellectual and developmental disabilities and actively supports their full inclusion and participation in the community throughout their lifetimes.

Rural Mental Health in Crisis

Mon, 27 Feb 2012 12:00:28 +0000

By Meg Reid, Undergraduate Research Fellow

We who live in more urban areas too often subscribe to the stereotype of rural life as peaceful and idyllic. We assume that, far away from the pollution and stress of city life, people live easily and free from worry. Open air, no traffic, a simple life—great for mental health, right?

Wrong. In reality, people living in rural areas often face a higher burden of mental health problems than their urban counterparts. Agricultural communities can see an accumulation of stressors that result in distress, depression, anxiety, and substance abuse. The Minnesota Department of Health reported in 2005 that rates of depression among rural women were as high as 40 percent, while only 13 to 20 percent of urban women were depressed. In one study, rural patients in treatment for depression were three times as likely to be hospitalized for physical or mental health problems than urban patients. Another found that rural patients with bipolar disorder were four times as likely to have a manic episode during the year after diagnosis and were 17 percent more likely to attempt suicide.

Many factors influence mental health, but today we’re going to focus on just one of them: Access to care. Rural Minnesota is facing a critical shortage of mental health providers. The Health Resources and Services Administration (HRSA) reports a shortage equal to 52 full-time equivalent practitioners in Minnesota. The shortage means that patients have to drive longer distances to reach mental health practitioners. Social stigma makes it even more difficult for people to access care, and beyond this, a lack of health insurance among rural residents means that even those able to access care often can’t afford it. HRSA estimates that 1,456,036 Minnesotans do not receive an appropriate amount of mental health services. These patients cannot receive the medication, treatment, or support that would help them.

Emergency medical services and police are too often the ones who must deal with patients facing mental health crises. They must transfer patients to hospitals. Often patients are admitted across the state in order to find an open psychiatric hospital bed. The fractured system can mean that people with serious mental illness end up in county jails.

Let’s take the example of Nobles County. Because there’s no psychiatric unit in Nobles County, any persons deemed to be potentially harmful and put on a 72-hour commitment must be driven by a squad car to Marshall or to Sioux Falls. These patients are interviewed, sometimes multiple times, by social workers who must drive to the place the patient is being held. Each time the person is called back to Nobles for a hearing, he must be transported back. And in the case that the person is deemed able to leave the unit, she must find her own transportation home.

It is essential that we address the shortage of rural mental health services. Attracting practitioners and funding to rural areas is crucial, but we also need innovative solutions that can help mental health patients now.

One such solution is telemental health – long-distance counseling with the help of technology like teleconferencing or video conferencing. Telemental health makes it easier for people to access mental health services because it removes the barrier of transportation. Better access leads to better diagnoses and better treatment for mental health patients. It saves money because people can stay in the community while receiving health care. And it means that psychiatrists can communicate among themselves in order to improve care.

The Itasca County Crisis Response Team coordinates its emergency medical services and its local mental health professionals through telemental health services in order to combat problems with emergency mental health situations. A team of mental health professionals is available to the county’s emergency medical services workers in order to provide face-to-face or telephone intervention, helping patients find care that is nearby and assisting with care from initial contact. Normalizing mental health emergency care to reduce stigma has resulted in better and more efficient care. Itasca county has seen both clinical benefits and savings from this program.

Even for such an innovative solution there are barriers. The Department of Health reports that Minnesota lacks a central telemental health resource to guide organizations on the development of telemental health programs. There is no consistency of reimbursement for telemental health care. The shortage of mental health practitioners means that even with telemental health services there are still few doctors available. Finally, inconsistencies in internet access across rural Minnesota and difficulties with technical support can impede telemental health.

Rural mental health care is in danger. Between the shortage of practitioners, the culture of stigma, and the fractured emergency mental health system that lands patients in jails instead of care facilities, it is clear that we are failing to appropriately address this issue. We can no longer afford to ignore our neighbors. Says Deb Hogenson, social worker in southwest Minnesota, “It’s a crisis – no question about it.”

Why Housing is a Bonding Bill Priority

Thu, 16 Feb 2012 11:00:45 +0000

By Colleen O'Connor Toberman, Guest Commentary

As the Minnesota Legislature and Governor Dayton work on their respective bonding bills, housing and homeless advocates are seeking $40 million in bonding money for affordable housing. Their vision for this $40 million includes preservation and improvement of federally subsidized affordable housing, development of supportive housing for those experiencing long-term homelessness, and creation of more housing opportunities for low-income households.

While housing will likely be only a small portion of the final bonding bill, it is a critical investment for all Minnesotans. Here are some of the reasons we can't afford to overlook housing in 2012:

Affordable housing is urgently needed. Minnesota has a serious housing affordability problem. Minnesota's rental vacancy rate has reached a ten-year low, causing rents to rise. Foreclosures have left neighborhoods littered with vacant homes in need of repair.

One-third of Minnesotans are considered cost-burdened by their housing (spending more than 30 percent of their income on their housing). An additional 13,100 are homeless on any given night.

Housing is a sound investment. Housing preservation is a crucial piece of this bonding proposal. Much of our affordable housing stock is 20-30 years old and requires efficiency improvements to lower operating costs. Publicly-owned housing could decline past the point of repair without interventions. Private landlords who serve low-income tenants have a tough time affording major updates without raising rents. In the next five years Minnesota risks losing up to 10,000 of these units if landlords opt to leave affordability programs such as Section 8 in order to make ends meet.

In addition, housing bonds leverage outside investment. One dollar in state investment into federally-assisted housing secures $5.50 in federal funding. State spending on other housing programs also leverages significant investment from nonprofits, housing developers, and private investors.

