Glenda Fauntleroy

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

"We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier," said Dr. Cecil Wilson, who is board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, said Peter Orszag, Ph.D., director of the Congressional Budget Office.

"In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that," testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, "No amount of tinkering can fix what is broken beyond repair." While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

"The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services," he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

"There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is," testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

"Given the scale of the problems that we face, we need to be trying lots of different things," he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck.

"We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy," he testified. The agency doesn't have the staff or information systems to move forward expeditiously. "We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time," said Mr. Hackbarth.

MedPAC Offers Choice of Two Paths

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed "Path 1" and "Path 2."

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put "financial pressure on providers to change." It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does go on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

"We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier," said Dr. Cecil Wilson, who is board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, said Peter Orszag, Ph.D., director of the Congressional Budget Office.

"In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that," testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, "No amount of tinkering can fix what is broken beyond repair." While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

"The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services," he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

"There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is," testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

"Given the scale of the problems that we face, we need to be trying lots of different things," he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck.

"We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy," he testified. The agency doesn't have the staff or information systems to move forward expeditiously. "We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time," said Mr. Hackbarth.

MedPAC Offers Choice of Two Paths

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed "Path 1" and "Path 2."

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put "financial pressure on providers to change." It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does go on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — It won't be cheap to fix Medicare's problematic physician pay formula, but lawmakers aren't saving any money by waiting to replace it either, experts testified at a hearing of the Senate Finance Committee.

"We have been kicking this can down the road for the past 5 years. This committee, and certainly Congress, understands it's not going to get any easier," said Dr. Cecil Wilson, who is board of trustees chairman for the American Medical Association.

The rising cost of health care is one of the biggest problems facing the government. At the current rate of growth, federal spending on Medicare and Medicaid will eventually consume 20% of the U.S. economy, said Peter Orszag, Ph.D., director of the Congressional Budget Office.

"In health care, we get what we provide incentives for. We currently provide lots of incentives for advanced technologies and high-end treatment, and we get a lot of that. We provide very little incentive for preventive medicine and get very little of that," testified Dr. Orszag.

Early in 2006, lawmakers asked the Medicare Physician Advisory Commission (MedPAC) to examine ways to shift those incentives. Their findings were presented to the committee a few days before MedPAC members presented the commission's annual report to Congress.

While the report represents the consensus of the commission, commissioners were unable to forge a consensus on what should be done to replace the Sustainable Growth Rate (SGR) system, MedPAC Chairman Glenn Hackbarth testified.

Instead, the commission offered lawmakers two alternative approaches—one that doesn't include an SGR-like spending target and one that does.

Eliminating spending targets altogether would require Congress to create a whole new system with incentives to physicians to provide high-quality and low-cost care, Mr. Hackbarth said. Choosing to keep spending targets would simplify payment reform but still would require changes to make the system more equitable.

In opposition to spending targets, Dr. Wilson said, "No amount of tinkering can fix what is broken beyond repair." While doctors account for a small portion of increasing premiums, they are the only group that has spending targets imposed on them, he added.

"The AMA asks that Congress ensure that physicians are treated like hospitals and other providers by repealing the SGR and enacting a payment system that provides updates that keep pace with increases in medical practice costs. We, in turn, are committed to helping assure appropriate use of services," he said.

No matter whose plan is embraced, fixing the SGR system is unlikely to come cheap. The CBO has estimated that current proposals will cost anywhere between $22 billion and $330 billion over 10 years.

"There are lots of steps, including [health information technology] and comparative effectiveness, that offer at least the potential to bend that curve over the long term, but the cost savings may not show up in the next 10 years. That is just the way it is," testified Dr. Orszag, adding that it will take time and resources to build a system in which Medicare pays for high-value instead of high-cost services.

"Given the scale of the problems that we face, we need to be trying lots of different things," he said.

There are good ideas out there, testified Mr. Hackbarth, but the Centers for Medicare and Medicaid Services is the bottleneck.

"We've got some very promising demonstrations under way, but it takes us forever to get them developed, in place, gather results, and translate them into policy," he testified. The agency doesn't have the staff or information systems to move forward expeditiously. "We're trying to run [Medicare] on the cheap. That won't work if we are trying to innovate at the same time," said Mr. Hackbarth.

MedPAC Offers Choice of Two Paths

In testimony to the health subcommittee of the House Ways and Means Committee, Mr. Hackbarth explained that the MedPAC commissioners struggled with their task of choosing an alternative to the current sustainable growth rate (SGR) system. He reported that there were many tough debates, and that commissioners couldn't agree on just one solution. So instead they offered two proposals—ones they've deemed "Path 1" and "Path 2."

