November 7, 2007 OPINION: SCHIP Reauthorization Saga is Déjà Vu All Over Again as Health Care for 10 Million Children Hangs on the “T” Word Another month, another congressional attempt at providing health care to millions of uninsured American children, another presidential veto threat? If it isn’t a bad sequel to Groundhog Day the movie, it must be the seemingly everlasting confrontation over the States Children Health Insurance Program, SCHIP. (by Andrew Leone) Read more Visit Florida CHAIN's Advocacy Resources page for newly reorganized categories: Florida, Children's Health, Medicaid, Medicare, Uninsured, Prescription Medications, Health Disparities, and more 1. Zella Reid, DCF Community Partnership Specialist for Central Florida speaks at town hall meeting in Osceola on health care access.  2. Roundtable participants discuss effects of Medicaid Reform in Broward.  3. Seniors discuss changes to health care legislation in Orlando town hall meeting
	SCHIP Influences Florida KidCare Legislation on 2008 Horizon The 2007 Florida Legislative Session paid great attention to Florida KidCare, partly due to the need for Congress to reauthorize the highly successful federal-state SCHIP partnership as well as recent reports of 700,000 uninsured Florida children. Unfortunately, the KidCare bill that passed the Florida House by a vast majority was not taken up during the last week by the Florida Senate. Fortunately, Florida’s Legislators once again have indicated they are ready to create a more efficient, seamless and simplified program to assure coverage for more children. But the final results of the Congressional reauthorization process will become a key factor. (by Linda Merrell, Florida Child Health Care Coalition) Read more
	Challenges of Medicaid Reform’s Next Steps Illustrate Need to Proceed with Caution The notion that Florida should take a deep breath and delay further expansion of Medicaid Reform has gained significant traction in recent weeks. This follows the findings of the Inspector General for AHCA that data available is currently inadequate to allow legitimate evaluation of the impact, and that a number of serious concerns already identified remain unresolved. Nevertheless, proposals to expand Medicaid Reform will likely be under consideration in the 2008 Florida Legislative Session. (by Greg Mellowe, Florida CHAIN) Read more

	If WellCare Sinks, Could Florida’s Most Vulnerable Patients Go Down with the Ship?   On Oct. 24, more than 200 agents from the FBI, the State Attorney General’s Medicaid Fraud Control Unit and Medicare’s Inspector General raided the Tampa headquarters of insurer WellCare Health Plans. WellCare has 2.3 million enrollees, including a share of Florida's Medicare and Medicaid managed care markets. To protect low-income, vulnerable enrollees, Florida CHAIN and other consumer advocates urge suspension of enrollment in WellCare plans while serious allegations are pending. (by Greg Mellowe, Florida CHAIN) Read more     It's Time to Enroll for Medicare “Extra Help”   If you have limited income and resources, or were a “Dual Eligible” (Medicare and Medicaid) recipient, you may qualify for Extra Help in paying for your Medicare part “D” premium and also lower prescription drug copays. If you have qualified for, or received LIS before, YOU MUST reapply for 2008. Approval can take up to 6 weeks, so APPLY NOW! (by Bill Rettinger, MedicaidAdvocates.Com) Read more
	Florida Special Session Avoids Further Cuts to Services for Persons with Disabilities Now that Special Session C is over, and its resulting changes signed by Governor and their implementation starting, advocates, individuals with disabilities and their families can breathe a little easier. Thanks to the combined efforts of advocates and legislators, administrative and provider costs were reduced instead of making further direct services reductions. Further, individuals with intensive needs will receive more Personal Care Assistance (PCA) hours. (by Ruben Betancourt) Read more
	Property Tax Cut Amendment on January Ballot Perplexes Many, Satisfies Few Following the Florida Legislature’s most recent Special Session, Florida voters will have a Property Tax Reduction proposal to approve by a 60% margin on a Jan. 29 ballot. This proposal has generated cries of foul play by those who do not believe it reflects the Governor’s promise of taxes “dropping like a rock.” Consequently, there are now 11 citizen initiatives brewing to place yet another amendment proposal, promising greater cuts, on the Nov. 2008 ballot. But what of the opposite concerns that a substantial cut in property taxes can cause harm to local and county agencies’ ability to deliver needed services? (by Andrew Leone) Read more
	Osceola Town Hall Meeting Gathers Diverse Interests to Spark Advocacy   On Nov. 1, Hispanic Health Initiatives, with Florida CHAIN, hosted a Town Hall meeting in Osceola County. Through the participants' diversity, consensus emerged regarding grave concerns over Medicaid Reform expansion; access to Medicaid Reform specialists; overcoming barriers to KidCare enrollment; and the need to expand SCHIP. (by Greg Mellowe, Florida CHAIN) Read more

	Medical Tourism Not an Answer for Many in U.S.   The high cost of U.S. health care is fueling the burgeoning industry of medical tourism. Buoyed by lower costs of a heart procedure to plastic surgery to a tooth implant in places like Thailand, India or Colombia, more and more Americans choose this exotic option. But the underlying U.S. health care crisis cannot be resolved with sexy foreign travel solutions out of the questions for most.  (by Andrew Leone)  Read more