Housing also yields long-term taxpayer savings in education, social services, and health care because people in unstable crisis situations tend to use expensive crisis-care services. One recent study in Hennepin County targeted the heaviest users of homeless shelters, jail, emergency rooms, and detox centers. By providing permanent supportive housing and other service interventions, the program saved taxpayers an average of $13,000 per each individual housed. Children and youth (who comprise nearly half of the state's homeless population) achieve better educational and health outcomes when they have a stable home.

Housing bonds will benefit the entire state. Unlike some bonding projects proposed for localized communities, housing bonds will be distributed statewide through a competitive process overseen by the Minnesota Housing Finance Agency. This provides trusted oversight and directs resources based on community need and project-readiness. Given that one-third of homeless Minnesotans live outside the metro area, we need this coordinated statewide effort.

In my work at Our Saviour's Housing I often tell people that ending homelessness isn't rocket science. We have excellent program models, proven successes, and demonstrated taxpayer savings. What we don't have is the community and political will to provide sufficient housing for those in need. Forty million in improved and expanded affordable housing is an investment opportunity we can't afford to pass up.

Colleen O'Connor Toberman is Volunteer Coordinator at Our Saviour's Housing in Minneapolis. Our Saviour's works to end adult homelessness with a range of programs that provide shelter, support, and a chance to start over. Our Saviour’s Housing is part of Our Saviour’s Community Services.

Partisan vs. Particular: Building a Health Exchange That Works for Minnesota

Wed, 08 Feb 2012 12:00:02 +0000

By Sarah Greenfield, Guest Commentary

Recently an editorial ran in the Star Tribune calling on the GOP to start participating in Minnesota’s Health Exchange development, and calling on Governor Dayton not to move too far ahead without them. Calls for bi-partisanship, cooperation, and compromise are all the rage. And for some good reason—recently, gridlock has crippled our state legislature and US Congress.

Unfortunately it can be hard to decide what to compromise on, or not, when it comes to a Health Exchange because most of us don’t know enough about what a Health Exchange is, and why it matters. So let’s step back for just a minute.

The Patient Protection and Affordable Care Act (ACA , also referred to as “Obamacare”) was signed into law March 23rd, 2010. A lot of things didn’t make it into the law—anyone remember the public option?—but a lot of things did. A simple way to think about the ACA is as an interwoven set of changes to our current health insurance system:

We won big-time insurance reforms, like no more pre-existing condition denials or life-time limits. More or less in exchange for reforms, the bill passed an individual mandate, requiring (almost) everyone to have health insurance. Because the bill requires everyone to have insurance, we had to make insurance more affordable, through subsidies for private insurance and a huge expansion of Medicaid. To help people access private insurance, public programs, and all these new benefits, we required states to set up Health Benefits Exchanges - websites where individuals and small businesses can compare apples to apples and easily enroll in quality, affordable health insurance plans.

In Minnesota, over a million people are expected to enroll through our Exchange, including 300,000 who currently don’t have insurance. According to an independent actuarial analysis, Minnesota families can expect to save $500 to $700 a year on insurance through the Exchange. So what’s the big deal? Exchanges are a pretty bi-partisan, if not Republican, proposal by origin. Current opposition to them is largely part of the “anything related to Obamacare is dirty” pandemic, not based on real policy concerns. But not all Exchanges are, or will be, created equal. Minnesota gets to decide, for example:

Will our Exchange be a public or private entity, or something in-between, and should insurance companies who stand to profit from the Exchange be allowed on its Governance Board? Will our Exchange be held accountable to health-improvement goals, including reduction of health disparities, and if so how should that disparity be measured? Will just any insurance products be sold on our Exchange, or only those that meet high standards for affordability and quality? In other words, can our Exchange negotiate with insurance companies? Will Minnesota offer a Basic Health Plan, basically a continuation of MinnesotaCare, to provide stable, quality coverage to low-income working families, or should they be dropped into the private insurance market?

These and other decisions are in front of us. Currently, the Dayton administration has been leading the Exchange development process. The Department of Commerce, which oversees insurance, appointed an Exchange Advisory Task Force to guide this development. The GOP majority refused to appoint legislators to that Task Force, and last year they didn’t grant a hearing to any Exchange bill, including their own from Representative Gottwalt. This year they say will be different, and that’s where the calls for compromise and bi-partisanship come in.

Governor Dayton has said that his administration has the authority needed to “get to the starting gate:” to develop our Exchange enough over the coming year to get approval from the feds that we are on track to have our Exchange up and running by 2014. He has also said they want legislative participation if they can get it, and that makes sense. Now it’s important for the public (that’s us) to understand enough about what kind of an Exchange will serve our families, businesses, and communities. That way we can tell our legislature and our administration not just to “compromise,” but to move forward an Exchange that will really work for Minnesota. We may not want them to be partisan, but we do need them to be particular.

Sarah Greenfield is the Health Care Program Manager at Take Action Minnesota. To learn more, or get involved can contact her directly at 651-379-0751.

Health Care Cuts Hurt Working Women

Thu, 19 Jan 2012 12:00:27 +0000

By Julie K. Schnell, Guest Commentary

Throughout our history, the working women of SEIU Healthcare Minnesota have stood up for justice at work. During the 1940s, many of our employers insisted on lower wage scales for women doing the same jobs as men. Together, the women of our union organized against this blatant discrimination and won equal pay for equal work.