Path 1 calls for repealing SGR and eliminating the system of expenditures targets. The MedPAC report suggests that Congress should implement new ways to improve incentives for physicians and other providers to offer quality care to their patients at lower costs. This could be done in the following ways:

▸ Giving the Centers for Medicaid and Medicare Services the authority to pay providers differently based on performance measures;

▸ Ensuring accurate prices by identifying and correcting mispriced services;

▸ Encouraging coordination of care and use of care management, especially for patients with chronic conditions.

Path 1 also calls for collecting information on physicians' practice styles and sharing the results with other physicians across the country. If physicians could see how they use resources, compared with their peers, they would revise their practice styles accordingly, according to MedPAC's report.

The commission proposes that Medicare could then use the results to adjust payments to physicians and base rewards on both quality and efficiency.

Path 2 calls for pursuing the approaches in Path 1 but also including a new system of expenditure targets. The MedPAC report states that expenditure targets are necessary because they put "financial pressure on providers to change." It also recommends that targets should be applied on a geographic basis—applying the most pressure to the parts of the country where there is the highest use of the particular service and the highest contribution to Medicare spending.

Path 2, however, does go on to propose that expenditure targets should not fall solely on physicians but rather be applied to all providers in an effort to encourage different providers to work together at keeping costs as low as possible.

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more states are set to debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an over view of what the association considers to be the top health care issues facing the 110th Congress.

“We have three priorities and [at] the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said.

“The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy,” she added.

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more states are set to debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an over view of what the association considers to be the top health care issues facing the 110th Congress.

“We have three priorities and [at] the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said.

“The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy,” she added.

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more states are set to debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an over view of what the association considers to be the top health care issues facing the 110th Congress.

“We have three priorities and [at] the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said.

“The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy,” she added.

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more additional states will be debating similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are still grappling to stem constantly rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. And although 25 other states followed suit with introductions of similar bills last year, none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The Blue Cross and Blue Shield Association “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country.

Together, these companies provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an overview of what the association believes to be the top three health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the Blue Cross and Blue Shield Association, a surprising 74% of children without health coverage are in fact eligible under public programs, but are not presently enrolled.

Adequate funding is necessary to streamline enrollment procedures for these children and ensure that they get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in State Children's Health Insurance Program funding of $5 billion over the next 5 years.

This sum, though large, still falls short of the $12 billion experts say is needed to fund the program.

Another priority for the Blue Cross and Blue Shield Association is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating [Medicare Advantage], and we are very concerned,” Ms. Fox said.

“The [Medicare Advantage] program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more additional states will be debating similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are still grappling to stem constantly rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. And although 25 other states followed suit with introductions of similar bills last year, none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The Blue Cross and Blue Shield Association “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country.

Together, these companies provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an overview of what the association believes to be the top three health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the Blue Cross and Blue Shield Association, a surprising 74% of children without health coverage are in fact eligible under public programs, but are not presently enrolled.

Adequate funding is necessary to streamline enrollment procedures for these children and ensure that they get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in State Children's Health Insurance Program funding of $5 billion over the next 5 years.

This sum, though large, still falls short of the $12 billion experts say is needed to fund the program.

Another priority for the Blue Cross and Blue Shield Association is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating [Medicare Advantage], and we are very concerned,” Ms. Fox said.

“The [Medicare Advantage] program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly.

At least 10 or more additional states will be debating similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country.

The overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are still grappling to stem constantly rising health care expenses.

“Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions,” she said.

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. And although 25 other states followed suit with introductions of similar bills last year, none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers.

Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The Blue Cross and Blue Shield Association “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country.

Together, these companies provide health coverage for almost 98 million Americans.

Blue Cross and Blue Shield Association officials were also on hand to provide an overview of what the association believes to be the top three health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the Blue Cross and Blue Shield Association, a surprising 74% of children without health coverage are in fact eligible under public programs, but are not presently enrolled.

Adequate funding is necessary to streamline enrollment procedures for these children and ensure that they get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in State Children's Health Insurance Program funding of $5 billion over the next 5 years.

This sum, though large, still falls short of the $12 billion experts say is needed to fund the program.

Another priority for the Blue Cross and Blue Shield Association is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people.

Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating [Medicare Advantage], and we are very concerned,” Ms. Fox said.

“The [Medicare Advantage] program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The Blue Cross and Blue Shield Association's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON – State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures across the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006, states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that a flurry of new legislation was introduced across the country last year and early this year–all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states–including Kentucky, Utah, Oklahoma, and Washington–also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities, and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years–short of the $12 billion experts say is needed to fund the program. (See article above.)

