The independent source for health policy research, polling, and news.
Nearly 10 million children in the United States lack health insurance coverage and over two-thirds of them or low-income. This databook provides baseline data on how many children are uninsured today and on the extent of Medicaid coverage. It provides astarting point to monitor and assess state efforts to reach and insure more children.
The Henry J. Kaiser Family Foundation
By Mason Essif April 21 – May 2, 2001
For ten days the six Fellows of the 2000/2001 Kaiser Media Fellowship program explored and evaluated the health care system of Cuba. They met with doctors, nurses, administrators, experts and government officials. The topics ranged from housing conditions to mental health and from STD/HIV prevention to cardiac surgery. While most of the time was spent in Havana, a few days were spent traveling into the mountains to analyze how universal access is guaranteed in the remote and rural areas.
While we were exposed to so much during the trip I divided my video material into four main areas: The Embargo, HIV/AIDS, Primary Care and Natural Medicine. Each segment strings together fragments of discussions with the experts in hopefully a rational manner. There is no narration just these excerpts and pictures of some of the sites and sounds encountered.
OverviewThe Embargo HIV/AIDS Primary CareNatural Medicine
The Henry J. Kaiser Family Foundation
2000/01 Kaiser Media Fellowships Program
Meeting of 2000/01 Fellows and Fellowship program advisory committeeSunday, May 20-Monday, May 21, 2001
Hotel Accommodations: The Washington Monarch Hotel, 2401 M Street NW, Washington, D.C., 20037 (Tel: 202-429-2400; fax: 202-457-5010)
Sunday, May 20 7:00pm: Meet in hotel lobby 7:30pm: Dinner–The Bistro, The Washington Monarch Hotel (at left of hotel lobby) Monday, May 21 8:00am: Metro to Food and Drug Administration 9:00 – 12:00am: Meeting at the Food and Drug AdministrationPharmaceuticals: (see separate detailed program)–drug approval process–single patient investigational new drug–risk management–drugs sold over the internet–drug withdrawal 12:00pm: Working lunch at the FDA 1:00 – 2:00pm: Continued meetings at the Food and Drug Administration 2:30pm: Return to hotel 3:30pm: Meet in hotel lobby: discussion of fellows’ projects 6:45pm: Walk to restaurantThe Melrose RestaurantThe Park Hyatt Hotel (opposite front door of WashingtonMonarch Hotel)1201 24th Street/M Street 7:00pm: Working dinner with the advisory committee to discuss fellows’ projects, fellowship program experience, lessons for future selections.16 Second Street North (Fellows depart Tuesday, May 22)
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This report presents information on the number of children enrolled in SCHIP for each state, for specific months from 1998 to June 2002. As of June 2002, the SCHIP program covered 3.6 million low-income children. An increase of 571,000 from the previous June.
The Henry J. Kaiser Family Foundation
Alcon Receives Warning from FDA
Problems Involving Test Batches are Fixed, Drug Manufacturer Says
12/09/2000
By Sarah LundayReprinted with permission of The Dallas Morning News
Alcon Laboratories Inc. has received a warning letter from federal regulators, saying the drug maker failed to meet several quality and safety standards during a recent inspection.
The problems could alter the purity of the company’s products, according to the Nov. 17 letter from the Food and Drug Administration.
Alcon, a subsidiary of Swiss-based Nestle SA, produces eye-care products and technologies, including surgical instruments, prescription drugs and contact lens care products. It employs 2,600 people at its Fort Worth facility.
Company spokeswoman Mary Dulle said the problems found during the inspection involved test batches of products that would not have been distributed to consumers. She also said that Alcon has since remedied those problems.
“We absolutely believe that there is no possibility of contamination of our product,” Ms. Dulle said.
FDA investigators who visited Alcon’s drug and device manufacturing plant in October documented “serious deviations” from the agency’s regulations governing manufacturing quality, according to the letter.
Michael Chappell, Dallas district director for the FDA, said the Alcon case continues as an open investigation until regulators review the company’s corrections.
“We don’t necessarily consider the matter closed until we go back and check that they follow the criteria they said they would and that it would actually solve the problem,” Mr. Chappell said Friday the date specified in the letter as the deadline for Alcon to fix the defects.
Ms. Dulle declined to discuss the products involved in the testing cited by FDA inspectors.