Again in the 1980s and 1990s, women in clinics and nursing homes across the state united with their co-workers to form unions in their healthcare facilities so that they could improve care and working conditions. Most recently, the women of our union stood behind our President and Congress when they passed the Lilly Ledbetter Fair Pay Act to root out the pay discrimination we had witnessed so blatantly during our union’s history.

As a union whose membership is now predominantly female, we are constantly vigilant against attacks on working women. As we enter 2012, it’s time for working women to get ready to stand up for justice and because we learned from the 2011 legislative session that the conservative-controlled legislature will fire salvos at every turn.

The $1.23 billion in healthcare funding cuts that we saw in 2011 were a direct attack on working women. In particular, the cuts to the Personal Care Attendant (PCA) program, and the additional 20% cut to family caregivers, will land squarely on the shoulders of female caregivers who are the backbone of the homecare industry.

According to estimates, women make up more than 80% of the home care and personal care attendant workforce. Within family caregiver subsection of that workforce, the percentage of women workers is probably higher. Thus, cuts to home care in general and family caregivers specifically, fall much harder on women workers. While it is not as blatant as the male and female wage scales we saw in the 1940s, it is another case of men in power undervaluing the critical work that women do every day.

Fixing these and other healthcare cuts will depend on if the economy recovers fast enough. Much has been made of the so-called ‘surplus’, in the last Minnesota budget forecast, but it is less well known that the healthcare sector is responsible for much of the improvement. In the most recent forecast, of the $876m ‘surplus’, approximately $457 million (52%) is due to better than expected numbers from HHS. If legislators want to give women a fair shake, they should use some of the surplus to restore previous cuts.

We are also anticipating conservatives to attack working women by trying to place a right-to-work constitutional amendment on the ballot. As with the legislature’s cuts to homecare funding, the act is troubling on its face. The GOP’s continued assault on union workers is an attempt to blame union workers for the state of our economy.

Right-to-work is a smokescreen to divert voters’ attention from the fact that the richest 1% in our state fail to pay their fair share. In addition to the rhetorical attack on workers, conservatives’ efforts will have real economic impacts on working Minnesotans, especially women.

The yearly difference in earnings is $10,400 for union members vs. non-union members, according to a Bureau of Labor Statistics’ 2011 report. The numbers are even more stark for women and women of color. Unionization raises female workers' wages by $2.00/hour (or 11.2 percent). Women who are in a union are also:

19 percent more likely to have employer paid health insurance and 24.7 percent more likely to have pension.

Joining a union has a much larger effect on a woman's probability of having health insurance than a four-year college degree (8.4 percent increase). Unionized women of color earn almost 35% percent more than non-union women of color. In their push to attack union workers, conservatives in the Legislature are also taking a direct shot at working women.

While these are just a couple of examples of the attacks we are likely to see on working women, they are indicative of the conservative movements attacks on the gains we have made—be it for workers, immigrants, women, or children.

We should not be cowed by these attacks but rather consider them an opportunity to organize and educate our communities on the actions of the Legislature and hold them accountable for their attacks. History has shown time and again that when we are vigilant and organized, we prevail.

Julie K. Schnell is president of SEIU Healthcare Minnesota.

Union Finds Better Health Care Formula

Mon, 16 Jan 2012 11:00:58 +0000

Across the country, health costs continue to skyrocket, increasing 6.7% annually in recent years.

Statistics, however, have long suggested the U.S. can lower health care costs while improving quality of care. One local union is proving these statistical trends into practice.

In implementing its new Value-Based Health System, the International Union of Operating Engineers Local 49 has kept costs flat the last three years.

The story starts with a familiar situation. In 2004, the Operating Engineers, or 49ers as they’re known, were struggling to manage their rapidly rising health expenses.

“We were hemorrhaging,” said Jim Hansen, Local 49’s recently retired Health and Welfare Trustee. When the union negotiated compensation increases, the numbers suggested it needed to invest the entirety of the raise in health insurance. The 49ers confronted a common dilemma: Either cut benefits or increase spending on health care.

Instead, the union opted to focus on value, an oft-overlooked third option. This focus resulted in the implementation of Healthier You, a Value-Based Health Care program, in 2006.

Choosing this course led Martha LaFave, Health Fund Coordinator for the 49ers, to a novel approach. “We didn’t look at the dollars,” LaFave said. The union instead focused on obtaining top-quality care and trusted costs would decline as a result.

Dr. Daniel Buss, the Minnesota Twins’ team physician and a supporter of the 49ers approach to health care, suggests it’s an insight one should expect from a union.

“[Operating engineers] are very attuned to the fact that if you have to come back out and redo something that wasn’t done correctly, it tends to be much harder to do then if you just did it right the first time,” he said in a video discussing the program’s benefits.

This insight led to Value-Based Health Care built on two central principles: (1) early detection and (2) seeking care from the best.

In prioritizing early detection, the 49ers have put the “prevention saves money” theory to the test to an extent few have dared try—and to noteworthy results. The union pays for an annual physical exam for each member and spouse—the health care fund covers more than 33,000 people.

The physicals are designed by HealthDynamics, a physician-founded firm focused on preventive care, and are valued at $5,000. Because of the 49ers large purchasing power, they pay $500 for the physicals. It guarantees an extremely comprehensive physical, including a medical evaluation, fitness assessment, nutritional analysis, cancer screening, and stress inventory. But the physical has proven effective: A whopping 70% of those who take it have made lifestyle changes as a result. Each change is a step toward prevention, preserving health and averting future medical expenses.

The second key to the 49ers’ success comes in finding the best doctors and specialists for any given job. For this, the union turned to Health Systems Management, a company that conducts data-driven doctor evaluations.

