Perspective Discusses SCHIP Reauthorization; Reports Examine Medicare Spending, State Health Care Overhaul Efforts

• "Expanding Coverage for Children -- The Democrats' Power and SCHIP Reauthorization," New England Journal of Medicine: In the perspective, John Iglehart, a national correspondent for NEJM, discusses congressional Democrats' "rapid action" on SCHIP reauthorization and expansion legislation. According to Iglehart, "Moving on to more ambitious [health care] reforms will be more difficult, given the rapidly increasing federal deficit, the competing claims for federal resources, and the determination of Republicans to forestall the growth of public insurance" (Iglehart, NEJM, 2/4).
  
  
• "Health Care on a Budget: An Analysis of Spending by Medicare Households," Kaiser Family Foundation: The report finds that in 2006, out-of-pocket health care spending accounted for 14.1% of all expenditures for Medicare households -- less than housing (34.1%) but about the same as transportation (15%) and food (13.6%). The report also finds that one in four Medicare households devotes more than one-quarter of total household expenditures to health care. This group includes a disproportionate share of Medicare households that are low- and middle-income, have older members ages 75 and older and live in rural areas. The Kaiser Family Foundation also released an updated analysis, "Revisiting 'Skin in the Game' Among Medicare Beneficiaries," that finds the financial burden of out-of-pocket health care spending by Medicare beneficiaries increased between 1997 and 2005. During the nine-year period, median out-of-pocket spending as a share of income for Medicare beneficiaries climbed to 16.1% in 2005, up from 15.6% in 2004 and 11.9% in 1997. For some beneficiaries, the spending burden was even greater, with 25% of people on Medicare spending nearly one-third or more of their income on health care. The analysis does not capture the effects of the Medicare Part D drug benefit, which began in 2006, because the data are not yet available (Kaiser Family Foundation release, 2/4).
  
  
• "State of the States 2009: Charting the Course: Preparing for the Future, Learning From the Past," State Coverage Initiatives: The report -- by SCI, a national program of the Robert Wood Johnson Foundation and administered by AcademyHealth -- examines efforts by states in 2008 to overhaul their health care systems. According to the report, despite the focus on the election and the economic recession, many states made progress on health reform in 2008; however, efforts likely will be hindered in 2009 amid declining revenue as a result of the recession. As a result of the economic recession, enrollment in Medicaid, SCHIP and other state health coverage programs likely will rise, but declining revenue will make it difficult for states to keep up with demand (Robert Wood Johnson Foundation release, 2/4).
  
  
• "Limits on Medicare's Ability To Control Rising Spending on Cancer Drugs," NEJM: In the report, former CMS senior adviser Peter Bach writes that if lawmakers "seek to slow the upward rise in cancer drug prices and spending, they could enable Medicare to use its existing approaches [to control costs] or provide legislation that would empower the program to experiment with new ones." He adds that previously Medicare has been successful in several areas that "suggest that the potential reductions in spending on cancer drugs could be meaningful." He concludes, "Determining whether innovation is hampered or helped by such actions should be an important part of the review process" (Bach, NEJM, 2/4).