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON – State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures across the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006, states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that a flurry of new legislation was introduced across the country last year and early this year–all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states–including Kentucky, Utah, Oklahoma, and Washington–also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities, and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years–short of the $12 billion experts say is needed to fund the program. (See article above.)

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON – State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures across the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006, states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that a flurry of new legislation was introduced across the country last year and early this year–all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states–including Kentucky, Utah, Oklahoma, and Washington–also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities, and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years–short of the $12 billion experts say is needed to fund the program. (See article above.)

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office.

Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up, with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that cost information be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country, and the overview presented by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem the increase in health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Maryland, Massachusetts, and Vermont. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Oklahoma, Utah, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up, with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that cost information be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country, and the overview presented by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem the increase in health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Maryland, Massachusetts, and Vermont. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Oklahoma, Utah, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up, with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that cost information be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country, and the overview presented by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem the increase in health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” Ms. Laudicina said. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Maryland, Massachusetts, and Vermont. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Oklahoma, Utah, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

WASHINGTON — State legislation mandating health insurance will continue, with "at least 12 more states going to debate bills to expand employer participation coverage" in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual "State Legislative Health Care and Insurance Issues" report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. "Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions."

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

"I read about 200 new legislations per week," said Ms. Laudicina. "That's how fast new legislation is coming in."

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA "State Legislative Health Care and Insurance Issues" report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country. Together these companies provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

"We have three priorities and [at] the top of the list is addressing the uninsured," said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' "priority has to be to enroll these children."

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for a $5 billion increase in SCHIP funding over the next 5 years—short of the $12 billion experts say is needed.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

"There's some talk in Congress about eliminating MA, and we are very concerned," Ms. Fox said. "The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy."

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is "very supportive of the bipartisan mission."

WASHINGTON — State legislation mandating health insurance will continue, with "at least 12 more states going to debate bills to expand employer participation coverage" in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual "State Legislative Health Care and Insurance Issues" report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. "Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions."

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

"I read about 200 new legislations per week," said Ms. Laudicina. "That's how fast new legislation is coming in."

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA "State Legislative Health Care and Insurance Issues" report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country. Together these companies provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

"We have three priorities and [at] the top of the list is addressing the uninsured," said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' "priority has to be to enroll these children."

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for a $5 billion increase in SCHIP funding over the next 5 years—short of the $12 billion experts say is needed.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

"There's some talk in Congress about eliminating MA, and we are very concerned," Ms. Fox said. "The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy."

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is "very supportive of the bipartisan mission."

WASHINGTON — State legislation mandating health insurance will continue, with "at least 12 more states going to debate bills to expand employer participation coverage" in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual "State Legislative Health Care and Insurance Issues" report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. "Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions."

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

"I read about 200 new legislations per week," said Ms. Laudicina. "That's how fast new legislation is coming in."

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA "State Legislative Health Care and Insurance Issues" report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country. Together these companies provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health-care issues facing the 110th Congress.

"We have three priorities and [at] the top of the list is addressing the uninsured," said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' "priority has to be to enroll these children."

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care.

In his budget submitted to Congress on Feb. 5, President Bush called for a $5 billion increase in SCHIP funding over the next 5 years—short of the $12 billion experts say is needed.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

"There's some talk in Congress about eliminating MA, and we are very concerned," Ms. Fox said. "The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy."

The BCBSA's third priority is the vision of the Bush administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is "very supportive of the bipartisan mission."

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage. “I read about 200 new legislations per week,” Ms. Laudicina said.

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were on hand to provide an overview of the association's top health-care issues facing the 110th Congress. “We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage program that provides coverage to more than 8.3 million people.

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said.

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage. “I read about 200 new legislations per week,” Ms. Laudicina said.

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were on hand to provide an overview of the association's top health-care issues facing the 110th Congress. “We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage program that provides coverage to more than 8.3 million people.

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said.

WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage. “I read about 200 new legislations per week,” Ms. Laudicina said.

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

In 2006, 11 states also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were on hand to provide an overview of the association's top health-care issues facing the 110th Congress. “We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage program that provides coverage to more than 8.3 million people.

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said.

WASHINGTON — Although the federal government should play a key role in repairing the nation's emergency health care system, much of the job of reform may fall on the emergency care community itself, according to health experts, lawmakers, and federal officials who met at the Institute of Medicine's final workshop on the future of emergency care.

Following previous regional workshops in Salt Lake City, Chicago, and New Orleans, the IOM conducted its fourth stop on a nationwide tour to disseminate the findings from this summer's three landmark reports on the state of emergency care.

