In a partisan stand against the Affordable Care Act, Florida Gov. Rick Scott (R-FL) and GOP lawmakers are turning away much-needed federal funds aimed at preventing child abuse and neglect. According to Linda Merrell of the Florida Child Healthcare Coalition, the state has missed out on up to $52 million in federal funding — $3.4 million of which Scott turned down this year and millions more in grants available under Section 2951 of the Affordable Care Act for home health visits.

The money is sorely needed. In 2010, the state legislature cut a staggering 43 percent of the budget for its Healthy Families Florida program, which provides home visitation services to both expecting parents and parents with newborn children in order to prevent future instances of abuse. As a result, Healthy Families was forced to scale back, dropping services for 5,800 children in 3,500 high-risk families.

But according to the annual study by the State Committee Child Abuse Death Review Committee, Florida should be beefing up its support of Healthy Families Florida to save its children, not cut its funding. After reviewing the deaths of 197 children statewide due to abuse and neglect, the committee offered its recommendations to Scott and the state legislature:

“#2 Fully Fund Healthy Families Florida - Support the Department of Children and Families 2011-12 Legislative Budget Request to restore Healthy Families Florida funding to the 2009-10 funding level…

With scarce resources, it is even more critical that the Governor and Legislature prioritize funding for programs and services that show consistent positive results and yield the greatest possible return for the recovery and future economic prosperity of Florida and its citizens. Healthy Families Florida, the state’s only nationally accredited, community-based home visiting program is one of these programs. [...]

Florida’s taxpayers pay an estimated $64,377 a year to care for an abused or neglected child, while Healthy Families Florida prevents the costs of child abuse and neglect for only $1,671 a year per child, saving taxpayers millions of dollars.

A rigorous five-year independent study and follow up study shows that Healthy Families prevents child abuse and neglect, keeping families together and children out of the child welfare system — 98 percent of the children served by Healthy Families are abuse free.”

Even though this report landed on the desks of Walker, Florida House Speaker Dean Cannon (R), and Senate President Mike Haridopolos (R) on Jan. 10, 2011, the legislature voted this year to keep the Healthy Families budget at 2010′s depressed level.

By refusing to provide, pursue, or even accept funding for child-abuse prevention programs, Scott and his GOP allies are sacrificing Florida’s children in order to cling to a partisan talking point.

– Sarah Bufkin

Our guest bloggers are Judy Feder, Urban Institute Fellow and Professor and former Dean, Georgetown Public Policy Institute, Harriet Komisar, Research Professor, Georgetown Public Policy Institute, and Paul Van de Water, Senior Fellow, Center for Budget and Policy Priorities

With most of the focus on the Affordable Care Act’s impact on health insurance coverage, little attention has been paid to one of its more remarkable initiatives: launch of a modest, but significant, public insurance initiative to protect people who need long-term services and supports. Despite its value and its fiscally responsible design, the so-called Gang of Six has put CLASS (Community Living Assistance Services and Supports Act) on the chopping block. Not only would repeal of CLASS forgo much needed help for people who become disabled; it wouldn’t reduce the budget deficit.

On the help side, CLASS addresses a huge hole in our social safety net: neither private insurance nor Medicare protects people against the risk of needing extensive and long-term help with fundamental tasks of daily living like eating, bathing or getting dressed. Needing that help is just the kind of catastrophic and unpredictable event for which we need insurance protection. Today, about four in 10 people who need long-term care are under the age of 65. Even among people now turning age 65, the risk is unpredictable; three in 10 will likely die without needing any long-term care, but one in five will require services for five years or more. At all ages, impairment is hard to predict or save for. And, if that impairment arises, the costs of care can be catastrophic: over $75,000 per year, on average, for a nursing home, and close to $20 per hour for care at home. With costs so high and no insurance protection, it’s no surprise that, today, so many people who need long-term care get inadequate help or exhaust all their resources and turn to Medicaid for support.

Although the CLASS program doesn’t address this problem today, it makes it possible for working aged adults to start paying now in case they need help in the future. Under the ACA, people can pay premiums while they’re working and — if they contribute for five or more years (and continue to contribute when they retire) — can collect a benefit if an illness or injury impairs their ability to perform basic tasks. The benefit will be meaningful but limited — an average of at least $50 per day that recipients can use to pay for home-based or institutional services, as they see fit. The benefit is quite basic, providing a core of protection that — along with family care, personal savings or private insurance — can help families cope without becoming impoverished.

On the deficit side, CLASS actually helps the budget in the coming decade because CLASS will collect premiums well before it will be obligated to pay benefits. Over the long term, the Secretary of Health and Human Services is required to design benefits and set premiums to assure that the program covers its costs — a standard CBO judged that CLASS can satisfy over the next 75 years.

Certain provisions of CLASS will make its implementation a challenge — in particular, getting lots of healthy people to participate and spread the risk of needing care. The law gives the HHS secretary flexibility to meet that challenge, however, and Secretary Kathleen Sebelius has indicated she’s using that flexibility to launch CLASS successfully. The secretary has made a firm commitment: “The program will not start unless we can absolutely be certain that it will be solvent and self-sustaining into the future.”