	CHAIN Reaction is a bi-weekly publication of Florida CHAIN (Community Health Action Information Network), a statewide consumer advocacy organization that works toward access to quality health care, empowering people to actively shape their world by participating in civic life and caring for each other’s well being.  Florida CHAIN: 6600 Cypress Road #508, Plantation, FL 33317   info@floridachain.org     www.floridachain.org
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SCHIP Reauthorization Saga is Déjà Vu All Over Again as Health Care for 10 Million Children Hangs on the “T” Word   OPINION   Another month, another congressional attempt at providing health care to millions of uninsured American children, another presidential veto threat? If it isn’t a bad sequel to Groundhog Day the movie, it must be the seemingly everlasting confrontation over the States Children Health Insurance Program, SCHIP.   Amidst the bitter partisan bickering of the last generation on almost everything, one issue has united members of both parties: providing health care to children whose working families earn too much to qualify for Medicaid but not enough to purchase health insurance. This was true in 1997, when a Republican Congress and a Democratic President first enacted SCHIP, and it is true today, when bipartisan majorities have voted to reauthorize and extend the program for five more years. Not once? not twice? but three times.   The difference now is that President Bush, and just enough members of the House to prevent a veto override, continue moving the goal posts so as to keep SCHIP legislation from passing, while protecting a very specific interest.   At first it was about “philosophical differences” on the future of how health care should be delivered in America.  As happens every time debate on the failures of health care in our country reaches fever pitch, the specter of “socialized medicine” is resurrected and the virtues of market-based solutions are touted. In a September 20 news conference, President Bush stated: “What I'm describing here is a philosophical divide that exists in Washington over the best approach for health care. Democratic leaders in Congress want to put more power in the hands of government by expanding federal health care programs. Their S-CHIP plan is an incremental step toward the goal of government-run health care for every American.”   Difficult as it is to envision SCHIP supporters like Sen. Orrin Hatch, Republican of Utah or Sen. Chuck Grassley, Republican of Iowa–among the most revered conservative legislators of our time–and organizations like the American Medical Association, supporting such a scheme, the argument is a valid one at this juncture in our history. The fact is, however, that the vast majority of Americans don’t see it in those terms. They see it as simply a matter of insuring children who have no health care coverage.   Trying to weather the political storm unleashed by that fact, the President and vulnerable House Republicans have resorted to other arguments. They have derided SCHIP as legislation that would “cover families that make up to  $83,000” or 400% of the Federal Poverty Level. That would have been the case only in one New York instance and following a waiver by Bush’s own Center for Medicare and Medicaid Services (CMS). In the overwhelming majority of cases, states, such as Florida, set the limit of eligibility at 200% of FPL. The bill would allow for states where the cost of living warrants it, to go up to 300% of FPL.   The next set of arguments centered on another hot button issue of our times: illegal immigrants. Colorado Representative and presidential candidate Tom Tancredo was at the forefront of this with statements reported in the New York Times like: “Again, the Democrats have proven their loyalty to illegal aliens over American citizens.” In railing against the bill on the floor of the House, those using this argument, pointed to specific passages in the legislation they thought left loopholes allowing undocumented children access to care.   Some would not think that a bad idea, considering that wherever these children roam, the whole community is healthier if they have access to preventive and affordable care. But bowing to a political climate of intolerance towards non-citizens, not only does the legislation explicitly not provide for care to undocumented children, it establishes a five-year moratorium for foreign-born children who are here legally. This prompted representatives of states with high immigrant populations to balk at the bill from the opposite perspective, but in the end, most fell in line with their leadership.   Following the presidential veto and the failed override, President Bush expressed willingness to compromise as long as these issues were addressed.  House Speaker Nancy Pelosi agreed to discussions but in an interview on NPR on October 30, reported no real overtures from the White House. Still, sensing the possibility of being able to ply just enough Republican votes to override a veto, House leaders adjusted the bill to address the stated objections. The new legislation, for instance, clearly limits eligibility for the program to children from families with incomes up to $62,000 a year for a family of four.   The House once again voted and passed SCHIP, this time 13 votes short of an override majority. In a press conference following the vote, the President dubbed the whole exercise a “waste of time.” On November 2nd, the Senate followed suit on a 64-30 vote.   At least one element in this debate is becoming clearer. The President and other opponents are placing center stage what was only a secondary argument throughout the SCHIP battle. It’s no longer about rationalizing philosophically why 4 million children who are eligible for the existing program and are not enrolled should not be covered; it’s no longer about how “illegal immigrants” would be “rewarded” for flaunting immigration laws; it’s no longer about how families that could afford to buy private health insurance would now drop it in favor of cheaper “government run programs.”   Now that those concerns have been addressed, the only argument standing is the least defensible one: opposition to the 61 cent/pack of cigarette tax that would raise $35 billion and fund SCHIP for the next five years. According to the Philadelphia Inquirer, “The White House has previously said it opposed tobacco-tax increases that Democrats included in the health-care legislation to cover its costs, but only after first detailing numerous other objections.”   If red herrings like “socialized medicine” “illegal aliens” and “rich people undeservedly partaking of a government program” can’t win the day, perhaps the “T” word might. According to the same Philadelphia Inquirer article, “President Bush told Republican lawmakers yesterday that he would not agree to legislation expanding children's health insurance if it included a tobacco-tax increase.” The conversation was “private.” But the word is clearly out. The only thing standing in the way of passing SCHIP and covering a full 10 million children is protecting big tobacco interests.    (Submitted by Andrew Leone) SCHIP Influences Florida KidCare Legislation on 2008 Horizon   The 2007 Florida Legislative Session paid great attention to the Florida KidCare Program.  Focus on the state child health insurance program was partially due to the need for Congress to reauthorize the highly successful federal-state SCHIP partnership this year as well as recent reports of 700,000 uninsured children in the state.   Unfortunately, the KidCare bill that passed the Florida House by a vast majority was not taken up during the last week by the Florida Senate.  The good news is that Legislators once again have indicated they are prepared to introduce legislation that will create a more efficient, seamless and simplified program to assure coverage for more children.   As the Florida Legislature prepares to move forward with a good consensus bill, the final results of the Congressional reauthorization process will become a key factor for consideration.  With the incredible bipartisan momentum in Congress yet to be finalized, a final analysis for Florida’s KidCare program is unclear. But, under most scenarios on the table in Congress, Florida was poised to have gained additional program funding for income eligible children and see many improvements for KidCare.    It’s encouraging to know that there is a continued political will by Florida Legislators to help more uninsured children in Florida get health care coverage.  This was evident during the recent special budget session when they allocated an additional $1.1 million to cover more uninsured income eligible children while other budgets were being reduced.   Another year of severe budget restraints and cuts is being forecast. Advocates for maternal and child health will no doubt face challenges during the session.   Having a good SCHIP Reauthorization bill passed by Congress would help greatly. Florida would receive additional federal dollars under the proposed formula to cover over 200,000 more income eligible children – this is above the amount of federal funds still available to the state.  In addition, dental services and behavioral mental health coverage would be included in SCHIP.   Again President Bush has vowed to veto the good compromise bill passed out of the US House and Senate. Pending his veto, we must and can do more to urge members of Congress who voted against the bill to vote yes the next time it is introduced in Congress.   The new compromise bill clearly addressed all the concerns raised by the limited number of members who don’t support the bill.  According to recent polls, between 70-80% of American’s support the legislation to cover 10 million uninsured children. There is no excuse to oppose this good bill to help Florida’s uninsured children.   Florida U.S. Senators’ Votes on compromise: Yea: Nelson; Nay: Martinez   Florida U.S. Reps Votes on compromise: Yea: Republicans Buchanan and Young joined Democrats Boyd, Brown, Castor, Hastings, Klein, Mahoney, Meek, Wasserman-Schultz, Wexler. Nay: Republicans Bilirakis, Brown-Waite, Crenshaw, L. Diaz-Balart, M. Diaz-Balart, Feeney, Keller, Mack, Mica, Miller, Putnam, Ros-Lehtinen, Stearns, Weldon (Submitted by Linda Merrell, Florida Child Health Care Coalition)       Challenges of Medicaid Reform’s Next Steps Illustrate Need to Proceed with Caution   The notion that Florida should take a deep breath and delay further expansion of Medicaid Reform has gained significant traction in recent weeks. This follows the findings of the Inspector General for the Florida Agency for Health Care Administration (AHCA) that data available is currently inadequate to allow legitimate evaluation of the impact of Reform, and that a number of serious concerns already identified remain unresolved. Nevertheless, proposals to expand Medicaid Reform will likely be under consideration in the upcoming 2008 Session of the State Legislature.   In the meantime, the pilot project continues, and so the next steps taken by AHCA, and whether they resolve, worsen or even ignore the concerns raised, will shed light on the longer-term prospects for Reform. A few of those concerns discussed by AHCA’s Technical Advisory Panel earlier this month include: Contract amendments for the health plans participating in Reform have been finalized, and AHCA’s pledge to provide access to information about which plans cover which medications has been codified, at least in part. Specifically, all plans are now contractually required to include their Preferred Drug Lists (PDLs) on their websites. However, the new requirements do not specify the ease with which consumers must be able to find a PDL on a plan’s website. Research by Florida Legal Services and others has shown this to be a significant concern with a number of plans who already post their PDLs. In addition, although a key concern of consumers and advocates alike remains unaddressed, namely that Choice Counselors do not have access to the PDLs when advising beneficiaries, AHCA has stated that this will change as of January 2008.    Meanwhile, the nursing position with the Special Needs Unit remains vacant. Consequently, Choice Counselors have no means of obtaining answers to medication-related questions, even if they have access to the PDLs. Participation in the Enhanced Benefits component of Reform, which rewards patients for healthy behaviors with credits to purchase medicines and health aids not covered by plans, continues to lag. Although the value of credits earned increased from $2.0 to $2.5 million last quarter, this still amounts to just over $3 per patient per month. Of greatest concern, however, is that only 5% of all credits earned to date have been used. This amounts to $1 of benefit per consumer over the course of their entire participation in Medicaid Reform. Furthermore, the overwhelming majority of behaviors for which credits were awarded seem to be actions that consumers would have taken anyway, raising concerns about both equity and efficacy. AHCA continues to study how to further improve participation. Doubts about when the data needed to evaluate the cost and program effectiveness of Reform will be available are further exacerbated by the fact that AHCA is currently transitioning to a new fiscal agent for the Medicaid Program. EDS, the new agent, will use an entirely different medical and financial information system scheduled to launch in March. Since adequate data is not even available now, how long it will be before meaningful data bridging the two systems can be accessed and analyzed? These are just a few of the examples illustrating the many different types of challenges yet to be resolved in the Medicaid Reform experiment. Progress may be visible, but more questions than answers remain.   (Submitted by Greg Mellowe, Florida CHAIN)       If WellCare Sinks, Could Florida’s Most Vulnerable Patients Go Down with the Ship?   