“As we went around the country, we heard that this [IOM] report may be the most important report on emergency medicine since 1966 to avoid accidental death and disability and neglected disease in modern society,” said Dr. A. Brent Eastman, chief medical officer of Scripps Health, San Diego, and a member of the IOM Committee on the Future of Emergency Care in the United States Health System.

Discussions from the first three workshops were overwhelmingly supportive of most of the recommendations that address the major issues facing the emergency care system: overcrowding of emergency departments, shortcomings in pediatric emergency care, lack of disaster preparedness, and disadvantaged emergency care research.

One primary area, however, fostered disagreement from workshop attendees: the IOM's recommendation that Congress establish a single lead agency to oversee and manage emergency and trauma care. Such an agency would consolidate resources currently spread throughout different agencies, such as the Department of Health and Human Services and the Department of Homeland Security.

The workshops' attendees, however, have strongly opposed a single-agency approach, Dr. Eastman said.

“The overall message that we heard was that we absolutely must unite to collectively move forward with the IOM agenda,” he said. Yet, “it cannot be done by one agency, one region of the country, or by one individual.”

There has been consensus that the emergency care community cannot wait for an act of Congress to institute change, Eastman added. Workshop attendees acknowledged that many of the IOM's findings were targeted to providers and provider organizations, and most have concluded that change was needed “from within.”

An Act of Congress

Congress has, however, given some attention to the matter of disaster preparedness. The House and Senate passed—and the president signed into law—the Pandemic and All-Hazards Preparedness Act of 2006, which aims to speed up emergency medical response, explained Ms. Jennifer Bryning of the Senate Committee on Health, Education, Labor and Pensions.

“To the IOM finding that there is a lack of disaster preparedness, we hope this bill will addresses this point,” said Ms. Bryning.

“We are aware that it doesn't cure all the problems, but it's a step in the right direction.”

The law reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and names the secretary of Health and Human Services as the lead federal official responsible for public health and medical response to emergencies. It also reauthorizes more than $1 billion per year in federal funding through grants from HHS for state and local public health and medical preparedness.

The workshop also gave officials of federal agencies an opportunity to discuss how their offices can assist in adopting the IOM recommendations.

In response to the finding that the emergency department system is poorly equipped to handle a disaster, Dr. Jeffrey W. Runge, the Department of Homeland Security's chief medical officer, conceded that the United States is not giving the emergency care situation the attention it deserves.

“How well we are able to treat patients every single day is exactly how we will treat patients in case of a disaster,” said Dr. Runge. “In cases of disaster or emergency, people call 911, not CMS and not FEMA …so we need people in emergency rooms who are expertly trained to treat our citizens.”

Emergency care in this country is a “victim of its own success,” Dr. Runge said. For the past 3 decades, he explained, emergency physicians have done a tremendous job of improving emergency care and fulfilling a need.

He also stressed that the word “crisis” might be overused in defining the current state of emergency care.

“It's not a crisis until people feel it,” Dr. Runge said. “Until the American public feels their system is breaking down, I'm not real hopeful there is going to be huge systemic change. We need to prevent this crisis before it's actually a crisis.”

A View From the Hill

In his keynote address, Rep. Pete Stark

(D-Calif.), gave a spirited dialogue on his view of the IOM reports, which he said had offered “no solutions, but lots of problems.”

One report finding that seemed to most amaze Rep. Stark was the shortage of specialists in such fields as neurosurgery or vascular surgery who will agree to work on call in emergency departments. That shortage results in “dire and sometimes tragic results,” according to the IOM reports.

“We don't pay firemen, teachers, and policemen for not doing their full job, and in my opinion, [on-call service for doctors] is part of the job,” Rep. Stark said.

“When you make upwards of $400,000 and $500,000 a year, you're more than compensated.”

Rep. Stark added that his solution to the on-call shortage would be to advise hospitals to withhold privileges to doctors who won't agree to be on call without extra payment.

Research Can Lead the Way

A common thread throughout the final workshop was the great need for further discussion among the emergency care community, the relevant federal agencies, and Congress. The IOM reports and the workshops' attendees also concluded that research is the cornerstone for improvement.

There are many opportunities for emergency care research, said Dr. William Barsan, chair of the department of emergency medicine at the University of Michigan, Ann Arbor.

“Emergency conditions are certainly high impact,” Dr. Barsan said. “You have access to large and very diverse patient populations. Almost every person in the country uses the emergency room at least one time or another, and you can't get any more diverse than that.”

Effective early treatment in emergency departments prevents some of the leading causes of death, such as trauma, stroke, and heart attack, he added. Proper research can help physicians to better treat these conditions.

The challenge, Dr. Barsan said, is that the medical community first needs to address the inadequate research training infrastructure, which provides only a small number of research fellowship training positions in emergency care.

