Iowa tops new scorecard on children's health care

Iowa received the overall top ranking in a new report on the health care system in all 50 states and the District of Columbia. The Commonwealth Fund is a private foundation supporting research on health care issues and policies to achieve "better access, improved quality, and greater efficiency, particularly for society’s most vulnerable." Researchers who compiled the 2011 state scorecard uncovered huge disparities in terms of access to care, health care quality, and health outcomes:

There is a twofold or greater spread between the best and worst states across important indicators of access and affordability, prevention and treatment, and potential to lead healthy lives (Exhibit 1). The performance gaps are particularly wide on indicators assessing developmental screening rates, provision of mental health care, hospitalizations because of asthma, prevalence of teen smoking, and mortality rates among infants and children. Lagging states would need to improve their performance by 60 percent on average to achieve benchmarks set by leading states.

If all states were to improve their performance to levels achieved by the best states, the cumulative effect would translate to thousands of children’s lives saved because of more accessible and improved delivery of high-quality care. In fact, improving performance to benchmark levels across the nation would mean: 5 million more children would have health insurance coverage, nearly 9 million children would have a medical home to help coordinate care, and some 600,000 more children would receive recommended vaccines by the age of 3 years.

Leading states-those in the top quartile-often do well on multiple indicators across dimensions of performance; public policies and state/local health systems make a difference. The 14 states at the top quartile of the overall performance rankings generally ranked high on multiple indicators and dimensions (Exhibit 2). In fact, the five top-ranked states-Iowa, Massachusetts, Vermont, Maine, and New Hampshire-performed in the top quartile on each of the four dimensions of performance. Many have been leaders in improving their health systems by taking steps to cover children or families, promote public health, and improve care delivery systems.

Iowa was the top-performing state in just one category: percentage of young children receiving all recommended doses of the six key vaccines. However, Iowa’s relatively high scores (among the top 5 states on nine indicators and in the top quartile for 14 indicators) made our state number one overall and in the “prevention and treatment” subgroup, number two in “potential to lead healthy lives” subgroup, and number six in the “access and affordability” subgroup. More detail on Iowa’s rankings can be found on this chart. To compare Iowa to other states, use this interactive map or download the full report here.

The new report’s executive summary highlights the benefits of the federal Children’s Health Insurance Program (generally known as SCHIP):

The Scorecard’s findings on children’s health insurance attest to the pivotal role of federal and state partnerships. Until the start of this decade, the number of uninsured children had been rising rapidly as the levels of employer-sponsored family coverage eroded for low- and middle-income families. This trend was reversed across the nation as a result of state-initiated Medicaid expansions and enactment and renewal of the Children’s Health Insurance Program (CHIP). Currently, Medicaid, CHIP, and other public programs fund health care for more than one-third of all children nationally. Children’s coverage has expanded in 35 states since the start of the last decade and held steady even in the middle of a severe recession. At the same time, coverage for parents-lacking similar protection-deteriorated in 41 states.

SCHIP used to be a favorite punching bag for Representative Steve King, who voted against funding what he called “Socialized Clinton style Hillarycare for Illegals and their Parents.” Fortunately, the majority in Congress recognized this program’s potential.

After the jump I’ve posted a sidebar from the general summary of the Commonwealth Fund’s report, called “Iowa’s Comprehensive Public Policies Make a Difference for Children’s Health.” I also included some methodological notes and listed the 20 indicators measured by researchers.

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Republicans put government between women and their doctors

Remember last year when Republicans claimed health care reform would put government bureaucrats between patients and their doctors? It was a hypocritical talking point to begin with, given how often insurance companies overrule doctors’ orders, in some cases denying sick people access to life-saving medical care.

The hypocrisy is especially apparent now that Republicans are cheering two new laws passed in Oklahoma.

The Oklahoma Legislature voted Tuesday to override the governor’s vetoes of two abortion measures, one of which requires women to undergo an ultrasound and listen to a detailed description of the fetus before getting an abortion.