On Oct. 24, more than 200 agents from the FBI, the State Attorney General’s Medicaid Fraud Control Unit and Medicare’s Inspector General raided the Tampa headquarters of insurer WellCare Health Plans. WellCare has 2.3 million enrollees, including a share of Florida's Medicare and Medicaid managed care markets. To protect low-income, vulnerable enrollees, Florida CHAIN and other consumer advocates urge suspension of enrollment in WellCare plans while serious allegations are pending. (by Greg Mellowe, Florida CHAIN) Read more     It's Time to Enroll for Medicare “Extra Help”   If you have limited income and resources, or were a “Dual Eligible” (Medicare and Medicaid) recipient, you may qualify for Extra Help in paying for your Medicare part “D” premium and also lower prescription drug copays. If you have qualified for, or received LIS before, YOU MUST reapply for 2008. Approval can take up to 6 weeks, so APPLY NOW! (by Bill Rettinger, MedicaidAdvocates.Com) Read more Florida Special Session Avoids Further Cuts to Services for Persons with Disabilities   Now that the so-called Special Session C is over and its resulting changes signed by Governor Charlie Crist and their implementation starting, social services advocates, individuals with disabilities and their families can breathe a little easier.   Fears were that services would be reduced even more after the dramatic service reductions and service eliminations, plus the “capped” system not yet fully implemented – the Agency for Persons with Disabilities (APD) is currently awaiting federal approval of that system – that came out of the regular session of the Florida Legislature that ended in May 2007.   Thanks to the combined efforts of advocates and legislators, administrative and provider costs were reduced during Special Session C instead of further reductions of direct services to individuals.   A shrinking budget and trying times ahead notwithstanding, no more services were reduced or eliminated, managed care proposals were not included in either the House or Senate packages, and individuals with intensive needs will receive more Personal Care Assistance (PCA) hours.   Click here for the “official” Agency for Persons with Disabilities’ Procedures for Implementing Eliminations and Rate Reductions explanation, briefly outlined below.   Personal Care Assistance (PCA) Services limit was increased for individuals with Intensive Needs   Florida Statutes will henceforth allow additional hours of personal care assistance (beyond the current 180 hours per month limit) for persons who have intensive physical, medical, or adaptive needs if such hours are essential for avoiding institutionalization.   PCA Rate Reduction   A 4 percent rate decrease to personal care assistance services was included in the course of the session’s negotiations -- this unanticipated decrease, which was not expected by either advocates or by APD, will provide a savings of $1.7 million and is scheduled to take effect on January 1, 2008.   Transfer of Children’s PCA Services Put on Hold   The Agency for Health Care Administration (AHCA), in consultation with APD, will analyze rates for personal care assistance services. Results of this joint study will be presented to and given consideration by the Florida Legislature during its regular 2008 session.   Effective July 1, 2008, AHCA, the state agency that oversees the Medicaid State Plan, is expected to assume funding responsibility for children with developmental disabilities’ PCA services. Currently, rates and provider eligibility requirements for AHCA and APD are different under the Medicaid State Plan. AHCA was asked to evaluate what systems need to be implemented in order to be able to serve children currently receiving PCA services, as well as to minimize interruption of the services being provided and the potential loss of existing service providers   Waiver Support Coordinator Duties will Change   In order to conduct customer needs assessments and ready initial cost plans, seventy-five temporary state employees were approved. These employees selected will be required to have at least a bachelor’s degree and four years of social service experience working with people with disabilities.   Managed Care for Individuals with Developmental Disabilities   No managed health care for people with developmental disabilities proposals were introduced during the referenced session. However, documents to put all health and waiver services for these individuals into managed care were discussed.   Transfer of Funds to Intermediate Care Facilities (ICF) & Developmental Disabilities Civil Commitment Program   The legislature approved an APD proposal to transfer funds from secure forensic services to the civil ICF/DD program. It is estimated this will save the state’s General Revenue Fund some $444,061, which will allow the state to move individuals currently residing in county jails throughout the state to more appropriate settings.                                                 (Submitted by Ruben Betancourt)   Property Tax Cut Amendment on January Ballot Perplexes Many, Satisfies Few   The one constant in the debate on how to reduce Florida property taxes, since Gov. Charlie Crist made it a campaign promise last year, has been perplexity.  First, Circuit Judge Charles A. Francis ordered the original proposal off the January 29 ballot proposal calling it “confusing, misleading, and unconstitutional.”   When this prompted a special session that produced another proposal, many tax cut proponents expressed lukewarm support at best. “The Legislature missed the opportunity to do something historic,” the South Florida Sun-Sentinel quoted a disappointed House Speaker Marco Rubio.   If anything, the proposal Florida voters will have to approve by a 60% margin on January 29, has generated cries of foul play by those who do not believe it reflects the Governor’s campaign promise of taxes “dropping like a rock.” Consequently, to date, there are at least 11 citizen initiatives brewing aimed at placing yet another amendment proposal in the November 2008 ballot to provide even greater cuts.   To date, only the Governor himself has begun campaigning enthusiastically in favor of the proposal.   But what of the opposite concerns that a substantial cut in property taxes can cause harm to local and county agencies’ ability to deliver needed services? Former Gov. Jeb Bush’s own former Chairman of the Governor’s Council of economic Affairs, J. Antonio Villamil, expressed those concerns last summer. “The mandates from Tallahassee have brought significant complexity and uncertainty to the property tax structure of Florida. In essence, they violate a principle of best practices of public finance, which is simplicity and transparency in the levy of taxes,” he cautioned.   “Finally, and perhaps most importantly, the Tallahassee-mandated cap will likely lead to severe problems over time in funding vital local programs for special needs populations in our many counties and municipalities, especially in large urban counties like Miami-Dade,” he wrote in the Florida TaxWatch publication “Ideas in Action”, in a piece titled: “Property Tax Reform: Unintended Consequences.”   