Archive for the ‘Funding’ Category

Puerto Rico’s Medicaid Cliff: A Crisis That Can’t Be Ignored

August 16, 2018

(Sarah Varney/ Kaiser Health News)

Puerto Rico (PR), still recovering from the devastation of Hurricane Maria in 2017, faces another looming crisis— this time manmade. Almost half of the island’s population relies on Medicaid for healthcare. Yet, in the midst of a $72 billion debt crisis, funding for the crucial program is rapidly waning.

As a U.S. territory, PR faces different Medicaid funding regulations than those governing states, which receive federal funding based on per-capita income, covering 50-83% of their running costs. If subject to the same rules, about 82% of PR’s Medicaid expenses would be covered. However, the federal match rate for territories is fixed at 55% and further limited by mandatory funding caps. Thus, in practice, less than 20% of PR’s Medicaid expenditures are federally covered. Established by Congress in the late 1960’s, this differential funding chronically underfunds PR’s Medicaid program and deepens the territory’s financial strain.

In 2016, PR’s Medicaid expenditures exceeded $2.4 billion, of which the federal government  covered only $335 million. Recent stopgap funding measures passed by Congress have helped keep PR’s vital safety-net afloat, yet are projected to run out next year, at which point the territory will be facing a $2+ billion budget shortfall. Referred to as the Medicaid Cliff, this could mean over a million Puerto Ricans losing coverage.

Aside from financially crippling Puerto Rico, continuing the current system is ultimately more costly for the U.S. government, since economic hardship drives migration from PR to states, where healthcare is more expensive. In fact, a recent analysis projected that changing PR’s Medicaid funding rules to match the states would save federal and state governments almost $24 billion over the next decade.

For a territory already struggling with an aging population, heavy burden of chronic disease, the new specter of the Zika virus, and infrastructure still crippled by the effects of Hurricane Maria, the impending  Medicaid cliff is nothing short of a disaster. As a matter of justice, compassion, and economic necessity, the U.S. Congress must pass legislation to increase federal funding for PR’s Medicaid program to a level commensurate with funding of the 50 U.S. states.

by Macall Leslie and Ellen Dupont



LGBTQ-Inclusive Sex Education for Maryland Schools

March 12, 2018


In Maryland, all youth, regardless of gender identity or sexuality, deserve the right live healthy lives and thrive in school. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, this can be difficult.


Research shows that this population is disproportionality at risk of experiencing dating violence and contracting sexually transmitted infections (STIs), including HIV. The CDC furthers this by stating that in 2015, 81% of the youth ages 13-24 who were diagnosed with HIV were gay or bisexual men.

Additionally, a survey on school climate conducted in 2015 found that Maryland public schools are not safe for most LGBTQ students, with 61% of LGBTQ students reporting that they were verbally harassed because of their sexual identity and 45% because of their gender expression. Furthermore, only 1 in 4 students reported being taught positive information about LGBTQ people in school. A hostile school environment can lead to mental health issues for LBGTQ youth, higher absentee and drop-out rates, and even suicide.

Providing LGBTQ-inclusive sex education to middle and high school students is a vital component in empowering this population to thrive.


With an inclusive curriculum, students obtain medically accurate and age-appropriate information on sexual health that integrates LGBTQ needs. LGBTQ youth learn about health risk behaviors that impact them and how to protect themselves against STIs. Equally important, all students are given the opportunity to explore topics related to sexuality and gender identity in a setting that positively depicts LBGTQ individuals. This helps dispel stigmas and negative stereotypes frequently tied to the LGBTQ community and builds a more welcoming and inclusive school environment.

Picture4Four states and Washington D.C. have passed legislation that mandates public schools provide sex education that respects and addresses the needs of all genders and sexual orientations.

It’s time for Maryland to follow suit and create similar legislation mandating inclusive sex education. In addition, funds should be allocated for the development of supporting materials, resources, and training for educators and school administrators. Research should be conducted alongside these changes to evaluate the impact LGBTQ inclusive-sex education has onSTI/HIV infection rates and bullying in Maryland schools. With these actions, we can help bridge the gap to providing LGBTQ youth with an equal opportunity to live healthy and successful lives.