The warning letter cited several areas of concern, including:
Failing to clean, maintain and sanitize equipment to prevent malfunctions or contamination.
Failing to establish appropriate written procedures to prevent microbial contamination in drug products.
Failing to assure and document that automated equipment used in manufacturing, processing, packaging and holding of drug products will perform its intended function.
Ms. Dulle said any problems investigators found were related to manufacturing lines that were being used for testing at the time of the inspection. Still, Alcon acted quickly to fix problems, Ms. Dulle said.
“It’s a warning letter, so they’re trying to bring something to your attention in a big way,” Ms. Dulle said. “We’re really trying to work with FDA so we don’t get these letters.”
The company has received two other warning letters since 1998 on separate incidents. In both cases, Alcon responded quickly and the cases were closed satisfactorily, Ms. Dulle said.
2001 Kaiser Media Fellowships Program
Kaiser Media Fellowships program sitevisit to San Antonio and Laredo, TX:Sunday, July 29-Friday, August 3, 2001
Accommodations: The Menger Hotel, 204 Alamo Plaza, San Antonio, TX 78205 (Tel: 210-223-4361; fax: 210-228-0022)
Sunday, July 29
Meet in Miami airport6:30pm: Meet in hotel lobby
7:00pm: Dinner, The Grant Room, The Menger Hotel, with Bibi Lobo, vice president, National Latino Children’s Institute
Monday, July 30-San Antonio
The Grant Room, The Menger Hotel8:30am: Buffet breakfast
9:00am-12:00pm: Overview briefings on national and regional immigration trends, issues; immigrant health policy and financing issues; medical interpretation services –Jeff Passel, The Urban Institute: Overview briefing on national and regional immigration trends, Census data –Leighton Ku, Center on Budget and Policy Priorities: Immigrants’ utilization of health services; impact on safety net providers
12:00pm: Working/buffet lunch
12:30-3:30pm: –Mara Youdelman, staff attorney, National Health Law Program: Medical interpretation services and related policy issues –Josh Bernstein, National Immigration Law Center: Overview of current national/regional immigration legal, welfare and policy issues
3:45pm: The AVANCE program Promotora and Health Initiatives: –Marisa Chapa, Maria Hudson, and Mercedes Perez de Colon
4:30pm/4:45pm: (Optional) Walk from hotel two blocks to the San Antonio Express-News
5:00pm: Visit the San Antonio Express-News
6:00pm: Return to hotel
6:45pm: Meet in hotel lobby, drive to restaurant
7:00pm: Dinner, Pico de Gallo, 111 S. Leona Street
Tuesday, July 31-San Antonio
The Grant Room, The Menger Hotel
8:30am: Buffet breakfast
9:00am-10:30am: Clarissa Martinez, director of state and local public policies, the National Council of La Raza: U.S./Mexico bi-national perspective on border issues and migration
10:45am-12:00pm: Anne Dunkelberg, Center on Public Policy Priorities, Austin:Texas state immigration and health policy legal issues:
12:00pm: Working lunch at hotel
12:50pm: Depart hotel by van
1:15pm: Arrive, Texas Diabetes Institute/University Health SystemUniversity Center for Community Health–Briefings and visit to the University Health System/Texas Diabetes Institute-financing indigent care; the CareLink program (insurance for county residents under 200% of federal poverty); financing trauma care; diabetes-contact: Ms. Leni Kirkman, public affairs department, University Health System
5:00pm: Depart Texas Diabetes Institute; return to hotel
6:45pm: Meet in hotel lobby
7:00pm: Dinner with Tom Ferguson, M.D., editor and publisher, The Ferguson Report, Paesano’s Ristorante, 111 West Crocket
Wednesday, August 1-am: San Antonio; pm: Laredo
8:30am: Depart hotel by van-bring overnight bag
9:00am-11:00am: Meeting at Catholic Charities–Theresa Coles Davila, Center for Legal and Social Justice–Steve Saldana, executive director, Catholic Charities
11:00am: Depart Catholic Charities by van
11:30am: Arrive The Guenther House, 205 East Guenther Street
11:30am: Working lunch, followed by visit to The Texas Center for Infectious Disease-TB, Hansen’s Disease, etc. Visit/Working lunch with hospital Director, Mr. Jim Elkins; colleagues; and potentially Texas health department staff
3:15/3:30m: Depart Texas Center for Infectious Disease by van for Laredo
6:00pm/6:30pm: Arrive/check in, La Posada hotel, 1000 Zaragoza Street, Laredo, TX 78040
7:30pm: Meet in hotel lobby
8:00pm: Dinner, El Rancho restaurant, 2134 Avenida Guerrero, Nuevo Laredo, with health and border health officials, and local health groups
Thursday, August 2-Visit to Laredo
7:30am: Depart hotel by van-border area issues: –Visit to Gateway clinic and El Cenizo colonias (c. 10 miles from Laredo)–Visit to Laredo port of entry, border patrol facility
Contacts: David Lauricella, public affairs department, Laredo Health Department; Jacque Crouse, public affairs department, INS regional office
12:15pm: Working lunch
4:00pm: Depart Laredo for San Antonio
7:00pm: Arrive The Menger Hotel
7:40pm: Meet in hotel lobby, walk to restaurant
8:00pm: Dinner, Boudro’s, 421 East Commerce
Friday, August 3
am: Fellows depart
Search the entire kff.org site or review a list of publications in a specific topic area:
This report analyzes data from a survey of 42 low-income families with children with moderate or severe disabilities to better understand the impact of welfare reform on health coverage for these families.