Although not immediately vowing to campaign against the proposal, News 4 Jax.com quoted Florida Education Association president Andy Ford as stating, "The current proposal does not hold public education harmless (as the Governor had promised it would). The FEA cannot support, and will not support, the current plan in its current form based upon the information we have today."   Some county governments have also expressed concern, especially regarding their ability to deliver emergency services to the indigent population. This sentiment was behind the Nassau County Commission’s recent appeal to Governor Crist to delay the implementation of Medicaid Reform in the county until the effects of property tax cuts could be gauged. (Submitted by Andrew Leone) 4th Town Hall Meeting Brings Together Diverse Interests to Spark Advocacy    On November 1, Hispanic Health Initiatives, with the assistance of Florida CHAIN, hosted a Town Hall meeting in Osceola County to spark interest and involvement in local health care advocacy. Consumers can impact health care service delivery through their advocacy as much as they can through their individual health choices, but may not consider influencing policy as part of the process of taking control of their own health care. The meeting, the fourth in a series conducted across Central Florida, follows similar gatherings convened in Orange, Seminole and Volusia Counties.   Zella Reid, DCF Community Partnership Specialist for Central Florida   The meeting was attended by a wide-ranging group of stakeholdersaffected in very different ways by critical health care policy decisions pending at the state and federal levels. They included local residents, local and neighborhood civic organizations, advocates, health plan representatives, the Florida Department of Children and Families, Osceola County government, State Senator Gary Siplin’s office and State Representative Darren Soto.    Greg Mellowe, FL CHAIN, & Josephine Mercado, Hispanic Health Initiatives The meeting provided an opportunity for constructive dialogue, in spite of and in fact as a result of the diversity of perspectives present. Consumers in need of health care services, advocates seeking to promote access to care, decision-makers concerned about how to fund services needed by their constituents, and even health plan representatives balancing the needs of their members with the imperative to control costs all agreed that education about and engagement in the decision-making process are critical. Among the topics presented were Medicaid Reform, KidCare and funding services through an increase in the Tobacco Tax.   More specifically, consensus seemed to emerge around the following issues: The potential expansion of Medicaid Reform, particularly into Central Florida, is of serious concern to the community, especially given the findings included in the State’s first evaluation. There are too many unanswered questions. Some of the problems that have cropped up in the Medicaid Reform experiment have long been identified as challenges associated with Medicaid managed care initiatives generally, if not with Medicaid itself, such as access to specialists. We must work to address these problems, regardless of how Medicaid Reform plays out. We have a responsibility to make certain that we utilize all available KidCare slots to provide coverage for the maximum number of uninsured children. Barriers to enrollment and misinformation remain, but partner organizations are connected to more of the community than ever, and so we are in a better position than ever to overcome those barriers. We have a responsibility to educate the public and our Congressional representatives regarding the urgent need to re-authorize and expand SCHIP, the federal program that funds KidCare. Ten years into the KidCare program, hundreds of thousands of Florida kids remain uninsured. The meeting served to illustrate well the sometimes surprising truth that consumers advocating for more or better health care services are likely to find more allies than they might expect. (submitted by Greg Mellowe, Florida CHAIN)   REAL STORIES FROM FLORIDA HEALTH CARE CONSUMERS    Medical Tourism Not an Answer for Many in US   The high cost of health care in the US is fueling the ever-growing industry of medical tourism. Buoyed by the lower costs of getting anything from a heart procedure to plastic surgery to a tooth implant in places like Thailand, India, Argentina or Colombia, more and more Americans choose this exotic option.   Websites and travel experts package the experience as medical “vacations”, usually accompanied by visions of tropical beaches, high-end urban shopping and the reassurance that doctors are “American or European trained.”   A recent Washington Post article recounts: “On learning he needed heart surgery last spring, Larry Shaw's first question was: How much?   The surgeon's fee, between $1,500 and $2,000, was within Shaw's means as a self-insured businessman. But the angioplasty, including placement of a thin tube in a clogged artery, would require a one-night hospital stay. He called the closest major medical center to his Dallas home. Estimated charge: $47,000, not including anesthesia.   Shaw's next calls were to Thailand and India.   The price at Bangkok's private Bumrungrad International Hospital: $6,400, including a two-night stay, surgeon's fees, anesthesiologist and drugs. The Apollo hospital in New Delhi: $4,600.” Shaw eventually chose Thailand and received the needed procedure.   But things don’t always work out as smoothly.   Leticia M., a senior from Bogotá, Colombia who had lost her husband a few years ago, two years ago followed her son, a US citizen, to the Orlando area.  Although in her 70’s, she does not qualify for public health assistance and cannot afford private insurance.   At an Orange County forum on health care access, Leticia recounted that she was recently diagnosed with cataracts and told she must seek treatment soon or risk going blind. Her doctor suggested she visit a specialist that she cannot afford. In Colombia, all her medical expenses would be covered by that country’s equivalent of Social Security. But she cannot go back. She suffers from cardiac problems and her doctor advised her against traveling to the high altitude of Bogotá.   It was suggested she go to a coastal city, like the picturesque Cartagena, a destination of many Caribbean cruises, but she has no family there, her son cannot leave his job to accompany her and she is afraid of going alone. Seeking indigent care through a local clinic, though not appealing, seemed her only solution.   Her situation is not unique. With 47 million uninsured in the US and an even greater number underinsured, the underlying health care crisis in this country cannot be resolved with sexy foreign travel solutions that are out of the questions for most.   (Submitted by Andrew Leone, Florida CHAIN) Florida CHAIN Seeks Stories   Florida CHAIN welcomes contributions from health care consumers who are interested in sharing their experiences with readers of CHAIN Reaction. If you have a story to share, please contact Andrew Leone at 954/684-9895 or gregm@floridachain.org