Jump In The Pool

March 11, 2018


Health insurance. The topic is enough to make anyone anxious—and rightfully so. The United States’ health care system is the most expensive in the world, averaging $10,348 spent per person per year. With the linkage of health insurance to employment and no publically-financed universal option, Americans are fractured into smaller and smaller coverage pools.

As a result, employee health insurance benefits are a significant portion of health spending. The State of Maryland is no exception. In 2017, the State spent $1.6 billion on state employee health insurance benefits alone. As of 2016, Maryland pays $9,745 for each active state employee’s health insurance benefits.

The State must share the costs and risks. The larger the insurance pool, the greater the spread. Therefore, Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers.

In fact, statutes already exist in the Maryland Code enabling consortium health insurance purchasing for county, local government, and select non-profit employees who opt into the state pool. However, this legislation has not been maximally leveraged to reduce healthcare costs since few entities have joined in. Furthermore, Maryland’s 100,000 public-school employees are currently in their own independent plans negotiated by the teachers’ unions. Legislation to include them as part of the state-wide insurance pool should be a priority.

By amending the law to include all 501(c)(3) non-profits, Maryland can take advantage of the its unique non-profit landscape. Over 260,000 Marylanders are employed by non-profits representing 11% of the state’s workforce. Of the 32,000 registered Maryland non-profits, half are estimated to employ 50 full-time staff or less. Because of their limited beneficiaries, these non-profits could benefit the most from opting into the state pool.

Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers. To this end, stakeholders should adopt the following recommendations:

  • The General Assembly should amend Maryland Code to include all 501(c)(3) non-profit organizations
  • County and local governments should take advantage of existing statutes allowing consortium health insurance purchasing by the State
  • With enabling legislation, Maryland public school employees should opt into the State employee insurance pool


Expanding Aid To Eviction Prevention Programs

March 11, 2018

Over 500,000 people were experiencing homelessness in the United States on a single night in 2017, so for every 10,000 people, 17 were experiencing homelessness.

The best way to end homelessness is to prevent it.

Eviction is a leading cause of homelessness. Every year, 2.5 million people in the United States face eviction. Preventing these people from being evicted will help prevent homelessness. The main cause of eviction is nonpayment of the rent, and low-income families are mostly affected by it. Over half of poor renting families spend at least 50 percent of their income on housing; a quarter of them spend over 70 percent of their income on housing. This results in many of them being behind on their rent or not being able to consistently afford to pay the rent; leading to their eviction.


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Eviction Prevention Programs are programs funded by the federal government to provide housing and rent assistance to tenants with low/moderate income facing imminent eviction. They assist those who are behind on their rent and help with unpaid water bills, legal conflicts and other problems. Unfortunately, there is only a fraction of people who can be assisted because of the high demand and limited funds. Therefore, for these programs to have more impact and assist a larger number of people, it is critical for the government to expand funds allocated to them.

The national Housing Trust Fund (HTF), established under the Housing and Economic Recovery Act of 2008, is a new housing resource that focuses on building, rehabilitating, preserving, and operating rental housing for low-income people. $174 million in HTF dollars were allocated to states in 2016 and $219 million in 2017. Although it is a step forward, far more resources are needed.

Too many people are being evicted yearly; however, eviction prevention programs can only assist a fraction of them due to limited funds. It is hence essential for important stakeholders like the Continuum of Care Program, Emergency Solutions Grant Program, National Coalition for The Homeless and Federal Finance Housing Agency to work with the National Low Income Housing coalition and Housing Trust Fund Implementation and Policy Group to build congressional support to protect and expand HTF, as well as other funds for eviction prevention programs. Expanding these funds will help prevent evictions, which will ultimately help with homelessness prevention.

Why 21 to Purchase Tobacco Products?

March 11, 2018

The Master Settlement Agreement of 1999 imposed major restrictions on tobacco industries, proved to be a victory for public health workers in the United States and their efforts in tackling the tobacco epidemic.

However, the rise of the use of electronic cigarettes prove to be yet another strategy with tobacco companies in promoting tobacco use. The NIH defines electronic cigarettes, or e-cigs, as battery operated devices that contain aerosol flavorings and other chemicals that mixes with health, producing a vapor.

Due to its’ lack of long term consequences and it’s gateway to adult smoking, I support the bill for increasing tobacco sales from 18 to 21 years old in Washington state.

