Children's Monitor Online
A Public Policy Update from the Child Welfare League of America

   
   
Vol. 23, Issue 1: 1/11/2010   
Headlines

Health Care Costs Slowed By Recession But Still Increasing

Health Care Talks Restart at Highest Levels

Senator Stabenow Circulates Letter for Therapeutic Foster Care Medicaid Coverage

Still Time to Register for CWLA's 2010 National Conference!

Three States Approved For Kinship-Guardianship Option, 11 More Pending

Key Upcoming Dates for Congress



Health Care Costs Slowed By Recession But Still Increasing

The cost of health care in the United States has been central to the health care debate and an annual report by the Department of Health and Human Services (HHS) offers evidence of why that is so. The National Health Expenditure Data, published by the Centers for Medicare and Medicaid Services (CMS) on January 5, indicates that health care costs increased by 4.4% in 2008 compared to 6% in 2007. It is the slowest increase since tracking began in the early 1960s. While there has been debate over the cost of the two health care bills, which will spend between approximately $870 billion and $1.1 trillion over a 10-year period, the annual data shows total health care cost were more than $2.3 trillion in 2008. Health care continued to increase as part of the total Gross Domestic Product (GDP), increasing by 2.6% to 16.2%. The costs for health care in the United States totaled an average of $7,681 per person.

Government health care spending at all levels increased faster than private health care spending with the two biggest programs--Medicare ($469 billion) and Medicaid ($344 billion state and federal funds)--increasing by 8.6% and 4.7% respectively. Much of the Medicaid spending increases were due to the stimulus funding and increased numbers of Medicaid recipients. Private health insurance covered 1 million fewer people while the enrollment in Medicaid went up by 1.3 million people. The full impact of the "Great Recession" likely won't be understood until next year's numbers on 2009 spending are available.

Despite the debate over the federal government's role in health care, the report indicates that a full 48% of health care is currently covered through government programs with Medicare covering 20%, Medicaid and CHIP 15%, and other programs such as veterans, defense, and state and local programs including workers compensation covering the balance. Private health insurance funding, including philanthropic spending, covered 40% of health care, with the remaining 12% coming from out-of-pocket costs.

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Health Care Talks Restart at Highest Levels

With the Senate's passage of the Patient Protection and Affordable Care Act (H.R. 3590) on December 24, Washington leadership took the next step last Tuesday, January 5. A meeting was held at the White House that included Speaker of the House Nancy Pelosi (D-CA), Majority Leader Steny Hoyer (D-MD), Senate Majority Leader Harry Reid (D-NV), and Majority Whip Dick Durbin (D-IL). The negotiations over a final bill will not go through a formal Conference Committee, rather the key leaders of the two houses and the White House will attempt to come to an agreement that would be acted on once the votes are there to pass the measure. Under such a process, the Senate version of H.R. 3590 would be amended again with any agreed-upon final bill. If the House approved that version it would then go back to the Senate for another debate and vote.

This informal process avoid going through a Conference Committee, which would include members from the key committees in both houses who may debate and vote on various positions. Before a Conference Committee could even formally meet, each house would have to approve which members will be on the Conference Committee. That means that even the approval of Senators for such a committee would be subject to potential filibusters and additional lengthy debate.

There are important differences between the two bills beyond the two issues that have received the greatest publicity: whether to include a public option and how to address abortion services. Other issues that will have to be negotiated include how much support or how high subsidies should be for the uninsured, the final total cost of the bill and how to pay for it, and the structure of the insurance exchanges. Two key issues for CWLA are the inclusion of a home visiting program and language assuring the ability to use rehabilitative services under Medicaid for children in foster care. The two houses have some difference in their approaches on home visiting. There are also differences on language regarding Medicaid coverage of therapeutic foster care (see article below).

There has been a generally discussed goal of getting a final bill to the President by the State of the Union, but that could be a challenge even if there is a quick agreement. There would have to be additional debate and likely Senate cloture votes before the final bill goes to the White House. A chart comparing the two versions of the bill side-by-side is available online.

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Senator Stabenow Circulates Letter for Therapeutic Foster Care Medicaid Coverage

One of the differences between the House and Senate bills on health care is that the House legislation includes language that protects the use of therapeutic foster care under Medicaid. The Senate version of health care that came out of Finance Committee contained some of the same protections, but when the two Senate bills were combined the Finance Committee language was not included. As a result, Senator Debbie Stabenow (D-MI) is circulating a letter to fellow senators asking that a final health care bill include the House language found in section 1727 of the House bill. At press time, more than 10 of Stabenow's Democratic colleagues had signed on. Stabenow's office is still seeking additional signatures through the close of business today, Monday, January 11. To call your senator to ask them to sign on to the letter, call the Capitol switchboard at 202-224-3121.

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Still Time to Register for CWLA's 2010 National Conference!

CWLA has posted its 2010 National Conference registration program. As the program indicates, CWLA's 2010 national conference features more than 120 child and family experts reporting on timely and important topics like adoption, foster care, technology, executive leadership, early childhood and mental health, juvenile justice, and residential services. The national conference is a month earlier this year--January 24-27, 2010--so it is important to register soon! Register online.

Advocacy Day will be held in the middle of the national conference, on Tuesday, January 26. This may be the same day as President Obama's first State of the Union address, but the White House has not yet set the date. CWLA's Advocacy Day is the largest national advocacy event of the year for child welfare advocates and CWLA encourages all conference attendees to go to Capitol Hill and carry the message for the children, youth, and families you serve. Learn more about Advocacy Day online.

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Three States Approved For Kinship-Guardianship Option, 11 More Pending

The Children's Bureau has now approved amended state plans from Rhode Island, Pennsylvania, and Tennessee that will allow the states to utilize Title IV-E funds for the new kinship-guardianship option as provided for through last year's Fostering Connections Act (P.L. 110-351). Ten other states along with the District of Columbia have also submitted state plan amendments. These states are Connecticut, Illinois, Maine, Massachusetts, Michigan, Missouri, Montana, New Jersey, Oregon, and Washington.

The kinship-guardianship option became effective shortly after Fostering Connections was signed into law in October 2008, but there is no timeframe or deadline for states to take the option. While some were expecting states to act more quickly, enactment coincided with the recession, which has had a delaying impact. Factors that may inhibit states include some states requiring legislative changes, other states contemplating dramatic cuts in human service funding, and other states awaiting greater instruction and clarification from HHS, including on an important issue as to whether or not children already in kinship placements and otherwise eligible being covered once a state has taken the option or whether coverage extends only to new kinship arrangements established after a state plan has been amended. HHS has stuck by the December 2008 guidance, requiring the narrower eligibility, but some states such as California are seeking a broader interpretation.

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Key Upcoming Dates for Congress

January 12: Second session of 111th Congress starts for House
January 18: Martin Luther King Jr. Day
January 19: Second session of 111th Congress starts for Senate
January 24-27: CWLA National Conference
January 26: Projected date for State of the Union
February 2: Release of Administration's FY 2011 budget
February 13: Presidents' Day break

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