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Events

Agency for Health Care Administration (AHCA) Medicaid Reform Workshops

Nov 8   9:00 am-noon (for Health Care Providers)

Nov 8   1:00-4:00 pm (for Medicaid beneficiaries)  

Hilton Ft. Lauderdale Airport, 1870 Griffin Rd, Dania Beach

The intent of this meeting will be to gather feedback from Medicaid beneficiaries related to various aspects of the Medicaid Reform Pilot. The specific topics of discussion will be Health Plans’ Customer Service, the Agency’s Outreach efforts and Health Plans’ benefit packages. All are invited.

Features international experts. $35 includes continental breakfast. RSVP or more information: 305/854-2568

Supported Employment and Benefits Management Training  

for Individuals with Disabilities, their Family Members and Support Coordinators. For information, contact 850/386-2022 or diamondw@wilres.com.

Health Foundation of South Florida Concern Awards Gala Luncheon

Dec 6  Conrad Hotel, Miami

This event will honor recipients of the Foundation’s annual Concern Awards. Email sgantman@hfsf.org or call 305/374-9199.

Notices

FLORIDA AUDIO CONFERENCES AND WEBCASTS

STATEWIDE NOTICES  

NATIONAL EVENTS & NOTICES

CONFERENCES AND EVENTS 

Sponsored by the Intercultural Cancer Council and Baylor College of Medicine. Presentations can address: Basic, clinical, and behavioral research, Community-based program research and evaluation, Community-based participatory research, Health services research, Health policy research, Papers addressing the disproportionate impact of cancer on racial, ethnic and medically underserved populations.

Creating a Culture of Wellness

Nov 27-29   Washington, DC

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention (CDC) will host this 2007 National Prevention and Health Promotion Summit. This groundbreaking event will unite health professionals, business entrepreneurs, and government leaders at all levels who are dedicated to health promotion, chronic disease prevention, health preparedness, birth defects, disabilities, genomics, and wellness.

National Congress on the Un- and Underinsured: From Practical Local and Regional Solutions to State and National Health Reform

Dec 9-12   Washington, DC

The challenge of the un- and underinsured in America puts great social and economic stress on the nation's health system. The goals of The National Congress are to: define the issue; identify and assess various federal and state health reform proposals; analyze the roles of Medicare, Medicaid and SCHIP in expansion of coverage; describe and compare various international approaches to the issue; identify voluntary, charitable initiatives across the country to address the issue at the local level and assess current obligations and practices of healthcare providers to render care to uninsured patients.

Making Race, Making Health: Historical Approaches to Race, Medicine, and Public Health

Submission deadline: Jan 1

Nov 13-15, 2008   Austin, TX

Paper topics are not limited to national field or geographic area and proposals that explore a particular topic within a diasporic, imperial, or transnational framework are welcome. Conference intends to generate a dynamic conversation among scholars around the following themes: the interconnectedness between medical knowledge, medical practice, and processes of racialization; race, difference, and power within public health discourse and policy; inequality, activism, and health; and diagnostic and therapeutic regimes as sites of contestation.

Health Action 2008 
Jan 24-26   Renaissance Mayflower Hotel, Washington DC

Families USA’s Health Action 2008 kicks off a year in which health care will be at the center of the national conversation. Learn and share strategies with other advocates around the country and to recharge for the year ahead.