Looking Ahead

The IOM's work on the future of emergency care is not yet complete. The panel is taking steps to incorporate the feedback gathered from the four regional workshops and publish an addendum in the coming months. It will provide more details on areas that the workshop attendees said were underemphasized in the first reports, such as geriatrics, mental health and substance abuse, and the nursing shortage. It also will summarize the workshops' formal presentations, including key sources of evidence.

For more information, visit the IOM Web site at

www.iom.edu

WASHINGTON — Although the federal government should play a key role in repairing the nation's emergency health care system, much of the job of reform may fall on the emergency care community itself, according to health experts, lawmakers, and federal officials who met at the Institute of Medicine's final workshop on the future of emergency care.

Following previous regional workshops in Salt Lake City, Chicago, and New Orleans, the IOM conducted its fourth stop on a nationwide tour to disseminate the findings from this summer's three landmark reports on the state of emergency care.

“As we went around the country, we heard that this [IOM] report may be the most important report on emergency medicine since 1966 to avoid accidental death and disability and neglected disease in modern society,” said Dr. A. Brent Eastman, chief medical officer of Scripps Health, San Diego, and a member of the IOM Committee on the Future of Emergency Care in the United States Health System.

Discussions from the first three workshops were overwhelmingly supportive of most of the recommendations that address the major issues facing the emergency care system: overcrowding of emergency departments, shortcomings in pediatric emergency care, lack of disaster preparedness, and disadvantaged emergency care research.

One primary area, however, fostered disagreement from workshop attendees: the IOM's recommendation that Congress establish a single lead agency to oversee and manage emergency and trauma care. Such an agency would consolidate resources currently spread throughout different agencies, such as the Department of Health and Human Services and the Department of Homeland Security.

The workshops' attendees, however, have strongly opposed a single-agency approach, Dr. Eastman said.

“The overall message that we heard was that we absolutely must unite to collectively move forward with the IOM agenda,” he said. Yet, “it cannot be done by one agency, one region of the country, or by one individual.”

There has been consensus that the emergency care community cannot wait for an act of Congress to institute change, Eastman added. Workshop attendees acknowledged that many of the IOM's findings were targeted to providers and provider organizations, and most have concluded that change was needed “from within.”

An Act of Congress

Congress has, however, given some attention to the matter of disaster preparedness. The House and Senate passed—and the president signed into law—the Pandemic and All-Hazards Preparedness Act of 2006, which aims to speed up emergency medical response, explained Ms. Jennifer Bryning of the Senate Committee on Health, Education, Labor and Pensions.

“To the IOM finding that there is a lack of disaster preparedness, we hope this bill will addresses this point,” said Ms. Bryning.

“We are aware that it doesn't cure all the problems, but it's a step in the right direction.”

The law reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and names the secretary of Health and Human Services as the lead federal official responsible for public health and medical response to emergencies. It also reauthorizes more than $1 billion per year in federal funding through grants from HHS for state and local public health and medical preparedness.

The workshop also gave officials of federal agencies an opportunity to discuss how their offices can assist in adopting the IOM recommendations.

In response to the finding that the emergency department system is poorly equipped to handle a disaster, Dr. Jeffrey W. Runge, the Department of Homeland Security's chief medical officer, conceded that the United States is not giving the emergency care situation the attention it deserves.

“How well we are able to treat patients every single day is exactly how we will treat patients in case of a disaster,” said Dr. Runge. “In cases of disaster or emergency, people call 911, not CMS and not FEMA …so we need people in emergency rooms who are expertly trained to treat our citizens.”

Emergency care in this country is a “victim of its own success,” Dr. Runge said. For the past 3 decades, he explained, emergency physicians have done a tremendous job of improving emergency care and fulfilling a need.

He also stressed that the word “crisis” might be overused in defining the current state of emergency care.

“It's not a crisis until people feel it,” Dr. Runge said. “Until the American public feels their system is breaking down, I'm not real hopeful there is going to be huge systemic change. We need to prevent this crisis before it's actually a crisis.”

A View From the Hill

In his keynote address, Rep. Pete Stark

(D-Calif.), gave a spirited dialogue on his view of the IOM reports, which he said had offered “no solutions, but lots of problems.”

One report finding that seemed to most amaze Rep. Stark was the shortage of specialists in such fields as neurosurgery or vascular surgery who will agree to work on call in emergency departments. That shortage results in “dire and sometimes tragic results,” according to the IOM reports.

“We don't pay firemen, teachers, and policemen for not doing their full job, and in my opinion, [on-call service for doctors] is part of the job,” Rep. Stark said.