The Henry J. Kaiser Family Foundation
Alcon Receives Warning from FDA
Problems Involving Test Batches are Fixed, Drug Manufacturer Says
12/09/2000
By Sarah LundayReprinted with permission of The Dallas Morning News
Alcon Laboratories Inc. has received a warning letter from federal regulators, saying the drug maker failed to meet several quality and safety standards during a recent inspection.
The problems could alter the purity of the company’s products, according to the Nov. 17 letter from the Food and Drug Administration.
Alcon, a subsidiary of Swiss-based Nestle SA, produces eye-care products and technologies, including surgical instruments, prescription drugs and contact lens care products. It employs 2,600 people at its Fort Worth facility.
Company spokeswoman Mary Dulle said the problems found during the inspection involved test batches of products that would not have been distributed to consumers. She also said that Alcon has since remedied those problems.
“We absolutely believe that there is no possibility of contamination of our product,” Ms. Dulle said.
FDA investigators who visited Alcon’s drug and device manufacturing plant in October documented “serious deviations” from the agency’s regulations governing manufacturing quality, according to the letter.
Michael Chappell, Dallas district director for the FDA, said the Alcon case continues as an open investigation until regulators review the company’s corrections.
“We don’t necessarily consider the matter closed until we go back and check that they follow the criteria they said they would and that it would actually solve the problem,” Mr. Chappell said Friday the date specified in the letter as the deadline for Alcon to fix the defects.
Ms. Dulle declined to discuss the products involved in the testing cited by FDA inspectors.
The warning letter cited several areas of concern, including:
Failing to clean, maintain and sanitize equipment to prevent malfunctions or contamination.
Failing to establish appropriate written procedures to prevent microbial contamination in drug products.
Failing to assure and document that automated equipment used in manufacturing, processing, packaging and holding of drug products will perform its intended function.
Ms. Dulle said any problems investigators found were related to manufacturing lines that were being used for testing at the time of the inspection. Still, Alcon acted quickly to fix problems, Ms. Dulle said.
“It’s a warning letter, so they’re trying to bring something to your attention in a big way,” Ms. Dulle said. “We’re really trying to work with FDA so we don’t get these letters.”
The company has received two other warning letters since 1998 on separate incidents. In both cases, Alcon responded quickly and the cases were closed satisfactorily, Ms. Dulle said.
A new survey conducted by National Public Radio/Kaiser Family Foundation/Kennedy School of Government looks at Americans’ knowledge and attitudes about Social Security and retirement. The survey finds the public considers Social Security a very important government program and keeping it financially stable a top priority. Americans are also concerned about the long-term future of Social Security and want to make some changes to the system now.
Bridging Benefit Gaps
Patchwork care makes health solution elusive
04/02/2000
By Charles Ornstein Reprinted with permission of The Dallas Morning News
Although the vast majority of Americans receive health insurance through their employers, by no means is the quality of coverage the same.
Just ask Harry and Louise.
The fictional middle-aged couple – created by the nation’s insurance lobby – helped undermine public confidence in President Clinton’s health-care reform proposal through a series of television commercials in 1993-94.