According to Washington21, 17, 800 Washington kids try smoking for the first time each year, 3, 900 kids become daily smokers with a third of them dying prematurely. The marketing of flavors for electronic cigarettes makes this product more appealing, with majority of teens not knowing exactly what is even in these e-cigs which makes e-cigs all the more dangerous in this population. The IOM Report in 2013 reported that there would be a 25% reduction in 15-17 year olds smoking tobacco and a 10% decrease in smoking related deaths if the age was raised to 21.

Like the effects of increasing the drinking age to 21, I believe that we would see similar effects when raising the age of 21 in purchasing tobacco in Washington, including e-cigs. By supporting the Washington21 campaign we are able to prevent further use of tobacco products among teens and also reduce health related tobacco issues such as cardiovascular/lung diseases, and cancer Participating in advocacy campaigns will also help with providing advocacy tools that can be used at your own state to enact policies to save lives.

On March 8, 2018, Washington house has passed SB 6048  raising the age to buy tobacco products to 21.Given this victory, it is promising that Washington state’s bill will hopefully pass the Washington senate! To support this cause and to protect the health of the youth, contact your district legislator and vote for Tobacco 21!

Title X Funding and Teen Pregnancy in Baltimore City

March 10, 2018

Teen pregnancy has a profound impact at multiple levels, including negative impacts to the physical and mental health of both the mother and child and worsened economic outcomes related to decreased maternal education and lost tax revenue. Although overall rates of teen pregnancy continue to decrease nationwide, the rate in Baltimore continues to be elevated above the national average. This is indicative of the social and environmental factors that differentiate it from the rest of Maryland and the rest of the United States and the clear need for continued intervention. The Baltimore City Health Department has made maternal child health and teen pregnancy a key target of intervention.

Title X is the only federal grant that provides funding for family planning health services. This funding is essential for low-income and high risk patients to receive family planning resource and is a single but critical program to combat teen pregnancy. Title X does not fund for abortion services, but rather, provides contraceptive services, education, STI screenings, and healthcare resources for pregnancy. Because it is funded by the Department of Health and Human Services, programs like this are always at risk of being de-funded or underfunded depending on the goals of the presidential administration. Currently, there has been significant resistance to the $300 million in funding that is provided by the HHS and efforts have been in place to decrease the funding. As this is the sole federal source of funding, continued advocacy is needed to ensure that Title X programs continue to be funded. Without it, low-income and high risk teens are deprived of resources that are necessary for their continued well-being.


Minnesota Needs the Clean Power Plan.

August 20, 2017

The Clean Power Plan enacted in 2015 aimed to reduce greenhouse emissions from the energy sector, which account for almost 40% of the U.S. carbon dioxide emissions, necessary to halt the predicted destructive impact climate change will have globally.  In March 2017, President Trump signed the Executive Order for Energy Independence, which sent the policy for review by the EPA to either withdraw or rewrite the plan, a lengthy process which will halt the policy’s regulation of power plant emissions.

The Clean Power Plan and all other actions to reduce climate change are necessary for all countries and individuals globally.  Coastal cities, such as Miami, are already dealing with flooding due to the sea level increasing.

Many Americans and Minnesotans may think climate change will have minimal effect on their wellbeing and daily Screen Shot 2017-08-20 at 6.57.48 PM.pngactivities.  The impact of climate change in Minnesota has been predicted and witnessed, as tornados, storms, and floods become more devastating and irregular.  Erratic changes in temperatures and precipitation will affect livestock and crop yields.


Individually, people should care for their health.  Energy production from coal leads to air pollution and climate change creating or worsening respiratory problems such as asthma, bronchitis, emphysema, and lung cancer, as well as increasing the risk of heart attack, heart failure, and stroke.  The length of allergy seasons has already increased, for example the ragweed season is 21 days longer than in 1995.

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Minnesota itself has not hit the emission targets set to reduce the impact of climate change, while the rest of the country has variable progressions.  In Minnesota, we need to be advocates for our health and wellbeing, and to do so, we must encourage others to support the Clean Power Plan and other efforts to combat climate change and turn our focus and investment to more efficient or cleaner forms of energy.