“When you make upwards of $400,000 and $500,000 a year, you're more than compensated.”

Rep. Stark added that his solution to the on-call shortage would be to advise hospitals to withhold privileges to doctors who won't agree to be on call without extra payment.

Research Can Lead the Way

A common thread throughout the final workshop was the great need for further discussion among the emergency care community, the relevant federal agencies, and Congress. The IOM reports and the workshops' attendees also concluded that research is the cornerstone for improvement.

There are many opportunities for emergency care research, said Dr. William Barsan, chair of the department of emergency medicine at the University of Michigan, Ann Arbor.

“Emergency conditions are certainly high impact,” Dr. Barsan said. “You have access to large and very diverse patient populations. Almost every person in the country uses the emergency room at least one time or another, and you can't get any more diverse than that.”

Effective early treatment in emergency departments prevents some of the leading causes of death, such as trauma, stroke, and heart attack, he added. Proper research can help physicians to better treat these conditions.

The challenge, Dr. Barsan said, is that the medical community first needs to address the inadequate research training infrastructure, which provides only a small number of research fellowship training positions in emergency care.

Looking Ahead

The IOM's work on the future of emergency care is not yet complete. The panel is taking steps to incorporate the feedback gathered from the four regional workshops and publish an addendum in the coming months. It will provide more details on areas that the workshop attendees said were underemphasized in the first reports, such as geriatrics, mental health and substance abuse, and the nursing shortage. It also will summarize the workshops' formal presentations, including key sources of evidence.

For more information, visit the IOM Web site at

www.iom.edu

WASHINGTON — Although the federal government should play a key role in repairing the nation's emergency health care system, much of the job of reform may fall on the emergency care community itself, according to health experts, lawmakers, and federal officials who met at the Institute of Medicine's final workshop on the future of emergency care.

Following previous regional workshops in Salt Lake City, Chicago, and New Orleans, the IOM conducted its fourth stop on a nationwide tour to disseminate the findings from this summer's three landmark reports on the state of emergency care.

“As we went around the country, we heard that this [IOM] report may be the most important report on emergency medicine since 1966 to avoid accidental death and disability and neglected disease in modern society,” said Dr. A. Brent Eastman, chief medical officer of Scripps Health, San Diego, and a member of the IOM Committee on the Future of Emergency Care in the United States Health System.

Discussions from the first three workshops were overwhelmingly supportive of most of the recommendations that address the major issues facing the emergency care system: overcrowding of emergency departments, shortcomings in pediatric emergency care, lack of disaster preparedness, and disadvantaged emergency care research.

One primary area, however, fostered disagreement from workshop attendees: the IOM's recommendation that Congress establish a single lead agency to oversee and manage emergency and trauma care. Such an agency would consolidate resources currently spread throughout different agencies, such as the Department of Health and Human Services and the Department of Homeland Security.

The workshops' attendees, however, have strongly opposed a single-agency approach, Dr. Eastman said.

“The overall message that we heard was that we absolutely must unite to collectively move forward with the IOM agenda,” he said. Yet, “it cannot be done by one agency, one region of the country, or by one individual.”

There has been consensus that the emergency care community cannot wait for an act of Congress to institute change, Eastman added. Workshop attendees acknowledged that many of the IOM's findings were targeted to providers and provider organizations, and most have concluded that change was needed “from within.”

An Act of Congress

Congress has, however, given some attention to the matter of disaster preparedness. The House and Senate passed—and the president signed into law—the Pandemic and All-Hazards Preparedness Act of 2006, which aims to speed up emergency medical response, explained Ms. Jennifer Bryning of the Senate Committee on Health, Education, Labor and Pensions.

“To the IOM finding that there is a lack of disaster preparedness, we hope this bill will addresses this point,” said Ms. Bryning.

“We are aware that it doesn't cure all the problems, but it's a step in the right direction.”

The law reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and names the secretary of Health and Human Services as the lead federal official responsible for public health and medical response to emergencies. It also reauthorizes more than $1 billion per year in federal funding through grants from HHS for state and local public health and medical preparedness.

The workshop also gave officials of federal agencies an opportunity to discuss how their offices can assist in adopting the IOM recommendations.

In response to the finding that the emergency department system is poorly equipped to handle a disaster, Dr. Jeffrey W. Runge, the Department of Homeland Security's chief medical officer, conceded that the United States is not giving the emergency care situation the attention it deserves.

“How well we are able to treat patients every single day is exactly how we will treat patients in case of a disaster,” said Dr. Runge. “In cases of disaster or emergency, people call 911, not CMS and not FEMA …so we need people in emergency rooms who are expertly trained to treat our citizens.”