Sitting around a kitchen table and driving in a car, Harry and Louise voiced the fears of middle-class workers that their coverage would suffer if the government extended health insurance to all Americans.
It is this patchwork system of health insurance – Cadillac benefits for some, nothing for others – that helped doom any hope of a comprehensive national solution, industry experts say.
When given a choice, they say, people generally won’t sacrifice an insurance benefit or two – or pay more – so that others can improve their lot.
“The problem with health care is that it’s very easy to divide and conquer, just because people have such different interests and different fears and different experiences,” said Darrell West, a political science professor at Brown University in Providence, R.I. His book, The Sound of Money, examines the effect of Harry and Louise on the Clinton health-care reform debate.
“The fear was that we would end up with a lowest-common- denominator health-care system,” Mr. West said. “In elevating the poorest elements within society, we might in the process lower the quality of the care received by others.”
Complicating matters, he and other researchers say, are the many classes within the insured population.
At one end of the spectrum, some workers don’t contribute a dime toward health insurance. At the opposite end, others have insurance but rarely seek care because they can’t afford the deductibles.
And on the margins lie one in six Americans, or 44.3 million citizens, many of whom hold jobs that do not offer health insurance.
Each group has its own fears and experiences, and rarely do their priorities coincide.
The lucky ones
Individuals with the richest health insurance benefits typically belong to labor unions.
These workers have coverage starting with the first dollar, so they don’t pay any money toward either their premium or doctor visits.
Because of this, union members have opposed employers’ efforts to shift costs to them. Earlier this year, 17,000 engineers at Boeing Co. in Seattle went on strike for 40 days because the company asked employees to pay a share of their medical premiums. The company relented last month and agreed to continue paying those costs.
“Ultimately, it’s part of us looking at our benefits package and saying, ‘What do we need to do to attract and retain workers?'” said Nancy Cannon, director of employee benefits.
Union negotiator Stan Sorscher said the proposal would have cost the average Boeing family $1,500 per year. Union members, he maintained, have accepted below-market wages for years to maintain their rich level of benefits.
“We thought this was just the start,” said Mr. Sorscher, a physicist at Boeing. “If 10 percent premiums were a good idea, then 15 percent premiums would be an even better idea. … There was an open-ended threat to us.”
The vast middle class
Many of the 155 million Americans with employer-provided health insurance are like Diane M. Johnson, a 41-year-old manufacturing specialist at Texas Instruments Inc.
Ms. Johnson, who is enrolled in the NYLCare HMO, pays a share of her premium every two weeks, in addition to copayments for doctor visits and prescription drugs. She says her top consideration when choosing a health plan is cost.
“If you’re like me and you have several prescriptions, it starts adding up fast,” says Ms. Johnson, who has severe asthma.
Data from the U.S. Bureau of Labor Statistics show that Ms. Johnson’s experience is hardly unique. In 1997, 69 percent of employees with individual coverage were required to contribute to their premiums, up from 26 percent in 1980.
The percentage of employees who contribute to family coverage grew to 80 percent from 46 percent in 1980.
“The numbers of companies that used to provide free family coverage was pretty high 10 years ago,” said Edith Rasell, an economist at the Economic Policy Institute in Washington, D.C. “Now almost no companies provide free family coverage.”
Young and restless
By and large, employees who are young and healthy are less concerned about health coverage than stock options, career advancement and personal satisfaction.
The Internet generation enjoys such perks as free massages, discounts at workout facilities and catered lunches. As for health insurance, “that’s not something they’re as concerned about as long as they know that they’re covered,” says Julie Muenzler, human resources manager for imc2, a 100-person Internet services company in Dallas.
When imc2 asked employees for benefit suggestions at an annual retreat last year, they responded by requesting dry cleaning pick-up at the office, more vacation time, additional floating holidays and stress management programs.
Mike Keller, a 27-year-old graphic designer at imc2, said when choosing his current job, he was impressed by the casual dress code, the free Coke machine and the rock-climbing wall.
Mr. Keller, who graduated from the University of North Texas, said he asked about health insurance benefits before he accepted his job, but that’s the extent of his research.
“I’m glad I have it; I just don’t use it,” he said. “As a matter of fact, I picked the wrong doctor to treat me. I picked a pediatrician on accident. I’ve been healthy my whole life – thank God – and I haven’t really needed all that.”
