November 15, 2012
Host: Ted Simons
Arizona Health Insurance Exchange
- Arizona Governor Jan Brewer must decide soon Arizona will establish a state-run health insurance exchange or let the federal government be in charge of providing that service to Arizona residents. It’s a key part of the Affordable Care Act, President Obama’s health-reform law. Suzanne Kinney, Executive Director of the Arizona Chamber Foundation, a research and education arm of the Arizona Chamber of Commerce and Industry, explains how a health insurance exchange works and what happens if Arizona decides not to operate its own exchange.
- Suzanne Kinney - Executive Director, Arizona Chamber Foundation
| Keywords: medical
Ted Simons: Well, Friday, was also a deadline for Arizona and other states to submit a plan for creating a state run health Insurance exchange. However, states now have until December 14th to submit their Plans to the federal government after health and human being Services secretary Kathleen Sebelius extended the deadline earlier today. Governor Brewer hasn't said if she will submit a plan or allow the government to create an exchange for Arizona. Joining me now to clarify the State's options on all of this is Suzanne Kinney, Executive director of the Arizona chamber foundation, a Research and education arm of the Arizona chamber of commerce, and industry. Thank you very much for joining us. Now, we got you here because we Figured tomorrow was the big deadline, and the big announcement. Got an extension, huh?
Suzanne Kinney: that's right. And it was really last-minute Information coming in, so you hear it here first.
Ted Simons: there we go. Ok. And regardless of the deadline, its coming up soon, and what are Arizona’s options regarding the health care exchange?
Suzanne Kinney: that's right. So, by that new December deadline, the governor will need to decide whether to, to move Forward with the state-based Exchange, default to federal Exchange, or potentially do the Hybrid model of the state and Federal partnership.
Ted Simons: and this has to be set up completely in toto, if you will, By January 1st of 2014?
Suzanne Kinney: that is the date when they need to be live and Operational. There are several other Milestones between now and then. For example, open enrollment would occur in October of 2013.
Ted Simons: and now you mentioned the Possibility of a joint exchange, Is that some, the hybrid kind of A thing? Is that -- how does that work?
Suzanne Kinney: that was not originally one of the choices available to States. It was something that was offered up later on. But, basically, under a partnership, the majority of the Decisions would still be made by the federal department of health and human services. The states would do some Functions like consumer Assistance. Managing the call centers. That type of activity, as well As plan management. Meaning, oversight of the health Insurance plans that sell the Product on the exchange.
Ted Simons: so regardless of whether it's a state run exchange or federal Run exchange or something in Between, governor has to make a Decision and the legislature has to approve this, correct?
Suzanne Kinney: that's right. The governor would need to Signal her intent, but then there would be certain things that the legislature would have to do. Such as determine what the Funding source for the exchange would be, and decide where it would be housed, in an existing Agency of government or in a, a New nonprofit or somewhere else, and several other decisions.
Ted Simons: and I guess, decide whether they want to agree with the Governor's decision.
Suzanne Kinney: that's right.
Ted Simons: she says, state and they say No, you have got problem.
Suzanne Kinney: you do, indeed.
Ted Simons: let's talk with the state run Exchange. Some of the benefits, some of the concerns.
Suzanne Kinney: the benefits of a state run Exchange, is that it would allow Maximum flexibility within the Parameters of the affordable Care act. So, for example, states would be Able to choose which insurance Providers can sell a plan on the Exchange. And if we have a federal model, then that decision will not be Up to us, and it's possible that the federal government would decide to limit the number of Insurers, thus reducing the Choice for consumers.
Ted Simons: in a state run exchange, how Much, how much federal Supervision would there be over A state run plan?
Suzanne Kinney: Well, basically, the Affordable care ac sets certain Parameters within which the State can make decisions. So, the state would not be able to decide what the premium Subsidies or tax credits were. Those are already stipulated in the law. So, there is some factors the State doesn't get to choose. But, there are many that they do. The biggest one is probably the Choice between market Facilitator or an active Purchaser. So, the active purchaser role is one where the government would really get more involved in Terms of, setting -- negotiating Prices between insurers, and Health care providers. And deciding who can participate and self-product on the Exchange. A lot of other decisions like that. The market facilitator has just a much reduced role for Government.