“It arms people with information they’d have no way of finding on their own,” said Jason George, the Legislative and Political Organizer for the 49ers. With the information in hand, the union locates the best doctors for any given medical problem and works to set up their members with those doctors. The union is even willing to fly members to the best possible care, paying travel expenses for a member and travel companion.

Such a drastic break from traditional American health care requires some extra attention. To tie it all together, the 49ers’ patient advocacy team, which includes Health Systems Management, is responsible for following up with members to guarantee the best possible health outcomes. They call members after exam results come in to help set up the appropriate appointments and follow up in the weeks and months after procedures to ensure there are no complications. Patient advocates work as a backstop to help members take maximum advantage of the information available and make sure no one slips through the cracks.

Value-Based Health Care does present its own set of challenges. Beyond the annual physicals’ high costs, the union also confronts the reality of members who are hesitant to shift away from their family doctors toward physicians with proven track records.

While only 10% of members have signed on for the annual physical Value-Based Health Care—offered at no additional cost—that percentage grows every year. The union holds educational meetings with members annually across the state, which has encouraged increased participation.

“When you implement anything new it’s critical to educate members about the benefits and the reasons behind the new program,” says George.

Yet despite this low participation rate and only a few years of implementation, the Operating Engineers are already realizing savings.

By their second year of implementation, the 49ers had already bent the cost curve; costs have now been flat for the past three years. For a system based on the importance of prevention, such a result is phenomenal, as the bulk of money saved through prevention, early detection and fewer wasted health care dollars can show up many years after the initial intervention. Savings for the 49ers can only grow as more members participate and expensive treatments even further down the road are prevented through early detection.

LaFave, Hansen, and George are brimming with stories of the better outcomes that result from early detection and top-quality physician care. These stories—and the numbers—demonstrate that the 49ers have cracked the U.S. health care riddle and discovered how to keep costs down while achieving an even better level of health.

Repair 2011’s Damage, Protect Rights in 2012

Thu, 12 Jan 2012 11:00:08 +0000

By Steve Larson, Guest Commentary

The last decade has brought nothing but “bad news budgets” for Minnesotans with disabilities, forcing advocates to play defense when it comes to maintaining services and protecting rights.

Here’s the good news. If the state’s projected $876 million surplus remains, expands, or doesn’t shrink much, we are hopeful that Minnesotans with disabilities will survive to at least July 2013 without facing further cuts.

Unfortunately, the state’s so far in debt, there’s little chance any surplus will restore 2011’s most devastating cuts (see the list below). The entire $876 million will replenish state reserves. Future revenue boosts will pay back school borrowing.

Still, we should devote this session to repairing that damage, beating back efforts restricting the rights of people with disabilities in 2012, and reforming disability services in the face of long-term funding threats.

Six months after this biennium’s cuts took effect, we’ve already witnessed their devastation. Home-based service reductions have isolated Minnesotans with disabilities and their families. Many service providers have also made deep cuts, with some fearing they will have to close their doors.

In the 2012 Legislative Session, we want to see funds restored to the thousands of PCAs getting a pay cut as they support their relatives with disabilities, who often have no one else to provide that support. We also want to see the cuts to “low needs” individuals restored. About 2,600 Minnesotans receiving services in the community are affected, including 900 individuals with intellectual or developmental disabilities, and many others with a diagnosis of mental illness. It will cost about $38 million to restore these two cuts.

Even if further cuts are avoided, 2012 will still be a challenge in protecting the rights of people with disabilities.

Last session, a bill to eliminate more than 50 laws and about 30 regulations that protect students with disabilities and their families failed to pass. Legislators plan to introduce similar measures this session. By doing so, they will jeopardize education services for students with disabilities and restrict their parents’ voice on education policy and services.

Adults with disabilities will have to overcome unnecessary hurdles to exercise their right to vote should we pass voter ID laws. The League of Women Voters Minnesota estimates that about 27,000 Minnesotans (10 percent of people with disabilities) would be affected. Citizens in states that have adopted voter ID laws have already run into barriers, resulting in voter suppression.

Instead of cutting people from services, policymakers should focus on reforms that will cut delivery costs to weather projected state budget deficits in future biennia. Modifications should focus on providing people with disabilities the right services at the right time in the right place, so we can create better lives at a better value for our public funding.

One successful reform is Minnesota’s Housing Access Services (HAS). So far, it moved 343 people with disabilities into homes of their own. These folks were ready to be more independent and didn’t need all the support they received before.

On average, HAS will save taxpayers $50,000 per year for each person who moves, as long as they stay in that more independent living situation. We also know that people who have more control over their budgets and staff for their services—a program formerly called “consumer-directed community supports”—save thousands of tax dollars and are more satisfied with their supports.

Besides increasing access to the above programs, Minnesota policymakers have other avenues to improve our services in the long term. They can implement legislation already passed that would expand services giving people with disabilities and their families more control—“self-directed services.”

State human services staff members are also developing a proposal to submit to the federal government that would waive some requirements for disability services. This could further increase self-direction, improve lives, and cut costs all at the same time.

Disability advocates have another full plate for the 2012 Legislative Session. Instead of always having to play defense and protect against budget cuts, we have a chance to create real positive change for people with disabilities and their families.

Steve Larson is The Arc Minnesota’s Senior Policy Director. The Arc Minnesota is a non-profit organization that promotes and protects the human rights of people with intellectual and developmental disabilities and actively supports their full inclusion and participation in the community throughout their lifetimes.