The small-business crowd
Because small businesses don’t have the purchasing clout of their larger brethren, they often don’t provide comparable health benefits.
Only 55 percent of firms with fewer than 10 workers offered benefits last year, according to a report by the Kaiser Family Foundation and the Health Research and Educational Trust. That compares with 99 percent of firms with more than 200 workers.
What’s more, small businesses that offer insurance are feeling the brunt of increased medical costs, and they are shifting the burden to their employees.
Jim Kollaja, for example, pays 50 percent of the cost of insurance for workers at his family-owned woodworking business in Corpus Christi. When this year’s higher rates took effect, the company charged workers 12 percent more for single coverage and 26 percent more for family coverage.
The company’s trade association reports that about half of similar firms offered health insurance for full-time shop employees in 1998.
“A lot of companies opt not to carry it, not to hassle with it,” said Mr. Kollaja, vice president of Imperial Mill and Fixtures Inc. “We look at it as what we need to have in order to compete for the best employees.”
Imperial is routinely turned down by insurance companies because several of its 30 employees have chronic medical conditions that are expensive to treat.
“It’s kind of a love-hate relationship. I hate my insurance company, but I can’t do without them.”
The gray and threatened
The people most affected by changes in health insurance are early retirees who are not yet eligible for Medicare.
A recent study by the consulting firm William M. Mercer Inc. found that the percentage of large companies offering benefits to this group has fallen each of the last six years, to 35 percent in 1999 from 46 percent in 1993.
Thousands of retirees have sued their former employers, saying officials reneged on earlier promises to provide them health benefits for life.
But courts have generally ruled that companies are entitled to reduce or even eliminate benefits as long as they reserve the right to do so in writing.
Pabst Brewing Co. in Milwaukee terminated health benefits to 774 retirees in September 1996. For those not eligible for Medicare, comparable coverage cost as much as $8,200, according to a 1997 government report.
Andy DeRuiter retired from Pabst in early 1995 after 23 years. Sixteen months before he was eligible for Medicare, Pabst terminated the retiree benefits. As a result, Mr. DeRuiter went uninsured, relying on free drug samples from his doctor to treat his high blood pressure and chest pains.
“When we retired, they told everybody, ‘You retire now, and you’re set for life,'” Mr. DeRuiter, now 67, says. “That was a big lie.”
The uninsured
Despite public perceptions to the contrary, 84 percent of the 44.3 million uninsured Americans are workers or members of a working family. And a full 20 percent have access to employer-paid health benefits on the job.
Standing in the way of coverage, researchers say, is low-income workers’ inability to afford their share of monthly premiums set by employers.
In many cases, uninsured people are willing to rely on public hospitals if it means having the money to buy extra groceries for their family.
Despite the growing number of uninsured, surveys indicate that the public believes these people are better off than in the past. According to a 1999 report, 57 percent of people believe the uninsured are able to get the care they need when they need it, up from 43 percent in 1993.
“People know there’s a problem, but the economy has hidden a sense of the crisis,” says Harvard University professor Robert Blendon, the study’s author. “For people who have a job and insurance, life has never been better. They say, ‘I’ve never had it so good in my life – money in my pocket, the employer is worried about me leaving – everybody must be doing better.'”
Timing is everything
Some policy experts and politicians believe the time is right for a national solution for the problems of the uninsured, even though others don’t believe there’s a crisis yet.
In the Democratic presidential primary, both Vice President Al Gore and challenger Bill Bradley presented proposals to expand health coverage to millions of uninsured Americans. The difference between the two plans involved cost and scope.
Republicans George W. Bush and John McCain did not discuss the issue during the primary stage.
The real push for change could come from within the Washington Beltway, not middle America, where the problems are most acute, researchers say. That’s because the voices of the uninsured can’t be heard above the din of lobbyists.
“When Gore and Bradley both put forward proposals, that was unprecedented in terms of the attention that health-care coverage got in a presidential campaign,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “This, to me, was a sign that there may be a lot more interest on the part of the public.”
Still, Mr. West of Brown University said the real push for government reform will come when the middle class sees massive increases in health-insurance costs.
“That would be a crisis,” he said.
Charles Ornstein, who covers health business issues for The Dallas Morning News, is pursuing a yearlong fellowship through the Kaiser Family Foundation.