Ted Simons: basically, a facilitator.
Suzanne Kinney: exactly. Providing the choice, or allowing the, the consumer to see the choices available, Setting up the infrastructure. On the website. And those types of decisions.
Ted Simons: as far as federal assistance for state run plan, I mean, you talk about the legislature having to figure out where the Money is going to come from. Does it differ if it's a state Run plan as opposed to a federal Plan as far as federal Assistance is concerned?
Suzanne Kinney: In terms of the financial Aspect of federal assistance, it would not make much of a Difference. So, consumers and employees of Small businesses who purchase Plans on the exchange would have the same tax credit subsidies available to them. One of the big questions is on the issue of Medicaid expansion, and what role the federal Government would play in setting that level on federal exchange versus a state exchange. And that's something that there is not a lot of clarity on it at this time.
Ted Simons: That’s a big one. That would hit the state very Hard. And we don't really know, do we?
Suzanne Kinney: we don't know, what we do Know is that, is that there Could potentially be a gap Between those individuals who, Who receive Medicaid, which we Call access in our state, and Those who are eligible for the Various subsidies for our state Chooses not to expand Eligibility, or to return to the 100% that we had before we froze Eligibility in the program.
Ted Simons: if the state decides whether it’s the governor or the Legislature decides, we don't want any part of anything, we're going to let the federal government do what it has to do and what it wants to do. And benefits and concerns with that decision.
Suzanne Kinney: Well, the way we're looking At it is those who oppose the Law have seen the court's Decision and seen an election. So implementation is going to take place. And it's now matter of figuring out which course of action makes the most sense for our state. So, our insurance market, our consumer base, the number of people that we have who are uninsured, is different than other states. And, you know, so we feel that it’s best to have the choices Left at the state level, rather than a one size fits all federal Model.
Ted Simons: if one size fits all federal model in terms of an expense to the state, do we have any idea whether it's cheaper, more expensive?
Suzanne Kinney: what the, the HHS has Indicated, is that, is that they Would fund the exchange by an Additional fee or tax on those Insurance providers who sell a Product on the exchange. So, you could imagine that will Most likely be passed along to the consumers by way of higher Are premiums. If we go the state route, our Legislature will need to decide what the appropriate funding Source is.
Ted Simons: Interesting. And we're talking about a health Insurance exchange for those who aren’t covered at work or aren't covered in other ways, correct?
Suzanne Kinney: that's right so initially, it will be individuals and Employees of small businesses who are eligible to buy their Insurance on the exchange. However, by 2017, it will be opened up to employees of all Sizes of companies that meet the various wage and other Parameters.
Ted Simons: So employees and, and/or Companies.
Suzanne Kinney: that's right. So, there are certain criteria for, for small businesses, and those are, basically, around the Average wage that they pay their employees. Now, one of the trends that a Number of folks are concerned about is the possibility that some businesses will reduce the Hours for their workers so that they fall below the full-time Threshold of 32 hours.
Ted Simons: if they fall below, where do they go?
Suzanne Kinney: That’s hard to say. Those individuals will still be required by the individual Mandate to have health Insurance. Depending on their salary, whether they have two or three Jobs. They may or may not be eligible for subsidies that could help to cover the costs of a policy.
Ted Simons: But that would be who the Exchange is for, is it not? If you cannot get covered at Work, the exchange is there, and you may be able to find what you need provided you can figure out what you are looking at.
Suzanne Kinney: You might be able to, and it will depend on the person and their family income.
Ted Simons: so, we talked about, you know, the benefits and concerns regarding state run coverage and the federal run exchange. The hybrid model in between, that really is -- that's a vague Kind of a thing, in it?
Suzanne Kinney: it is, and so far three States have indicated that they prefer that choice. So --
Ted Simons: in other words, but, you know what; you could possibly see that because for political Purposes, a lot of folks in Government are simply against this particular health care Reform. This particular aspect of health care reform. Politically, they may say no, But there may be wiggle room in between, would there not? And you have other aspects to be concerned about.
