The 2010 General Session of the 58th Legislature convenes on Monday January 25th.  By making your voice heard in Utah’s Capitol, you can help us work towards achieving the goal of quality, affordable coverage for all Utahns.  Join us for a practical, hands-on advocacy training where you’ll get the tools and inside tips you need to advocate effectively for the issues you care about. Participants will also learn where key issues stand in week 1 of the legislative session.
What: Advocacy Training for busy people
When: Wednesday, January 27th at 7:00 PM
Where: Board Room, Utah State Capitol (2nd floor on the east side)
RSVP to jessica@healthpolicyproject.org

On Tuesday, the Health and Human Services Appropriations Committee began its deliberations on how to trim 4%, or $23.5 million, from the Department of Health and Department of Human Services’ fiscal year 2010 budgets.  After experiencing deep cuts over the last two years, there is little room to squeeze out savings without harming access to medically necessary care for Medicaid beneficiaries.

The proposals presented by the Department of Health (DOH) and the Department of Human Services (DHS) would cut costs by $15 million.  DOH would meet this target through administrative cuts including furloughs (unpaid days off) and the elimination of currently unfilled positions.  DHS presented a proposal that included a mix of job cuts and reductions in provider payments.

However, these proposals do not meet the Legislature’s 4% target.  So while it is likely HHS Appropriations will adopt the Departments’ recommendations, they will need to find additional cuts—somewhere.   For Medicaid these additional cuts likely mean significant reductions in provider reimbursement rates.

Looking ahead to FY2011, the situation becomes even more dire as the Legislature is seeking a total reduction of 5%.  Most of the cuts being considered for FY2010 are 1-time savings, which means they will not count toward the FY2011 5% goal.  As a result, deep cuts to Medicaid eligibility are being considered yet again, including elimination of the Breast and Cervical Cancer Treatment Program, Medically Needy Medicaid (all categories), and Foster Care Children’s Medicaid Expansion, and the scaling back of eligibility from 100% of poverty to 75% of poverty for people with disabilities and seniors.  In addition to these eligibility cuts, further cuts to provider reimbursement rates will likely be necessary to reach the Legislature’s goal.

NOW IS THE TIME to contact HHS Appropriations members and tell them the harmful impact these proposed cuts will have on Utah families.

Their contact information is below:

The Senate, House and White House are moving forward with negotiations on merging the two bills into one.  There are several key differences between the legislation that will need to be resolved, as we have discussed previously.  Once a compromise is negotiated, the bill will be sent to the Congressional Budget Office (CBO) for a score or cost/savings estimate.  As you know, that process could take up to a week or more.  As per custom, the House will then give its members 72 hours to review the legislation before voting on it.  The goal is to have the bill finalized before the President’s State of the Union; the two dates for the address being floated are Jan 26th or Feb 2nd, so things will begin moving quickly soon.

Both in Utah and nationally, over the last few weeks there has been much discussion about the United States Constitution, the powers of Congress and the respective roles of federal and state government and how health reform fits in this paradigm. It is an important discussion.  The public benefits from these occasional civic lessons about how their government works.  However, there are some who appear to be using the Constitution as a tool to create fear and beat down health reform as being un-American.  Their claims, however, appear to have little bases in the actual text of the Constitution.

In an effort to dispel the fear and demystify the Constitution, UHPP has decided to open up the text and juxtapose the critics’ claims with the powers afforded to Congress under this most American of documents.  Our full analysis can be read here.

Article 1 Section 8 of the United States Constitution defines the power of Congress to enact laws.  These powers are very broad, permitting the Congress to enact laws affecting everything from the military, tax policy, and economic activity.   Congress’ work on health reform (including such things as the mandate on individuals to purchase insurance, health insurance exchanges, and varied Medicaid payment levels to the states) fall well within these powers.
Ultimately, while critics of health reform may have strong arguments on policy grounds, their constitutional claims are misguided and distract from the very real need to solve the health care crisis that confronts us all.