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Expanding Medicare’s Immunosuppressive Drug Coverage to All Kidney Transplant Recipients

August 20, 2017
The high cost of necessary transplant medicines can lead to some kidney transplant recipients losing their new kidneys.

The high cost of necessary transplant medicines can lead to some kidney transplant recipients losing their new kidneys.

As of January 2016, about 660,000 individuals in the United States are being treated for kidney failure. While dialysis can be an effective solution for some individuals, the current best care for renal failure is a kidney transplant, which offers better health outcomes and is less expensive long term than dialysis. While the initial transplant costs about $90,000 and required post-transplant medicines cost $16,000 per year, dialysis costs about $44,000 per year; most transplants pay for themselves and become cheaper than dialysis after 2 to 3 years. Kidney transplant recipients must take expensive immunosuppressive medications to keep their transplants healthy and working. Medicare currently pays for dialysis and kidney transplants as needed for everyone in the United States. However, while Medicare will cover the cost of transplant medications indefinitely for those 65 and older or disabled, Medicare will only cover transplant medications for 36 months for those under 65. After 36 months, many transplant recipients are not able to afford their medication and stop taking it; many then lose their transplant and have to go back on dialysis.

A doctor preparing a donated kidney for transport.

A doctor preparing a donated kidney for transport.

Multiple professional, patient-centered, and nonprofit groups support changing the law to expand Medicare’s indefinite immunosuppressive drug coverage to anyone in the United States with a kidney transplant. While bills have been introduced multiple times in Congress to address this issue, none have yet passed. A proposal put forward in 2009 was blocked by a major industry coalition who opposed plans to generate cost-savings from dialysis care to pay for the new coverage.  Subsequent proposals have failed to make it to a vote, due both to a Congress unwilling to address more health legislation in the wake of the Affordable Care Act and to real concerns about continued funding for Medicare. While the long term savings will be high, initial funding for such a measure may be difficult to find. Nevertheless, expanding post-transplant drug coverage in this way has substantial advantages both in increased quality of life for patients and in long-term savings for Medicare. Patients, health care professionals, and kidney-focused nonprofit groups should continue to contact their legislators through both private communication and public statements to urge them to expand transplant drug coverage.


Give Thailand’s Migrants their Health Insurance (MHI)

August 20, 2017

In 2011, Thailand was estimated to have 3.7 million migrant workers. They form 5% of the total labour workforce and are estimated to contribute to 6.2% of the Thai national gross domestic product (GDP), or US $ 2 billion dollars in 2005. The majority of these migrants may be displaced, illegal or undocumented. Hence, they do not enjoy health protection through the Social Health Insurance (SHI) private employees provide to workers with a permit. In 2013, the MHI was expanded to include coverage for undocumented workers and other services for a yearly fee of 2100 baht (approximately US $60). Human rights groups applauded Thailand as it became a global leader in universal healthcare for non-citizens. However, reports have surfaced on the refusal of hospitals to register undocumented workers under the MHI, especially in the greater Bangkok metropolitan area.

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Figure 1. Proportion of Non-Thai Citizens in 2011 (adapted from the International Health Policy Program Foundation)

Migrants smuggled to Thailand UN

Figure 2. The UN Office of Drugs and Crime reports Thailand as a destination country for migrant smuggling and labour trafficking

Displaced people due to civil war or poor economic conditions in neighbouring countries, the trafficked, smuggled and asylum seekers all need the MHI to have access to healthcare. Yet, hospitals are given discretion in their interpretation of the policy and face no penalty for refusing migrant workers. A hospital’s refusal to allow a migrant healthcare because they do not have documentation is a violation of the policy and the human right to a standard of living adequate for health and the well-being of a person and his family according to the Universal Declaration of Human Rights 1948 Article 25. Sadly, they are motivated to do so for fiscal survival in fear of the migrant workers over-burdening their resources.

Cambodian migrant worker

Figure 3. Yum, 29, was sold from Cambodia to a Thai fishing boat. He sailed for days at sea before knowing he was sold. After nine months at sea, he escaped. Now with a wife and newborn baby, he is hoping to find work in Thailand again. – The Guardian.

The health ministry must enforce the MHI for undocumented migrants to protect the community against communicable disease and increase pooled funds. It is a moral imperative to allow the people who make significant contributions to the nation’s economy access to healthcare.