Suzanne Kinney: And i think that some of those key choices, though, may not be available in the Partnership model.
Ted Simons: ok.
Suzanne Kinney: in terms of who is on the Board of the exchange, and whether it's the market Facilitator and active Purchaser, where in government It is housed and financed. Some of those core decisions would still not be available to States if they do the Partnership route.
Ted Simons: so the governor decides in December, legislature takes it Up and decides whether it's Thumb's up or down and by January 1st of 2014, ball game Is on?
Ted Simons: this is moving very quickly.
Suzanne Kinney: it sure seems like it.
Ted Simons: it's good information, I Think a lot of folks are Confused but if you are covered Already at work, this would not Necessarily apply to you unless Your work says, they are not Going to cover you anymore.
Suzanne Kinney: If you work for a larger Employer it would not directly apply to you immediately. There may be broader Implications for our health Insurance market. But you would not be on the Exchange for the first three Years.
Ted Simons: well, it's good to have you here, and we'll see what happens when the next deadline approaches, and that one is, no doubt, moved. So, thank you for being here. We appreciate it.
Suzanne Kinney: it's my pleasure.
Child Fatality Report
- 837 Arizona kids died last year according to the Arizona Child Fatality Review Program’s 19th annual report. The overall number of child deaths continues to decline, but homicides and suicides are on the rise. Find out more about the report from Will Humble, Director of the State Department of Health Services, and Dana Wolfe Naimark, President and CEO of Children’s Action Alliance.
- Will Humble - Director, State Department of Health Services
- Dana Wolfe Naimark - President and CEO, Children’s Action Alliance
| Keywords: child
, children health
Ted Simons: 837 Arizona children died Last year according to the Arizona child fatality review Program's 19th annual report, the overall number is declining. The deaths caused by homicide And suicide are on the rise. Here to tell us more about the Study is Will Humble, director Of the Arizona department of Health services, and Dana Wolfe Naimark, president and CEO of Children's action alliance. Good to have you both here. Thanks for joining us.
Will Humble: Thanks.
Dana Wolfe Naimark: Thanks.
Ted Simons: Will, let's talk about the Study. How was the study done? What did the study look at?
Will Humble: it's a study that's been done For the last 20 years, and it's Really been instrumental in, and A very good tool that we have Been able to use over the years To identify interventions or Ways that we can make systemic Changes in the community to save Lives, so, this report looks at Every single kid under the age of 18 That dies in Arizona, there is An in-depth review of what the Circumstances were. And more important, Recommendations about what can be done as a system, at the Community level to make Difference.
Will Humble: I noticed fewer deaths, fewer Child deaths reported in 2011 than in year's past, is that Accurate, a, and b, what's going On?
Will Humble: Yeah, well, we have seen a Good trend over time, still way Too many child deaths, but, by Using the report, and Identifying interventions, we've been able to save lives. So for example, a few years ago, you may have heard of sudden Infant death syndrome, infants die in their crib because they were put on their stomach to Sleep. We did this back-to-sleep Campaign after the child Fatality review report to get Kids on their back, and we brought down SIDS death to zero. Used to be a couple of dozen a Year.
Ted Simons: That’s a wonderful example. The idea of using a report like this as a tool, talk to us about that.
Dana Wolfe Naimark: Right, and it's a heart wrenching report to read and Work on, looking at child Fatalities, but the whole point Is for us to face the reality and see what we can learn and do differently in the future.
Ted Simons: Things like unsafe sleep Environments, which we'll talk, about and firearms, disease, Drugs and alcohol, these are all Still factors in children. What do you do when you get these numbers, where do you go from there?
Dana Wolfe Naimark: Well, each year, the report makes specific recommendations, but it's also up to us, groups in the community to look at it and see what else we can do and what we want our policymakers and our leaders to do with it. You mentioned guns, and I think that’s an area that we have not improved too much, and for many Years the report recommended doing more to keep guns out of the hands of kids, and away from Kids' families. And I don't think that we have done too much in that area.