Affordability: the keystone of health reform
Another hot issue dominating Congress’ negotiations is affordability.  Health reform can only succeed if it makes coverage truly affordable for families.  One of the most compelling arguments for federal government participation in health reform has always been that the federal government has the resources as well as the infrastructure to help Americans afford the cost of private health insurance. State governments can and should be working on reforming aspects of the healthcare system including insurance regulation, containing costs within their healthcare infrastructure and providing consumers with more education and tools to address lifestyle issues. However, most states (including Utah) do not have the resources to provide subsidies on a large scale or to expand their Medicaid programs in the best of times, let alone during an economic downturn, when these programs are most needed.

Beyond these practical considerations, there is a philosophical precedent to addressing affordability at the federal level. Our national approach to issues of public well-being has always been to allow the private marketplace to provide the goods and the government assists consumers in purchasing those goods. Homeownership is the best example of this philosophy. The private marketplace provides the goods—homes, financing, etc and then the government helps consumers have access to those goods through guarantees on mortgages, tax deductions for interest payments on mortgages, and rent subsidies for the lowest income residents. We, as a nation, decided this was a better approach than having the federal government plan, design and construct homes or neighborhoods.

A similar philosophy undergirds the affordability provisions within national reform. Most of the newly insured will pick up insurance in the private marketplace. Those who need it will get government-funded subsidies to help pay their portion of the premium.  Those without a reasonable offer of coverage in the workplace (most poor adults, including childless adults), will become eligible for Medicaid.

All of this sounds good in the abstract, but what about in practice? As the Senate and House complete their negotiations, differences around affordability will be a critical sticking point. The Senate bill provides somewhat better protections of middle income workers.  However, the House bill provides a stronger subsidy program, especially for those earning less than 200% of the poverty level–most of the uninsured.  In addition, the House offers better benefits to those that qualify for the subsidy and invests more resources into subsidies–$900 billion compared to the Senate’s $600 billion. A couple billion here, a couple billion there and pretty soon you’re talking real money!   There’s no question: the $300 billion difference between the two bodies could be the most difficult hurdle to overcome.  We urge the delegation to support the best elements of both approaches to create a final bill that will protect all Utah families from costs they cannot afford.

The Utah Multicultural Health Network (MHN) is on fire these days preparing for a busy legislative session but also gearing up for the introduction of Healthy People 2020, the nation’s 10-year blueprint and framework for eliminating health disparities. MHN will be working with the state’s Center for Multicultural Health and other key partners in DHS and DWS and the Federal Office of Minority Health’s Utah liaison to create, at long last:  an integrated blueprint. The idea here is to ‘sing off the same song sheet’ to the extent possible so that we might get more done and get underneath the more perplexing challenges related to the broader socio-economic determinants (SED) of health.

On December 17 MHN and UHPP convened a group of about 36 minority health leaders in the state. This group gave tremendous input on the Blueprint project and formed a working group to start work on the Blueprint. Stay tuned for further details about a community forum that will be organized to shape the draft Blueprint that this group come up with.

The good news is that the Healthy People 2020 framework places a heavy emphasis on SED: so we won’t be alone as we endeavor to create better economic and educational opportunity for all communities.

In the meantime, please take a moment to review these materials:

* MHN Policy Committee’s Draft Priorities for the 2010 Session of the Utah Legislature
* Healthy People 2020 Draft Objectives (NOTE: public comment period has been extended to February 12, 2010)
* National Partnership For Action Strategic Framework
These documents will be critical in the weeks and months ahead. Be sure also to register for the upcoming Advocacy Training for Busy People, an exciting collaborative effort between UHPP, MHN, and Enrich Utah (new name for Utah’s immigration coalition).  Lots to do together in 2010!

–Judi Hilman, Executive Director

Sometimes it’s the issue that doesn’t get all the media attention that is the most worthwhile.  Behind the scenes and with little pomp and circumstance, the state has been developing an exciting new tool: the All Payer Database (APD).