Emergency care in this country is a “victim of its own success,” Dr. Runge said. For the past 3 decades, he explained, emergency physicians have done a tremendous job of improving emergency care and fulfilling a need.

He also stressed that the word “crisis” might be overused in defining the current state of emergency care.

“It's not a crisis until people feel it,” Dr. Runge said. “Until the American public feels their system is breaking down, I'm not real hopeful there is going to be huge systemic change. We need to prevent this crisis before it's actually a crisis.”

A View From the Hill

In his keynote address, Rep. Pete Stark

(D-Calif.), gave a spirited dialogue on his view of the IOM reports, which he said had offered “no solutions, but lots of problems.”

One report finding that seemed to most amaze Rep. Stark was the shortage of specialists in such fields as neurosurgery or vascular surgery who will agree to work on call in emergency departments. That shortage results in “dire and sometimes tragic results,” according to the IOM reports.

“We don't pay firemen, teachers, and policemen for not doing their full job, and in my opinion, [on-call service for doctors] is part of the job,” Rep. Stark said.

“When you make upwards of $400,000 and $500,000 a year, you're more than compensated.”

Rep. Stark added that his solution to the on-call shortage would be to advise hospitals to withhold privileges to doctors who won't agree to be on call without extra payment.

Research Can Lead the Way

A common thread throughout the final workshop was the great need for further discussion among the emergency care community, the relevant federal agencies, and Congress. The IOM reports and the workshops' attendees also concluded that research is the cornerstone for improvement.

There are many opportunities for emergency care research, said Dr. William Barsan, chair of the department of emergency medicine at the University of Michigan, Ann Arbor.

“Emergency conditions are certainly high impact,” Dr. Barsan said. “You have access to large and very diverse patient populations. Almost every person in the country uses the emergency room at least one time or another, and you can't get any more diverse than that.”

Effective early treatment in emergency departments prevents some of the leading causes of death, such as trauma, stroke, and heart attack, he added. Proper research can help physicians to better treat these conditions.

The challenge, Dr. Barsan said, is that the medical community first needs to address the inadequate research training infrastructure, which provides only a small number of research fellowship training positions in emergency care.

Looking Ahead

The IOM's work on the future of emergency care is not yet complete. The panel is taking steps to incorporate the feedback gathered from the four regional workshops and publish an addendum in the coming months. It will provide more details on areas that the workshop attendees said were underemphasized in the first reports, such as geriatrics, mental health and substance abuse, and the nursing shortage. It also will summarize the workshops' formal presentations, including key sources of evidence.

For more information, visit the IOM Web site at

www.iom.edu

WASHINGTON – People who abuse substances are more likely to develop a mood disorder than are those who do not, Dr. Kathleen T. Brady said during the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Brady, professor of psychiatry at the Medical University of South Carolina, Charleston, said the comorbidity of substance abuse and mood disorders is an increasingly serious concern in the psychiatric community.

Depression is the most common comorbidity, but bipolar disorder strikes a higher percentage of those who abuse substances–whether they be alcohol, cigarettes, or narcotics, Dr. Brady said at the meeting, which was sponsored by Brown Medical School.

Those diagnosed with an alcohol dependency, for example, are 1.3 times more likely to suffer from depression and 5.1 times more likely to have bipolar disorder, reported Dr. Brady, whose numbers were based on findings in the National Comorbidity Study. The impact of substance abuse on a bipolar disorder patient can be significant, as it has been shown to increase suicide rates, emergency department visits, and hospitalizations, as well as lead to poor treatment compliance.

Cigarette smoking and nicotine addiction also have a strong relationship with depression. Dr. Brady said 30%–60% of smokers have episodes of depression, while nicotine withdrawal can precipitate depression as well. Research has found early substance abuse in adolescent years increases the likelihood of developing psychiatric disorders when a person reaches his or her late 20s.

Dr. Brady said researchers have pinpointed one of the chief causes of most substance abuse and mood disorders. “Stress is the biggest environmental factor,” she said. “We know that stress, such as in early childhood, can influence the development of substance abuse and mood disorder.”

Childhood sexual abuse was characterized as a key trigger for depression and substance abuse disorder in adulthood. The more severe the childhood sexual abuse, the greater the risk of later mood disorders.

With regard to treating the dual disorders, Dr. Brady said debate is ongoing within the community on whether there is any advantage to adopting a combined therapy regimen. “To address the question of 'should you add medications to curb alcohol dependency to your bipolar medications or antidepressants?' the answer is yes,” she said.

Dr. Brady said the two general principles of treating comorbidity should be screening for both disorders carefully and managing both problems simultaneously with medication. “Most doctors are not doing enough to treat substance use disorder with pharmacologics,” she said.

