When it comes to improving health outcomes, many policymakers look first to strategies that can provide better care for people who are ill. But some experts argue that medical care itself accounts only for a small part of positive health outcomes. The vast majority of interventions that can make people healthier, and reduce spending on health care, need to happen long before someone enters a doctor’s office.
That’s why states across the Midwest are exploring ways to address so-called “social determinants” to health — from low levels of income and education, to high levels of community violence, to a lack of access to housing and transportation.
Which states have the highest rates of avoiding preventable deaths? How does the Midwest compare to the nation in providing equitable access to health care?
The most recent edition of a Commonwealth Fund report aims to provide policymakers with the tools to start answering these questions — and look for the best policies for maximizing health system performance.
Since 1996, states have had the authority under federal law to require welfare recipients to undergo drug testing.In recent years, more and more legislatures have given serious consideration to using this authority, including a handful of states in the Midwest. Kansas and Minnesota are among the nine U.S. states with drug-testing laws already in place, and according to the Center for Law and Social Policy, at least 30 states considered bills last year (Illinois, Indiana, Iowa, Michigan and North Dakota among them).
Illinois is in the process of becoming the latest U.S. state — and the second in the Midwest — to allow residents to purchase and use marijuana for medical purposes. Earlier this year, the state Department of Public Health issued proposed rules to implement legislation signed into law in 2013.
Nearly half of the U.S. states (including Illinois and Michigan) now have laws allowing patients with certain conditions to use marijuana for medical purposes.
In 1977, South Dakota’s state prisons held just 550 inmates. Over the next 35 years, however, that population would multiply six times — and, in the process, drive costs through the roof.
By 2011, the state’s corrections budget was more than $100 million and had quadrupled in 20 years. And the prison population was projected to grow by another 25 percent in 10 years, with costs increasing to the tune of $224 million.
When Indiana Rep. Robert Behning was recently visiting a preschool, one of the instructors cited some alarming statistics.
The teacher pointed to three young African-American students. “She told me, ‘One of the three — if they don’t have the opportunity for a high-quality education in early childhood — [is likely to] end up in the criminal-justice system. Which one are you going to pick?’”
“No one wants to pick any of them,” Behning says. “It is much better for our society to provide early education and an opportunity to be a successful member of our community.”
Since its inception in 1965, Medicaid has been a critical part of our nation’s safety net. And as both enrollment and spending have been steadily increasing — and a new federal health law is poised to take full effect — the strength of that net is being tested.
In response to an ongoing shortage of primary-care providers — coupled with the fact that millions of Americans will be added to Medicaid and private insurance rolls under the federal Affordable Care Act next year — state policymakers are considering how to better train and deploy their health care workforces.
One strategy being considered by at least 12 states is to leverage an asset that already exists, by allowing certain “advanced practice” nurses to open their own practices.
Starting next year, Minnesota will begin issuing individual income-tax refunds via debit cards instead of paper checks. While most refunds are deposited directly into checking accounts, the state has still been printing 1 million paper checks each year, according to the Minneapolis Star Tribune.