Ted Simons: What you do in that area?
Dana Wolfe Naimark: There can be a lot of gun Safety things, and in addition To, to laws that, that help keep Weapons out of the hands of Kids.
Ted Simons: Well, Will, I also saw something called prematurity as Far as a child death?
Will Humble: The number one preventable cause among Kids is prematurity, so kids Born too early. And there is simple things that Can be done, it's not simple to Do but it's something called Preconception health where the Idea is to get young women in The reproductive years to take Better care of themselves in Terms of physical activity, Nutrition, and so that they have Better chance at a good outcome, Meaning that the kid stays in For 39 full weeks, which is full Term so we focus on Preconception health in our maternal and child Health programs. We have worked with the Hospitals across the state, so That to prevent the elective Inductions, in other words, People electing to have their Kid delivered before 39 weeks, Even though it's not medically Necessary, which on a Case-by-case basis may not be a Big deal but on a population of People, even a couple weeks Early, is going to end up with Bad outcomes, so it's this Approach trying to find leverage Points in the community so that We can implement strategies, and Policies to make improvements In, and try to look at this Number of kids born too early.
Ted Simons: Something like that sounds Societal. You have to go to a culture and Say, this is not right. The not good. And has to be difficult to do.
Dana Wolfe Naimark: and there are a lot of things That need behavioral changes, And that's will's expertise in Working in public health, and There are ways to help people Make better decisions, and take Better care of themselves, but There is also things that we can Do systemically, to make it Easier for people to do that, And give them access to good Health care and other good Resources.
Ted Simons: These are educational things, Informational things?
Dana Wolfe Naimark: Right and having services Available. So, one reason that young people don’t take care of their health is they cannot afford health Insurance. They are not covered. They cannot get to doctor. They cannot get to an Appointment, so, there are Systemic things that we can to and based on the first story you did, will be expanding health Care coverage so more do that.
Ted Simons: Let’s talk about a couple of Familiar things. Certainly child drowning. We have heard about drowning Deaths for decades. Watching kids around water, and, You know, two seconds is too Long, there is so many campaigns Out there, what are we seeing as Far as those numbers?
Will Humble: We still had 34 deaths from Drowning in 2011, and not all Swimming pools, sometimes it's Bathtubs and those things. Predominantly, it's the same old swimming pool Issue. Broken gates. Fences. But bottom line, lack of Supervision. These are tragic situations, and it really does take a minute, and so, it's a combination of Just making sure that you watch your kids but also, get them Water safe early. Get into the programs in the Community where you can teach your kids to, to be water safe, Earlier. Cities have these programs. And it does not take long. I did it with my kid when she was crying really badly but it worked.
Ted Simons: 94% preventable. Child drowning, and but, again, I get back to, you know, Information, culture. And after all these years, of Being told to watch your kids, Two seconds of this, that and The other, and how dangerous a Pool is and with laws and community codes with the gates Around pools, it is with us. How much more you do?
Dana Wolfe Naimark: We have to keep at it, that's the thing. We cannot think because we had a Campaign last year or two years ago, we're done because there is always new parents, and there is New people moving to Arizona. So, it has to be a continuous, relentless effort of campaign.
Ted Simons: Carpet bombing sort of thing. And child suicides, talk to us about that.
Will Humble: We had an increase in the Number of child suicides over the last year from 24 to 39 in 2011, so, there again, it's, It's a, a -- it's a societal Thing. There is systemic things that we Can do, and for example, we can Work, we have, we have Continuing medical education, They are called CMEs comes out There, where we can, we have Online tools, where physicians And health care workers go on And get their continuing medical Education to learn about ways That they can identify signs of Depression and other precursors Like substance abuse for people Who present to an emergency Department, and what looks like May have been an accident could Be an early sign of a suicide. So, there are tools that, that can be used for health care Workers, for example, to identify those situations and Conduct early interventions. It's called an expert program for substance abuse, but there is some tools that can be used, But again, it takes an entire Village to get these things done. It's not the public health Department that gets these Things done. Not Dana, your organization. It's the community working Together, and that's what's Valuable about this report, is it really is multi-sectorial.