A 20% wage cut for personal care attendants (PCAs) who provide services to relatives. A 10% cut in rates to services to individuals with disabilities judged to be “low need.” Continued limits on enrollment in programs that help people with disabilities live more independently in the community. A cut in rates for a variety of community-based services funded by Medical Assistance. A cut in funding to counties that normally covers expenses for unexpected increases in needs of some residents with disabilities served in the community. A cut to funds for the counties that help fund, among other services, supports to people with disabilities and their families like respite care and county-funded day training and habilitation services. Cuts to grants for adults and children who have mental illness.

Minnesota’s Health Exchange Takes Shape

Thu, 15 Dec 2011 11:00:24 +0000

Pop Quiz!

Identify which of the following elements were and were not included in the final health reform package President Obama signed into law:

a. A new government-run insurance plan
b. Subsidies to help individuals pay for health insurance
c. Tax credits for small businesses
d. A ban on co-pays for preventive care
e. A government panel that makes decisions about end-of-life care for Medicare recipients

The Affordable Care Act crossed the President’s desk in March 2010—just over a year and a half ago. Yet even today, most Americans don’t know much about what’s in the law.

(Quiz answers: b, c, and d are all actual components of the law.)

A recent poll from Kaiser Health shows that Americans struggle to identify what was and wasn’t included in the 2010 reforms. In some ways, our collective ignorance is understandable: Health care is a complex issue, and the Affordable Care Act marks a complex solution with many different parts. Further adding to the confusion, many pieces of the legislation have yet to be implemented. On top of it all, conservatives insist on continuing the rhetoric of what the law will and won't do.

Luckily, information surrounding one central piece of the legislation has just become easier to grasp in Minnesota. Our state is now piloting five models of health insurance exchanges.

It’s worth clicking through (the health insurance exchanges link) to see what the future holds, but the central premise is this: An exchange is a marketplace where individuals and small businesses can shop for health insurance. Because of the exchanges' structures, individuals and small businesses will be able to band together and share their risk in order to purchase insurance at a “bulk” discount.

These exchanges will likely be similar to, say, Amazon.com’s used books purchasing section. Individuals will enter their basic information and the exchange will return a list of insurance plans, their prices, and what they cover.

The Affordable Care Act allows states to craft their own exchanges. Minnesota’s executive branch is doing just that, despite Tea Party resistance in the legislature to do anything resembling compliance with President Obama’s signature legislative accomplishment. In the end, such resistance could hurt our state’s ability to craft an exchange tailored to Minnesota, as failure to implement a state exchange would mean the federal government will step in with a national exchange.

The exchange plays a crucial role in health reform going forward. Minnesota 2020 has previously detailed how the Affordable Care Act will impact Minnesota (see here and here), but it’s worth noting that the exchange plays a central role by (1) providing a one-stop shop for purchasing insurance on the individual marketplace, a previously-difficult way to buy insurance, and (2) offering an easy access point to determine one’s eligibility for health insurance subsidies.

The law makes health insurance affordable like never before by expanding Medicaid up to 133% of the federal poverty line—an annual income of $29,000 for a family of four—and by offering graduated subsidies for households making up to four times the poverty line—$88,000 for that same family of four.

Furthermore, an exchange will allow side-by-side comparison shopping between insurance plans in a way that just might introduce greater competition into the health insurance market, driving down costs.

While these sample exchanges will be available through the end of January, health insurance exchanges will truly open for business in 2014. That might seem like a long way off, but crafting a Minnesota-targeted exchange, setting up its ground rules, and ensuring it is fully functional will take time.

In the meantime, these pilot exchanges can begin educating Minnesotans on the details of last year’s health reform effort. Reshaping the U.S. health system toward a lower-cost, higher-quality model won’t happen overnight, and implementing a fully-functional exchange will be central to that effort.

VIDEO: Health Care Homes

Thu, 15 Dec 2011 11:00:03 +0000

By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist

During the 2008 Health Care Reform, the Minnesota legislature expanded on a national trend of converting clinics to Health Care Homes. Four years later the Department of Health has certified 134 clinics across the state. The legislation includes payments to primary care providers to improve coordination of care and treatment of chronic health conditions by shifting to a team approach.

Dr. Paul Erickson of Northpoint Health Center says it gives the primary care provider more flexibility to evaluate what is best for the patient and for the community.

VIDEO: A Virtual Checkup for Real Life Savings

Mon, 05 Dec 2011 11:00:41 +0000

By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist

Delivering quality healthcare to rural patients tends to require significant travel. In recent years, however, patients have been receiving some of the important care they need without leaving their communities, or in some cases their living rooms.

Telemedicine industry innovations are changing healthcare to a more patient-centric system, allowing physicians to virtually examine and treat folks. This cuts back on travel and increases preventative care access.

VIDEO: Putting the Care in Healthcare

Thu, 01 Dec 2011 11:00:52 +0000

By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist

If we're going to achieve better health care outcomes at lower costs, we must support nurses, attract well trained, caring people to the profession, and maximize their skills. In doing so, we can increase disease prevention, keeping people healthy and out of hospitals.

A key portion of healthcare reform aims to train more nurses, and help them attain more advanced degrees and specialties. In a time of continuing public health funding cuts, well-trained nurses will be a major factor in ensuring a healthy population.

Follow Minnesota’s Lead, Regulate BPA

Mon, 28 Nov 2011 11:00:22 +0000

By Renee Jordan, Macalester College

Today we present another installment in Minnesota 2020’s series of columns focusing on environmental policy issues. It’s part of our continuing collaboration with Macalester College's Environmental Studies Department and its students.

Many of us question the safety of the water we drink, but few consider the safety of the container that we drink from. Bisphenol A (BPA) is a chemical used in many plastic bottles that may be connected to health risks and environmental pollution.