The APD pulls together medical claims, pharmacy claims data, hospital and provider data and insurance data for all Utahns receiving care from Utah providers.  APD can then provide reports to insurance companies, providers, researchers and the general public.  The importance of this data simply cannot be understated.  For example, the APD could help us learn the cost of care for patients based on the number of chronic conditions or the geographic differences in the cost for a normal child birth without complications.  We could also see a ranking of the top ten prescriptions by volume for different cities or small areas in the state.  If queried properly, the APD will likely illustrate why it is more cost-effective in the long run to have comprehensive and affordable benefits! To put the capabilities of APD in context, it does for the healthcare system in Utah what Henry Ford’s assembly line did for the auto industry at the turn of the last century. It puts all the components of health reporting under one roof—like an assembly line floor. It standardizes reporting in a way similar to putting standardized components into a car, instead of manufacturing one by hand. Both of these components are necessary to providing timely, inexpensive and useful products. The full rollout of the APD is expected over the summer, just in time for key legislative interim decisions!

This new tool is one of many exciting payment and delivery health reforms underway in the state.  By investing in reforms like these, our state is on the way to becoming a national leader in transforming our health care system to ensure that Utahns receive high quality care at the right price.

Janice Houston, Coverage Initiatives Director

We are just a week and a half away from the official start of the 2010 Legislative Session.  Budget committee hearings are already underway, however.  New bills are getting filed and released daily as legislators and stakeholders gear up for what promises to be an intense legislative session.  UHPP is a resource to you as you prepare to navigate the legislative session.  We have created a series of tools to help you advocate for quality, affordable coverage for all Utahns.

A. Advocacy Training
The UHPP, Utah Multicultural Health Network, and Enrich Utah are joining forces to offer a hands-on advocacy training. Here you will get the tools and inside tips you need to advocate effectively for the issues you care about.

What: Citizen Advocacy Training
When: Wednesday, January 27, 2010 at 7:00 PM
Where: Capitol Board Room, Utah State Capitol (2nd floor on the east side)
RSVP to events@healthpolicyproject.org

B. Legislator List
Check out our handy 2010 spreadsheet of legislators and their contact information.  Use it to track your conversations with legislators, find out who sits on the committees that oversee health issues, count votes on bills, or mail merge to contact legislators individually!  To download in Excel, click here.

C. Fact Sheets
UHPP is continually preparing materials to give you the latest nonpartisan information and talking points.  You’ll find one-page factsheets to help you with your advocacy, as well as in-depth issue briefs to give you a thorough explanation of the issues.  Check out our Publications Page for our latest materials.

D. Advocacy Tool Kit
The State Capitol is called the People’s House for a reason.  Legislators are there to represent YOU, but they can only do that if you communicate with them.  If you want to get more involved, but are new to Capitol Hill, we have gathered all the tools you need to learn the basics of respectful citizen advocacy.  They are posted on the Advocacy Toolkit page of our website.

E. Getting to the State Capitol
Public Transportation: If you are downtown, the UTA bus is a great option to get up to the Hill.  Route 500 will take you right to the East Building’s front door!  The Capitol is in the Downtown Free Zone and buses run every 15 minutes.  The bus schedule is posted here, along with the route map here.  UTA has a great trip planner tool, as well.

Driving from outside of Salt Lake:  If coming from northbound I-15, take the 600 South exit, or if coming southbound, take the 400 S exit.  Head east to State Street. Turn left on State Street and head up the hill to the State Capitol.

Where to park?
If you must drive, a public parking lot is right next to the East Building (also known as the Senate Building).  There is also plenty of street parking on the east and north sides of the Capitol, though you should plan to walk a bit.  If parking in the neighborhoods to the west, make sure to check the signs for parking time limits.

F.  Overview of key issues for the 2009 Legislative Session
No matter what issues you care about, it’s always helpful to know what key general issues the legislators will be considering this Legislative Session.  The Office of Legislative Research and General Council has summarized the key issues for 2010 here.

G.  Stay tuned for UHPP’s Health Bill Tracker 2010—in the works.

Welcome to UHPP’s blog, Health Matters!  In our latest effort to embrace web 2.0 applications and be more interactive online, we’ve upgraded our e-newsletter, Health Matters, into a blog.

On these pages, we’ll bring you with real-time insights, expertise and opinions on health care policy issues impacting Utah–everything from aligning national and state health reforms to optimizing Utah’s Medicaid program.  While we hope to provide a wealth of reliable and insightful information, we hope you also use this space to share your comments and ideas.

Be sure to subscribe to our RSS feed or check back often for updates.

—Jessica Kendrick, Community Engagement Director