Given CLASS’ clear value and its fiscal responsibility, why would anyone want to nip it in the bud? The right action is to make CLASS a success.

Bob Murray, executive director of Maryland’s Independent Health Services Cost Review Commission — which has been setting price levels for the state’s hospitals since 1971 — tells CommonHealth that the state’s revolutionary rate-setting structure has produced “the absolute lowest rate of growth of hospital cost per case of any state.” “And that if we had grown at the U.S. level there would have been $45 billion more in hospital expenditures. If the U.S. had grown at our level during this period, it could have saved nearly $2 trillion,” he predicts. Check out this graph:

For more on the history and benefits of all-payer rate setting, read my primer here.

California-based Consumer Watchdog is blowing the whistle on a malpractice-reform provision within the Gang of Six’s $3.7-trillion deficit-reduction plan, deriding such an attempt as a “gimmick” meant to satisfy GOP lawmakers and their backers. If the budget-cutting proposal is passed, the Judiciary Committee would have six months to recommend legislation that would reduce entitlement spending by an “unspecified amount through medical malpractice reform.”

But according to Consumer Watchdog’s Washington director, Carmen Balber, such an effort would not cut spending in any meaningful amount but instead put patients at risk:

“Limits on liability for doctors who commit medical negligence is a political bone for the Gang of Six to throw for buy-in from Republicans, not a meaningful compromise that will provide real savings to help close the deficit. President Obama should reject this gimmick in favor of solutions that are proven to reduce the cost of medical malpractice: improving patient safety and decreasing medical errors…

“Medical liability limits are likely to increase health care spending and the national debt by burdening Medicare and Medicaid with the cost of care for patients who are injured by doctors’ mistakes but cannot hold them accountable.”

Texas’ experience with malpractice tort reform supports Consumer Watchdog’s claims. In 2003, the state capped damages from malpractice suits at $250,000 in order to control rising health care costs. Yet since the legislation went into effect, health care costs have shot up even faster, according to a study by the Public Citizen:

* The cost of health care in Texas (measured by per patient Medicare reimbursements) has increased at nearly double the national average;
* The state’s uninsured rate has increased, remaining the highest in the country;
* The cost of health insurance in the state has more than doubled.

In fact, the only improvement the Texas health care system saw was a fall in doctors’ liability insurance premiums.

The nonpartisan Congressional Budget Office (CBO) estimates that malpractice reform reform has the potential to “reduce total national health care spending by about 0.5 percent…That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums and an additional indirect
reduction of 0.3 percent from slightly less utilization of health care services.”

The CBO does acknowledge that malpractice reform could damage health outcomes, but states that most research must be conducted to assess the effect on patient care . –Sarah Bufkin

RH Reality Check’s Jodi Jacobson offers the best take on why the controversy surrounding the Institute of Medicine’s recommendations that health care plans in the exchanges offer all FDA-approved contraceptives and several other preventative services at no additional cost sharing is only controversial in the minds of a small group of anti-abortion zealots. The reality is that the guidelines will “essentially extend to the exchange plans the same coverage that is currently provided by most employer-sponsored plans as well as the Federal Employees Health Benefits program” and are in line not only with the “the existing guidelines and evidence on the effectiveness of different preventive treatments,” but also with the views of the majority of Americans.

As Jacobson points out, “the IOM recommendations make eminent sense, whether you are concerned about individual rights, public health, or financial responsibility.” Below are five reasons why the recommendations are critical and noncontroversial:

1) WILL REDUCE UNINTENDED PREGNANCIES: Nearly half of all pregnancies in the United States are unintended. Approximately seven in 10 women of reproductive age (43 million women) are sexually active and do not want to become pregnant, but could become pregnant if they and their partners fail to use a contraceptive method.

2) UNINTENDED PREGNANCIES LEAD TO WORSE HEALTH OUTCOMES: Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.

3) WILL LOWER GOVT SPENDING: Unintended pregnancy costs U.S. taxpayers roughly $11 billion each year. A study by Adam Sonfield and colleagues at the Guttmacher Institute found that two-thirds of births resulting from unintended pregnancies — more than 1 million births — are publicly funded, and the proportion tops 80 percent in a couple of states.

4) MOST WOMEN ALREADY USE CONTRACEPTION: More than 99 percent of all women ages 15 to 44 who have ever had sexual intercourse have used at least one contraceptive method. Overall, 62 percent of the 62 million women ages 15 to 44 are currently using a method of contraception.

5) MOST AMERICANS SUPPORT CONTRACEPTION: A national poll conducted in May of this year, found that 88 percent of voters, including four in five Republicans, support women’s access to contraception. Most Americans think that improving women’s access to contraception is a more effective way to reduce the number of abortions than enacting more restrictive abortion laws.

IOM’s guidelines are not binding, but most observers expect HHS to adopt its recommendations. HHS Secretary Kathleen Sebelius praised the committee’s work as historic and said it was “based on science and existing literature.’’ “We are reviewing the report closely and will release the department’s recommendations…very soon,’’ she said.