Within the U.S., BPA remains mostly unregulated despite “possible health effects on the brain, behavior and prostate gland of fetuses, infants and children,” according to the National Toxicology Program (NTP) at the Department of Health and Human Services.

“The Food and Drug Administration… is also taking steps to reduce human exposure to BPA in the food supply by finding alternatives to BPA in food containers,” according to a Mayo Clinic advisory.

Fortunately for Minnesotans, state policymakers have been leaders in regulating this toxic chemical to ensure public safety. It is now time for the nation to follow Minnesota’s lead in creating more stringent regulations on BPA.

Minnesota set the precautionary bar in 2009, becoming the first state to prohibit the sale and manufacture of children’s cups and infant bottles that contain BPA. With the NTP study raising concern levels, this law passed by quite a large margin. The NTP study also raised concern that BPA may cause premature puberty and damage mammary glands.

Test results from a 2010 scientific study through Kaiser Permanente found that male Chinese factory workers exposed to high levels of BPA had poor quality of semen in comparison to workers with little or no exposure to BPA.

Despite this scientific evidence, there is still much debate around BPA's severity of risk. Discussions over whether or not BPA demands government policy and regulation have been prevalent in the last four years, yet few decisions have been reached.

Minnesota is one of a very few states that have recognized BPA's potential harm and implemented precautionary regulations against it. However, no one disputes that BPA is toxic. The argument is over what level of BPA exposure is safe for humans.

The Centers for Disease Control and Prevention studied urine samples of U.S. citizens ages six and older to better estimate human BPA levels. Results found that almost everyone had traces of BPA in their urine, which suggests that BPA is widespread throughout the nation. Even those of us who are conscientious about BPA are still exposed to it through the many commodities that contain the chemical.

It might not just be humans that are affected by BPA exposure. Environmental concerns have been raised about the leakage of BPA into water systems. National Geographic released an article on the impacts of plastic chemicals in the ocean, and claimed that some animals’ reproductive systems—which are essential for species survival—are disrupted by BPA.

The article also discussed BPA’s potential accumulation in marine animals. Another environmental concern is accidental consumption of plastic, which directly puts BPA into an animal’s body.

According to a study published by the Association for Environmental Health and Science Foundation, the U.S. releases surprising amounts of BPA into the environment; about 85,300 kilograms of emissions into the air, and 14,600 kilograms into the water. So far, studies have not confirmed BPA emissions to be considerably hazardous to the environment; however, there has not been enough research to safely assume that BPA emissions are negligible.

There must be more research on environmental impacts of BPA pollution. We can start in our own backyard. BPA has been found in the Mississippi River close to St. Paul. A Drexel University study revealed that male walleyes in the Mississippi have lower testosterone levels in their blood stream due partly to the presence of BPA in their environment. More studies on the impacts of BPA in the Mississippi could call further state and national attention to the current BPA emission standards.

Traditionally, Minnesotans have pursued strong public policy regulating potentially harmful products. Unfortunately, this does very little on a national scale, as Minnesota accounts for less than 2 percent of the U.S. population. BPA exposure is a significant issue that must be addressed nationally. Minnesota has been a beacon in preventative policy, and it is time for the nation to follow suit. We have enough evidence of BPA’s toxicity that it would be devastating to continue ignoring the problem at hand.

Renee Jordan is a sophomore majoring in chemistry at Macalester College. She's also on the school's diving team.

VIDEO: Impending Nurse Shortage

Mon, 28 Nov 2011 11:00:16 +0000

By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist

With the combination of a slowing economy and an aging population, the health care system will feel deep impacts of a nursing shortage. Fewer students are seeking advanced practice nursing degrees, and retiring instructors are not being replaced fast enough.

Leading educators, nurse advocates, and students are preparing for the future, are our policy makers doing the same?

Treat Obesity as a Collective Responsibility

Wed, 16 Nov 2011 11:00:35 +0000

A central tenet of conservative philosophy is “individual responsibility.” In many ways, individual responsibility is an important ideal: Who doesn’t like the sound of taking responsibility for our own lives and actions, and accepting the consequences of our decisions?

Unfortunately, for many conservatives, “individual responsibility” has become code for “you’re on your own.” Having pushed a logical concept to its ideological extreme, radical conservatives now use the tenet as an attack on government and on collective problem-solving.

But the fallacy of conservatives’ focus on the individual over the community becomes clear in many respects. The United States’ obesity epidemic is one great tool for pointing out the failure of an ideology built solely on individual responsibility. After all, what could better embody individual responsibility than the personal control one has over one’s own weight?

Yet the data points to a different story. First, note there is a statistically strong correlation (greater than 0.3) between the percent of a state’s population that is obese and the percent lacking a bachelor’s degree. Strong correlations also exist between a state’s obesity rate and its poverty rate, as well as a strong inverse correlation (when one goes up, the other goes down) between obesity and median household income.

These stats demonstrate that outside factors weigh heavily on whether a person is obese or not. More persuasive still is research indicating a pattern of weight gain shared by individuals with up to three degrees of separation. Or as Rachael Combe summarizes the findings of Nicholas Christakis and James Fowler, “[I]f your friend’s friend’s friend gains weight, it increases your risk of getting fat—and the closer the degree of separation between you and the person beefing up, the more likely you’ll pack on some pounds as well.”

The conclusion comes from a 2007 study reexamined earlier this year, and once again suggests any individual’s weight is largely influenced by factors outside of that person’s control.