Dana Wolfe Naimark: and it takes our leaders Because once health care workers Identify risk factors, where do They send people and refer People to do, what help is out There, and if there is no help, There are no services, and it's Done, done us no good to Identify that.
Ted Simons: I thought the maltreatment Part of the report was Interesting in that so many Cases were never reported to CPS In the first place. A lot of attention on CPS when they take case and something Bad happens thereafter. But it's, and again, back to the Community, lots of these cases are never reported to start With.
Dana Wolfe Naimark: Right. And there are strange things that happen. People are isolated or things happen all of a sudden. Or sometimes, neighbors and others are afraid to report. But there were many cases that were reported, as well. And in fact, about half of the, of the deaths from mall Treatment had contact with cps previously.
Ted Simons: So what are we seeing with them now as far as get that go Act together? The more money is being requested, or we talk to the Director here on the program about that, what else is going on?
Dana Wolfe Naimark: They are completely overwhelmed. Their system cannot keep up with the needs. They have seen big increase in Reports. A huge increase in the number of Kids in foster care. And they cannot keep up. So, hence they are asking for more revenue. In their budget requests for Next year, but I would like to Also see them look at this Report and say, what we learn And what can we do better at Cps. It's not only fatalities; they give you that tip of the Iceberg, that warning sign. But, we know that there is many Cases where there are children Neglected or injured, or abused, and they don't die thankfully. So what can cps learn from these Cases they can do differently.
Ted Simons: What can all agencies learn? What the community -- community Recommendations in this, what we do?
Will Humble: Here’s a perfect example. It's low tech. We had 64 deaths in 2011 from what we call co-sleeping. The kids get fussy in the night; Parents bring the kid into their Bed with them. And co-sleep. And the kid, you roll over in The middle of the night, the Covers are stuck or something Like that, and the kid Suffocates, it's co-sleeping. A, as simple as avoid the Temptation to bring your fussy Infant into bed with you and do Your breastfeeding in their room And put them back in their crib Because when you co-sleep, Everyone gets a good night's Sleep, that's true but we know It's not safe. So, we get better awareness out There through the pediatricians so they can work with new Families to make sure that they understand the dangers of bringing their babies, their Infants into bed with them because I know. I know it works. They are fussy at night, and there is a temptation to bring them in. And they do, but we see in this Report that it is just not Face-off practice. You think about it, 64 kids, that are almost as many as mall Treatment. That's right here towards the Top of the list.
Ted Simons: And traffic accidents, I Would imagine that sounds like Telling people to buckle up, that’s probably a concern?
Will Humble: There is 70 kids that died because they were unrestrained in cars, and it's not across the Board. We have some areas in the, especially with the Latino Community. We see a disproportionate number of deaths from kids who were Unrestrained in cars in the Latino community. We have got to do a better job getting out to Spanish language Media about the importance of Car seats. Booster seats and teenagers buckling up. By and large it's younger kids. Not restrained in the car seats, and it's disproportionately Latino.
Ted Simons: What do we take from this?
Dana Wolfe Naimark: Will and I were noticing that a contributing factor in many of the causes of death is substance Abuse among the parents. And I think that we have to do a Better job being willing to help Friends and family and neighbors Get into treatment. Being willing to support Treatment with our tax dollars. Because it will pay off tremendously.
Ted Simons: All right, good to have you both. Will, we'll get you back regarding medical marijuana.
Will Humble: A good segue.
Ted Simons: Yeah. Got the ok?
Will Humble: We approved a dispensary more no more than 45 minutes ago, we inspected one in Glendale. Everything was on the up and up, so there is one permit out There.
Ted Simons: So one permit out there, and If you are within 25 miles, Knock it off.
Will Humble: No more. No more new application, we’ll grandfather the old ones.
Ted Simons: Thank you for joining us.
Dana Wolfe Naimark: Thanks.