Though other states have passed similar measures requiring women to have ultrasounds, Oklahoma’s law goes further, mandating that a doctor or technician set up the monitor so the woman can see it and describe the heart, limbs and organs of the fetus. No exceptions are made for rape and incest victims.

A second measure passed into law on Tuesday prevents women who have had a disabled baby from suing a doctor for withholding information about birth defects while the child was in the womb.

To clarify: Republicans passed a law dictating the way doctors communicate with patients and how they must proceed with every woman seeking an abortion, regardless of her individual circumstances. According to the New York Times, the Center for Reproductive Rights has already filed suit to challenge the constitutionality of the ultrasound law, claiming it “violates the doctor’s freedom of speech, the woman’s right to equal protection and the woman’s right to privacy.”

The second law is in some ways more offensive, because the government is shielding doctors who deliberately do not level with their patients. I have close friends who have learned while pregnant that their future child has serious medical problems. To give doctors license to deceive women in that situation is unconscionable. Pregnant women must be able to make informed decisions regarding all medical care. Who’s to say that doctors will stop at “merely” hiding birth defects? Maybe some will decide it’s better not to tell women they have cancer or some other disease that might prompt them to terminate a pregnancy.

The new laws are similar to two anti-abortion laws the Oklahoma Supreme Court already struck down. Clearly Republicans won’t let a little thing like the state constitution get in the way of their desire to intimidate women and interfere with the information they receive from their doctors. I agree with Charles Lemos: this is a sign of how extreme today’s Republican Party has become.

Iowans who don’t take reproductive rights for granted may want to know that Arianna Huffington is coming to Des Moines next Tuesday to help raise money for Planned Parenthood of the Heartland (formerly Planned Parenthood of Greater Iowa). Click the link for event details.

Share any relevant thoughts in this thread. I recommend this post from the Ms. Magazine blog on the 10 worst myths about abortion in the United States.

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Obama orders end to discrimination by hospitals

President Barack Obama has instructed the Health and Human Services department to develop new rules for hospitals that receive Medicare or Medicaid funding.

The memorandum from Obama to HHS Secretary Kathleen Sebelius, made public late Thursday night, orders new rules that would ensure hospitals “respect the rights of patients to designate visitors.”

Obama says the new rules should require that hospitals not deny visitation privileges on the basis of sexual orientation or gender identity.

“Every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides whether in a sudden medical emergency or a prolonged hospital stay,” Obama says in the memo.

Affected, he said, are “gay and lesbian American who are often barred from the bedsides of the partners with whom they may have spent decades of their lives — unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.”

Cue conservatives to start whining about “special rights for homosexuals,” as if there is something extraordinary about visiting a loved one in the hospital or granting your life partner power of medical attorney. I’m glad the president took a stand on this issue.

I’m curious to see how the U.S. Conference of Catholic Bishops reacts to this executive order. I don’t know whether Catholic hospitals are more likely to have rules in place preventing visitation by gay or lesbian partners, but I would expect religious conservatives to complain about the government nullifying such rules. I wonder whether there is even grounds to challenge Obama’s order in court, if hospitals could demonstrate that their visitation bans are grounded in religious principles.  

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Massive Iowa Legislature linkfest (post-funnel edition)

The Iowa Legislature has been moving at an unusually fast pace during the shortened 2010 session. It’s time to catch up on what’s happened at the statehouse over the past three weeks. From here on out I will try to post a legislative roundup at the end of every week.

February 12 was the first “funnel” deadline. In order to have a chance of moving forward in 2010, all legislation except for tax and appropriations bills must have cleared at least one Iowa House or Senate committee by the end of last Friday.

After the jump I’ve included links on lots of bills that have passed or are still under consideration, as well as bills I took an interest in that failed to clear the funnel. I have grouped bills by subject area. This post is not an exhaustive list; way too many bills are under consideration for me to discuss them all. I recommend this funnel day roundup by Rod Boshart for the Mason City Globe-Gazette.