The definitive nail in the coffin comes from a pair of studies conducted by Dr. Albert Stunkard in the 1980s and ‘90s. Stunkard’s work built on research by Dr. Jules Hirsch showing an overweight person who has lost significant weight is functioning in a permanent state of starvation and by Dr. Ethan Sims demonstrating that if a normal-weight person bulks up significantly, he or she can effortlessly lose the weight within months. Stunkard’s work, meanwhile, focused on adopted children. His first study found that “adoptees were as fat as their biological parents, and how fat they were had no relation to how fat their adoptive parents were.”

Take a moment to let that sink in. Parents’ influence on their children’s weight is limited purely to genes and has nothing at all to do with upbringing.

His next study, focused on pairs of twins separated at birth, reached similar conclusions: “70 percent of the variation in peoples’ weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease.” Despite a mantra that individuals need to eat less and exercise more, America’s obesity epidemic grows out of modern circumstances exploiting inherent biological traits.

In today’s world, even one’s own weight is the result of a complex web of biology and relationships, both of which have overwhelming influence compared to personal choice or discipline. Furthermore, not only do the causes of obesity cross individual boundaries, but so do obesity’s consequences.

The most direct impact of obesity on the non-obese comes through health insurance premiums. Both public and private health insurance work by distributing the costs of care across all beneficiaries in the form of regular payments. By spreading around risk, health insurers can help guarantee no individual’s costs are too high.

However, when many obese people enroll—with averaging lifetime health costs 30% greater than that of individuals of normal weight—everyone’s premiums go up as the average price of care per person climbs. In fact, obesity has been credited with causing 25% of the growth in U.S. health spending over the last couple decades.

The problem extends beyond the health sector, too—the National Business Group on Health estimates businesses lose $13 billion annually due to obesity-related costs ranging from medical fees to decreased productivity to missed work. That’s almost $150 the average American family must spend every year for the obesity-related increase in production costs of goods and services. No matter how you slice it, we would all benefit from a slimmer society.

Minnesota has an obesity rate of 25.3%, well over twice as high as its 10.2% rate just 20 years ago. To really address our obesity epidemic as a state and as a nation, we need to stop viewing weight as an individual responsibility and instead recognize the far-reaching social causes and consequences of weight gain. The sooner we recognize we’re all in this together, the sooner real progress can be made.

Dr. Watson Will See You Now

Mon, 31 Oct 2011 11:00:15 +0000

The book Superfreakonomics describes a problem rocking the late 19th century developed world: horse poop. With horses the major transportation source in urban centers, cities were beset with waste management problems of a kind unknown today.

“The average horse produced about 24 pounds of manure a day,” Superfreakonomics reads. “With 200,000 horses [in New York City], that’s nearly 5 million pounds of horse manure. A day.” The book describes manure lining streets, sometimes piled 60 feet high, spreading disease, and seeping into basements. An 1898 urban planning conference on manure management ended a week early with no solutions to be found.

And then? “[T]he problem vanished… The problem was solved by technological innovation.” The advent of the automobile suddenly rendered the dung-producing horse obsolete. Problem solved.

The United States’ health care problems don’t reek nearly as bad as urban centers’ horse-related ones at century’s turn. In fact, our imbalance between health spending and health outcomes compared to other industrialized nations suggests our problems can be addressed within today’s constraints, without relying on what the future might bring.

But given today’s political climate, maybe we need something to break through the gridlocked arguments between those advocating single-payer and those who want to privatize Medicare, between those looking to control costs responsibly and those raving about death panels.

Rather than waiting for one side to win out, perhaps a technological innovation could break the deadlock by revolutionizing our health system?

While reliance on a future innovation to magically solve our problems is dangerous, it’s worth asking what might be on the horizon.

First, it’s important to identify the horse-dung corollary clogging America’s health system. Right now, it’s unnecessary care. A Rand Corporation study found only 55% of patients receive recommended care, with overuse driving up costs and underuse potentially causing complications which could also add to costs.

Groups from the U.S. Preventive Services Task Force to the newly-minted Patient-Centered Outcomes Research Institute examine care practices to identify unhelpful ones and dissuade patients and doctors from using them. But the problem extends further: For many medical conditions, no one knows which care method will be most effective for an individual patient, so physicians use trial-and-error to find the strategy that works for a given patient.

What if we could change that?

Step One to front-loading personalized care solutions is ensuring proper diagnosis.

“As Atul Gawande wrote in The Checklist Manifesto, ‘the ninth edition of the World Health Organization’s international classification of diseases has grown to distinguish more than thirteen thousand different diseases, syndromes, and types of injury.’ And that doesn’t take into account all the possible symptoms and recommended lab tests and side effects of, and interactions between, various medications,” Ezra Klein explains. “That’s complexity beyond any human’s capacity to handle. But it’s not beyond a computer’s ability.”

That computer comes with a name: Watson, famous for taking down two acclaimed Jeopardy! champions on that game show last year.

Watson has already turned his electronic gaze toward the medical world. Earlier this month, the computer defeated two teams of cardiologists in a Jeopardy!-like game at the 2012 Medical Innovation Summit. Health plan provider WellPoint Inc. has already announced plans to develop IBM’s Watson technology for commercial use. Watson is attractive for health diagnoses because not only can it comb through mountains of data to offer solutions, but it can interface with regular human dialogue and provide a list of possible conditions ranked by probability of accuracy.

With Watson on the case, medical diagnoses could become much more accurate and reliable, reducing health costs and ineffective treatments related to misdiagnoses.

Step Two to personalizing care solutions is to increase the odds a prescribed strategy for addressing a diagnosed condition will be effective for each individual patient.