Those diagnosed with alcohol dependency are 5.1 times more likely to have bipolar disorder. DR. BRADY

WASHINGTON – People who abuse substances are more likely to develop a mood disorder than are those who do not, Dr. Kathleen T. Brady said during the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Brady, professor of psychiatry at the Medical University of South Carolina, Charleston, said the comorbidity of substance abuse and mood disorders is an increasingly serious concern in the psychiatric community.

Depression is the most common comorbidity, but bipolar disorder strikes a higher percentage of those who abuse substances–whether they be alcohol, cigarettes, or narcotics, Dr. Brady said at the meeting, which was sponsored by Brown Medical School.

Those diagnosed with an alcohol dependency, for example, are 1.3 times more likely to suffer from depression and 5.1 times more likely to have bipolar disorder, reported Dr. Brady, whose numbers were based on findings in the National Comorbidity Study. The impact of substance abuse on a bipolar disorder patient can be significant, as it has been shown to increase suicide rates, emergency department visits, and hospitalizations, as well as lead to poor treatment compliance.

Cigarette smoking and nicotine addiction also have a strong relationship with depression. Dr. Brady said 30%–60% of smokers have episodes of depression, while nicotine withdrawal can precipitate depression as well. Research has found early substance abuse in adolescent years increases the likelihood of developing psychiatric disorders when a person reaches his or her late 20s.

Dr. Brady said researchers have pinpointed one of the chief causes of most substance abuse and mood disorders. “Stress is the biggest environmental factor,” she said. “We know that stress, such as in early childhood, can influence the development of substance abuse and mood disorder.”

Childhood sexual abuse was characterized as a key trigger for depression and substance abuse disorder in adulthood. The more severe the childhood sexual abuse, the greater the risk of later mood disorders.

With regard to treating the dual disorders, Dr. Brady said debate is ongoing within the community on whether there is any advantage to adopting a combined therapy regimen. “To address the question of 'should you add medications to curb alcohol dependency to your bipolar medications or antidepressants?' the answer is yes,” she said.

Dr. Brady said the two general principles of treating comorbidity should be screening for both disorders carefully and managing both problems simultaneously with medication. “Most doctors are not doing enough to treat substance use disorder with pharmacologics,” she said.

Those diagnosed with alcohol dependency are 5.1 times more likely to have bipolar disorder. DR. BRADY

WASHINGTON – People who abuse substances are more likely to develop a mood disorder than are those who do not, Dr. Kathleen T. Brady said during the annual conference of the Association for Medical Education and Research in Substance Abuse.

Dr. Brady, professor of psychiatry at the Medical University of South Carolina, Charleston, said the comorbidity of substance abuse and mood disorders is an increasingly serious concern in the psychiatric community.

Depression is the most common comorbidity, but bipolar disorder strikes a higher percentage of those who abuse substances–whether they be alcohol, cigarettes, or narcotics, Dr. Brady said at the meeting, which was sponsored by Brown Medical School.

Those diagnosed with an alcohol dependency, for example, are 1.3 times more likely to suffer from depression and 5.1 times more likely to have bipolar disorder, reported Dr. Brady, whose numbers were based on findings in the National Comorbidity Study. The impact of substance abuse on a bipolar disorder patient can be significant, as it has been shown to increase suicide rates, emergency department visits, and hospitalizations, as well as lead to poor treatment compliance.

Cigarette smoking and nicotine addiction also have a strong relationship with depression. Dr. Brady said 30%–60% of smokers have episodes of depression, while nicotine withdrawal can precipitate depression as well. Research has found early substance abuse in adolescent years increases the likelihood of developing psychiatric disorders when a person reaches his or her late 20s.

Dr. Brady said researchers have pinpointed one of the chief causes of most substance abuse and mood disorders. “Stress is the biggest environmental factor,” she said. “We know that stress, such as in early childhood, can influence the development of substance abuse and mood disorder.”

Childhood sexual abuse was characterized as a key trigger for depression and substance abuse disorder in adulthood. The more severe the childhood sexual abuse, the greater the risk of later mood disorders.

With regard to treating the dual disorders, Dr. Brady said debate is ongoing within the community on whether there is any advantage to adopting a combined therapy regimen. “To address the question of 'should you add medications to curb alcohol dependency to your bipolar medications or antidepressants?' the answer is yes,” she said.

Dr. Brady said the two general principles of treating comorbidity should be screening for both disorders carefully and managing both problems simultaneously with medication. “Most doctors are not doing enough to treat substance use disorder with pharmacologics,” she said.

Those diagnosed with alcohol dependency are 5.1 times more likely to have bipolar disorder. DR. BRADY