ACHI’s 2008 Spring Training for Health Champions

Conference Dates: March 5-7, 2008  Atlanta

Topic Tracks: Minimizing Chronic Disease: Strategies for Social Determinants; Maximizing Coverage: Proven Programs and Innovative Proposals; Harnessing Data: Health Assessments to Health Outcomes; Delivering Community Benefit: Management Tools and Community Strategies (co-sponsored by Catholic Health Association and VHA, Inc.); Breaking Silos: Public Health and Health System Partnerships

National Initiative for Children's Healthcare Quality (NICHQ) Annual Forum for Improving Children's Health Care 

March 19-21   Miami

This event is for people committed to eliminating the gap between what is and what can be in health care for all children.  The Forum will feature breakout sessions and in-depth workshops, in four tracks, focused on NICHQ's Improvement Agenda: Assessing, Preventing and Treating Childhood Obesity; Providing Seamless, Evidence-based, Family-Centered Care for Children with Chronic Conditions; Purging Harm from Children’s Health Care; Profound Knowledge: Methods and Tools for Improvement and Innovation. Improvement processes/programs in all of these areas should address disparities and include parents/families.

Active Living Research Conference Seeks Abstracts

April 9-12 Washington DC

The theme of this year's conference is "Connecting Active Living Research to Policy Solutions." Abstracts on all topics related to active living policies and environments are welcome. In addition to policy-relevant research, Active Living Research welcomes abstracts about children and adolescents at greatest risk for obesity—African-American, Latino, Native American, Asian-American and Pacific Islander children and adolescents living in low-income communities.

AUDIO AND WEB EVENTS    

 
November 
 
American Diabetes Month: November
American Diabetes Association
(800) DIABETES (342-2383)
askada@diabetes.org   www.diabetes.org

Diabetic Eye Disease Month: November
Prevent Blindness America
(800) 331-2020
info@preventblindness.org   www.preventblindness.org

Lung Cancer Awareness Month: November
Lung Cancer Alliance
(800) 298-2436
info@lungcanceralliance.org   www.lungcanceralliance.org

National Alzheimer's Disease Awareness Month: November
Alzheimer's Association
(800) 272-3900
info@alz.org  www.alz.org

National Family Caregivers Month: November
National Family Caregivers Association
(800) 896-3650
info@thefamilycaregiver.org  www.thefamilycaregiver.org

National Healthy Skin Month: November
American Academy of Dermatology
(888) 462-DERM (3376)
mediarealtions@aad.org   www.aad.org

National Hospice Palliative Care Month: November
National Hospice and Palliative Care Organization
(703) 837-1500
jradulovic@nhpco.org   www.nhpco.org

Pancreatic Cancer Awareness Month: November
(877) 272-6226
information@pancan.org  www.pancan.org

Prematurity Awareness Month: November
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Prematurity Awareness Day: November 13
March of Dimes Birth Defects Foundation
(888) MODIMES (663-4637)
askus@marchofdimes.com  www.marchofdimes.com

Great American Smokeout: November 15
American Cancer Society
(800) ACS-2345
www.cancer.org

Gastroesophageal Reflux Disease Awareness Week: November 18-24
(888) 964-2001
iffgd@iffgd.org  www.aboutgerd.org

December

World AIDS Day: December 1
Joint United Nations Programme on HIV/AIDS
unaids@unaids.org   www.unaids.org/en/default.asp

New listings, in order of submission deadlines

Community-Campus Partnerships for Health (CCPH) Annual Award
Nominations deadline: Feb 12
The CCPH Annual Award recognizes exemplary partnerships between communities and higher educational institutions that build on each other's strengths to improve higher education, civic engagement, and the overall health of communities.

Planning Grant for Oral Health Promotion across the Life Span (R21)
Closing date for applications: May 7, 2010, Multiple deadlines
This funding opportunity announcement (FOA) is intended to encourage and support meritorious oral health promotion research directed at improving oral health and preventing diseases and/or their sequelae across the lifespan.

Healthy Kids Grant Program
Deadline: Jan 15
The General Mills Foundation, in partnership with the American Dietetic Association Foundation and the President's Council on Physical Fitness, is accepting applications for the Champions for Healthy Kids grant program. This national program will award fifty grants of $10,000 each to  community-based groups across the United States that develop  creative ways to help youth adopt a balanced diet and physically  active lifestyle. 

Continuing listings, in order of submission deadlines 

The Humana Foundation
Proposals accepted: Nov 1-June 15

The Humana Foundation supports nonprofit organizations in communities where the company has facilities in states including Florida. The Foundation is committed to serving the needs of children, families, and seniors in their quest to build healthier lives and communities. Special consideration is given to proposals that focus on the following areas: health and fitness efforts that lead to better lifestyles; literacy activities that lead to improved health experiences; and the development of technology, tools, and resources that lead to healthy communities. 

National AIDS Fund: Southern REACH
Application deadline: Nov 16

Southern REACH (Regional Expansion of Access and Capacity to Address HIV/AIDS), a new grantmaking initiative of the National AIDS Fund, will support community-based organizations (CBOs) in nine southern states including Florida to strengthen community capacity to address HIV/AIDS among marginalized, at-risk, and underserved populations. Grants will be provided to CBOs that have the demonstrated ability to reach priority populations with HIV prevention and care services or to lead policy and advocacy efforts that will impact priority populations.  

Improving Health and Educational Outcomes of Young People

Application deadline: Nov 21
The purpose of the program is to improve the health and well-being of youth and prepare them to be healthy adults.