Imagine that following your diagnosis, a doctor is able to pull up an aggregated account of individuals with a similar diagnosis to yours who share with you a similar medical history, family medical history, perhaps even DNA sequence. The doctor can then examine which methods of care were most effective for patients most like you, skipping much of the guessing game sometimes involved in selecting a treatment strategy.

It might sound like science fiction, but the medical IT world is currently working toward such a tool. CONNECT is an open-source software model created by dozens of federal agencies working together to create a system for interoperable data-sharing across clinics.

If CONNECT or a similar health record gateway could be implemented in hospitals and clinics across the country, medical histories could be easily evaluated, avoiding duplicated treatments or situations like the prescription of two drugs that are harmful when taken together. Furthermore, by providing the opportunity to aggregate patient data and compare it to individual circumstances, a health record gateway could lead to personalized care like we’ve never seen before.

What’s holding us back from this health care world of tomorrow? Right now, only ten percent of doctors have moved to electronic medical records. And since the federal government has set only voluntary standards for putting medical records in a state where they can be easily and securely shared, transformation will occur as quickly—or slowly—as the medical industry moves.

We can’t rely on Watson, CONNECT, or other technological solutions to materialize and solve our health care problems, so it’s still important to find savings within the system we have. But we can help these changes along, especially considering that from railroad lines to telephone infrastructure to the internet, government has often played a major role in funding tomorrow’s connective technology.

To remove waste and inefficiency from our health system, it’s worth thinking about the miracle that removed horse waste from the streets of New York, then seeing what we can do to proactively replicate such a miracle in the health world.

Growing Holes in Health Care Safety Net

Mon, 10 Oct 2011 11:00:42 +0000

By Sunni Monson, Policy Associate

Marcia Spaise went from a full-time team truck driver to spending her days and nights taking care of her son Sam after an automobile accident left him a quadriplegic, with a traumatic brain injury.

Initially, Marcia took time off and looked for a way to balance her transportation career with her new role as caretaker. She hired outside personal care assistants (PCAs), but realized the best care for Sam would be her own.

“The PCAs could not do the third shift [overnights] needed for turning my son to prevent bed sores (which is required every two hours throughout the night). Some PCA’s were not strong enough to transfer my son, and one person dropped him.”

As a driver who spent most work time in other states, she couldn’t just clock out and run home when there was an emergency with Sam or if a PCA did not show up.

“I immediately realized that having an outside PCA was problematic and would not contribute to Sam’s development. I decided to retire the truck” and become Sam’s PCA.

Minnesota’s personal care assistance program provides persons with disabilities assistance with “activities of daily living,” including eating, toileting, grooming, dressing, and bathing.

Marcia’s situation is common among families who have loved ones with disabilities. Often a child’s care forces a parent to leave the workforce, or a parent’s care forces a child to leave the workforce.

This program has helped families recover a portion of their lost salaries. Family tends to provide better care at a more cost efficient rate than outside PCAs or other nursing care options.

Minnesota is one of 47 states to allow family members to act as paid PCAs at rates and hours determined by the state on a case-to-case basis.

However, these payments have been cut by as much as 20%—a result of a conservative all cuts budgeting approach.

A parent or child leaving the workforce can devastate a family budget. The middle 50% of PCAs earn between $7.81 and $10.98 an hour, according to the Bureau of Labor Statistics. The number of allotted PCA hours per day generally grossly underestimates the 24/7/365 commitments involved. In Minnesota, the state caps hours at 275 per month.

While some family members continue work outside the home while serving as a PCA, most can’t juggle both commitments.

“It was not possible for me to continue holding a job outside the home and get up every two hours throughout the night to turn him/catheterize him,” said Marcia, whose salary diminished from comfortably middle-class to near poverty level.

In Marcia and Sam’s case there were some positive outcomes. With her help and intensive physical therapy, Sam has regained most of his brain functioning, earned his bachelor’s degree, and completed various physical tasks his doctors had deemed impossible.

Joe Haines, who receives PCA services from his mother and his daughter, speaks passionately about investing in relative PCAs.

He’s concerned that the 20% cuts will generate a “mass exodus” of family members out of the field. The system in general would be losing the services of trained, qualified, reliable PCA’s, straining and already meagerly staffed care provider network.

Dena Belisle, a PCA for her son founded ADENA, LLC, a home health care organization for family caregivers.

“We are parents first,” she says. “We are able to provide the best care and do preventive care, which ultimately costs the state less since we spot things much earlier than would an outside PCA who may not notice until the person needs to be hospitalized.”

Hiring non-related PCA’s to supplement family caregivers’ shifts is neither a viable nor effective solution in many cases.

“Most of my clients receive an average of 12 to 12.5 hours of paid PCA services per day at a maximum of 275 hours per month,” said Dena. When hiring a PCA from outside the home, the uncoverable “third shift,” usually requiring check-ins every two hours, would remain family members’ responsibilities and likely impede their productivity at out-of-home jobs.

More likely, families who are unable to continue as PCA's, will need to investigate assisted living facilities such as nursing homes and adult foster care settings, options that may cost the state far more overall. The average assisted living facility costs $40,000 annually, while a semi-private nursing home costs $75,000.

Medicare doesn’t cover these costs, and Medicaid will cover them only after one’s savings have dwindled below the federal poverty level.

Strong policy must ensure not only the highest quality care, but the sustenance of those who care for people with disabilities.

“The last few years since the Pawlenty administration have been very tough. I took pay cuts; I took hour reductions, and now to imagine another 20% cut… There is no way we can financially make it,” said Marcia.

No matter what the cost, family members will continue providing the best care possible—tirelessly and courageously, and constantly. However, slashing the lifelines of dedicated family members is not a solution, and it’s bad economic policy.