Note: the Iowa legislature’s second funnel deadline is coming up on March 5. To remain alive after that point, all bills except tax and appropriations bills must have been approved by either the full House or Senate and by a committee in the opposite chamber. Many bills that cleared the first funnel week will die in the second.  

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Some Health Care Thoughts

I was going to comment on desmoinesdem's snow link story, but I decided to write my first diary instead…here she is:

Many on the left might be feeling depressed right now.  After all, this filibuster proof majority in the Senate is not really helping that much, and health care is seemingly being excessively watered down.

However, Democrats should not be overly depressed.  They have effectively shut down the voices of the Republican Party in Washington, save Olympia Snowe.  Isn't that what the supermajorities were all about?

Furthermore, according to President Obama, the public option is not everything.  I know many folks believe that it is, but there are many reforms in this bill that, if voted on by themselves, would easily receive over 80 votes in the Senate (i.e. they're popular and good policy).  Plus, if a bill does pass before the State of the Union address, even a sub-par one, President Obama can use that platform to boast, and tell us all about the wondrous portions of the health care reform that the Democrats alone passed through Congress.

I'm sure it'll be quite a speech.

As for the public option, moderate Democrats are quite the thorn in the side of the Democratic leadership.  It's kind of a Catch-22, though, as we can see in the following conversation:


Senator Lieberman: “The public option is a huge deal!”

President Obama:  “Look, Joe, the public option is only a small part of reform.  As such, if it's such a small portion of reform, why would you sink all of health care just to stop the public option?”

Lieberman: “Oh…it's only a small part of reform?”

Obama: “Yes…didn't you hear my speeches over the last 3 months?”

Lieberman: “Great…so if we get rid of the public option, it really won't harm reform that much…after all, it's only a small part of reform.”


Moderate Dems are probably thinking one of two things.

1.         If this PO is huge, then I’m justified in opposing it…more govt, more spending, my constituents don’t like it, yada yada yada

2.         If this PO is not huge, then I’m justified in opposing it…why are we fighting over something so small?

Some may disagree with their logic and/or facts, but the situation remains.


I'm willing to declare that the “public option” will be one of the following four options:

1.  The idea that was floated yesterday was of Medicare 55-65.  Although it could be problematic, politically.  thereisnospoon had a diary that speaks to that yesterday.  Interesting points.

2.  The good ole' Snowe trigger.  Many on the left believe that this is actually designed never to trigger.

3.  This OPM buy-in, so people can purchase federal insurance…although, many people are saying that it's not a real public option.

4.  Some sort of Opt-In public option…which probably would not be as robust as an Opt-Out, considering the nature of it.

Another big question is, if the final PO is one of these four options, is an individual mandate a political winner for the Democrats?  I’d have to say no.  desmoinesdem seemed concerned about it today too.  Why alienate younger voters?

The political play-out of this has been fascinating, and rarely do we have a time in American politics where we truly do NOT know the outcome.  We’ll see how it plays out.  Of these four options, or a fifth that I may have overlooked, what would be the best from a policy standpoint?  A political standpoint?

Nancy Pelosi's Genius

Something I just realized, from reading about the tightening results in NY-23 – prior to the two special elections, Pelosi had literally a one vote margin on the health care. From the article:

Before Owens was sworn in Friday, Rep. John Garamendi, a Democrat who won a special election in California, was sworn in Thursday. The two gave Pelosi the votes she needed to reach a majority of 218 and pass the historic health care reform legislation in the House.

The bill passed 220-215 late Saturday with the support of only one Republican. The Republican, Rep. Anh "Joseph" Cao of Louisiana, said he voted for the legislation only after seeing that Democrats had the 218 votes needed for passage.

This isn’t quite right; with both special election seats vacant, 217 would have provided a majority. If both seats had been claimed by opponents of health care, Pelosi could have held the vote before seating the new representatives. Without their two votes and without counting Cao, this would have left her with exactly 217 votes. Wow.

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