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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Legislators not sold on new junk food rules for schools

In April the Iowa State Board of Education approved new nutrition standards:

A special task force drew up the standards, which set limits on calories, fat content, sugar and other nutritional measures. Carbonated beverages are banned. Caffeinated beverages and sports drinks are banned in elementary schools.

But the rules do not apply to food provided by school lunch or breakfast programs, items sold at concession stands or certain fundraisers or items provided by parents, teachers or others for class events.

Although I would have preferred tougher guidelines, these rules were a step in the right direction. To be more precise, they would have been a step in the right direction. After protests from some school officials, the State Board of Eduation “delayed most of the standards from going into effect until the 2010-11 school year.”

By that time, the regulations may have been relaxed, judging from what happened last week in the state legislature’s Administrative Rules Review Committee (unofficial motto: “Where good rules go to die”). The rest of the story is after the jump.

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The week in Tom Harkin news

I’ve been meaning to write up a few stories about Senator Tom Harkin this week. As you may recall, he has been working on a compromise for the Employee Free Choice Act, which would build the middle class by making it easier for workers to join a labor union. (Click here for background on the EFCA.)

On Monday Harkin told Bloomberg News that the “card check” provision may have to be dropped from the EFCA in order to get the bill through the Senate. “Card check” means that workers could form a union if a majority sign a document stating that they would like to join a union. Republicans and business groups are loudly complaining that this would destroy “secret ballot” elections on unions, ignoring the reality: “[t]he current process is not secret or democratic.”

Anyway, Harkin told Bloomberg that he hopes to find a compromise

that will gain “maybe the grudging support of labor and maybe the grudging support of some businesses.” […]

A softened version of the bill may attract support from more lawmakers, Harkin said. “Many do feel there is an imbalance” in current laws that favors business over labor, Harkin said.

“They may not be for the card-check, but they are for changing election process and procedures and shortening the period of time for elections” to form unions in a company.

The Bloomberg piece didn’t say anything about binding arbitration, which in my opinion is as important a part of EFCA as card check.

Also this week, Harkin told CNN that he supports appropriating funds to shut down the Guantanamo Bay detention complex this year, as President Barack Obama has promised to do.

In other news, I read at La Vida Locavore that Harkin just introduced a bill to amend the Child Nutrition Act of 1996. Jill Richardson writes that Harkin’s bill

will update the rules on what’s allowed to be served or sold in schools. Right now, almost everything is fair game to sell in schools. You just can’t sell the worst junk in the cafeteria during lunch time. Outside of the cafeteria, anything goes. In the cafeteria when it’s not time for lunch, anything goes.

Harkin’s commitment to improving the health and nutrition of American children continually impresses me (see here, here and here).

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King and Latham vote against health care for children (again)

Great news, everyone! Today the House of Representatives approved an expansion of the State Children’s Health Insurance Program (SCHIP). In Iowa, this program is known as HAWK-I, and it provides coverage for thousands of children whose families are not poor enough to qualify for Medicaid, but not wealthy enough to purchase health insurance:

The child health bill would provide $32.3 billion over four and a half years to continue coverage for seven million children who now rely on the program and to extend coverage to more than four million who are uninsured.

“This is a day of triumph for America’s children,” Speaker Nancy Pelosi of California said. “We put women and children first.”

After years of frustration, Democrats were exultant.

“Today is a new day,” Representative Dave Loebsack of Iowa. Representative Chris Van Hollen, Democrat of Maryland, said, “Passing this bill sends a very important signal that change has come to Washington as a result of the last election.”

Representatives Bruce Braley and Leonard Boswell joined Loebsack in voting for the bill, which passed by a comfortable margin of 289-139. But as you can see from the roll call, Representatives Steve King and Tom Latham voted no.

King has been a proud opponent of the SCHIP program for years. In the bizarro world he inhabits, this program is Socialized Clinton-style Hillarycare for Illegals and their Parents.

Gee, I thought it was for people like my friend, who owns her own business but couldn’t afford health insurance for her kids after her husband got laid off. With the enormous job losses of the last few months, more and more families will need this program.

Anyway, we’ve all come to expect this kind of vote from King.

I hope some Democrats who crossed over in the fourth district to support Latham will open their eyes now. Today’s vote should not surprise anyone, because Latham has voted against expanding the SCHIP program on several occasions.

Still, I doubt this is what most voters had in mind when they saw television ads touting Latham’s “trusted leadership” on health care.

The Senate will take up this bill within the next two weeks, and I doubt Republicans will be able to filibuster it. So, Barack Obama will have a major achievement on health care very early in his presidency. Let’s hope it will be the first of many.

UPDATE: In typically dishonest fashion, Steve King (who never met a tax cut for the rich he didn’t like) claims the SCHIP bill “provides new benefits to illegal immigrants and wealthy families at the expense of low-income children.”

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