Echoing Green Fellowships for Social Entrepreneurs

Application deadline: Dec 3
The Echoing Green Fellowship Program helps passionate social entrepreneurs worldwide develop new solutions to some of society’s most difficult problems. Through the program, Echoing Green offers individuals, and partnerships of no more than two individuals, seed funding to launch new organizations that turn their innovative ideas for social change into action. Projects must be the original idea of the applicants, and should not be the extension or expansion of another individual's or organization's mission or idea. Applicants must make a full-time commitment to the development of the project and must agree to lead the project for a minimum of two consecutive years.

2008 Barbara Jordan Health Policy Scholars Program

Application deadline: Dec 14

Allegany Community Outreach Grants
Deadline:  March 1
ACOR is a grant program of Allegany Franciscan Ministries, Inc.  It provides short-term support to local community projects. The grant award range is $1,000-$5,000; limited numbers of grants. Priority to organizations for projects that strive to: improve the health, wellness and quality of life through a holistic approach to education or direct service; bring about systemic change and promote self-sufficiency; benefit a disenfranchised segment of society; Sponsoring organization strives to incorporate the viewpoint and participation of individuals who are direct recipients of its services (e.g. service recipients are represented on the governing board).

Tobacco Policy Change: A Collaborative for Healthier Communities and States

Application deadline for implementation grants: March 14

Tobacco Policy Change: A Collaborative for Healthier Communities and States, a national initiative of the Robert Wood Johnson Foundation, provides resources for local, regional, and state-based organizations and tribal groups to advocate for effective policies that decrease tobacco use and exposure. This initiative is issuing a special solicitation that will build on previous success in attracting new partners whose constituencies are most directly affected by tobacco use and exposure. Grantees are expected to apply their advocacy skills and experience to advance tobacco and other public health policies in their communities. Organizations from Florida are able to apply.

Research on Social Work Practice and Concepts in Health (R03)

Closing date for applications: May 7, 2009, Multiple deadlines

This funding opportunity announcement (FOA) issued by the Office of Behavioral and Social Sciences Research solicits Small Research Grant (R03) applications from organizations/institutions that propose to develop empirical research on social work practice, concepts, and theory as these relate to the NIH public health goal of improving health outcomes for persons with medical and behavioral disorders and conditions.

Structural Interventions, Alcohol Use, and Risk of HIV/AIDS (R21)
Multiple deadlines
This Funding Opportunity Announcement (FOA) issued by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, solicits Exploratory/Developmental Research Grant (R21) applications from institutions/ organizations that propose to investigate the effectiveness of structural interventions that reduce the risk of HIV/AIDS transmission by changing the environment of alcohol use.

Fulbright Scholar Award

Multiple deadlines
Applications continue to be accepted for some Fulbright Scholar awards for lecturing, research or combined lecturing/research awards in public health during the 2008-2009 academic year.  Faculty and professionals in public health may apply for awards specifically in their field, as well as one of the many "All Discipline" awards open to any field. 

Donors Forum of South Florida on-line database
The new online searchable Donors Forum of South Florida database has up-to-date information about funders in South Florida. This resource— which is also available in hard copy — presents continuously updated information about the giving interests and procedures of funders with a track record of investing in the South Florida area and working collaboratively with others. To order, email leot@donorsforumsf.org or call 305/371-7944. 

Directory Of Health Policy Fellowships

This Kaiser directory contains new listings for undergraduates, graduate students and professionals searching for summer, school-year, or post-doctoral positions. 

Health Insurance, Health Care Costs

Health Disparities

This current issue demonstrates an increase in the number of uninsured for a second year in a row.  The rate increase was most notable in the African American and Hispanic American populations. There was also an increase in the number of uninsured children under 18 years of age. (Aug 2007, U.S. Census Bureau)

Issue Brief: Racial and Ethnic Health Disparities 

Key Facts: Race, Ethnicity and Medical Care, 2007 Update

This updated quick reference source on health disparities presents the best available data and analysis, ncluding data on the uninsured and access to care by race/ethnicity as well as information about the isproportionate effect that specific conditions such as diabetes, HIV/AIDS, and asthma have on racial and thnic minority populations in the U.S. New in the 2007 Key Facts are demographic data on the racial/ethnic minority population in each state and the U.S. territories. This edition of Key Facts also includes data from the National Healthcare Disparities Report, examining changes in health care disparities over time.  (Jan 2007,

Kaiser Family Foundation)

Assumed Equity: Early Observations from the First Hospital Disparities Collaborative

This article describes early findings from the planning phase of Expecting Success, a hospital-based collaborative project focused on reducing disparities in health care. (Sept/Oct 2007, Journal for Health Care Quality)

We're the Ones We've Been Waiting For: The State of AIDS in Black America ... and What We're Doing about It

assesses the impact of AIDS on the African-American community. The report offers statistical data on HIV and AIDS prevalence in the U.S., describes the current state of AIDS mobilization, and issues a call to action. (09/07, Black AIDS Institute)

Racial and Ethnic Disparities in Access to and Quality of Health Care

This report identifies the causes behind racial and ethnic disparities in health care access and quality. One of the key findings shows that Spanish-speaking Hispanics are most likely to lack access to health care when compared to other ethnic groups. (Synthesis Project at the Robert Wood Johnson Foundation)

Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality

This background paper examines the impact of stress and stress mediators on pregnancy outcomes for African American women. The report also examines social support and other relational experiences and makes recommendations for related changes in public policy and maternal and child health practices. (09/07, Joint Center for Political and Economic Studies)