State-level Activity Research Articles

The State of HPM Policy: Opportunities to Expand and Protect Access to Palliative Care and Hospice at the State and Local Levels (FR470)

•Describe the importance of state-level activity in expanding and protecting hospice and palliative care.•List 3-4 state policy levers available to improving the availability and quality of hospice and palliative care services.•Discuss high-impact activities conducted by state and local collaborations. It is difficult to understate the impact of the 2016 election on the care of seriously ill patients in the coming years. After 8 years of unprecedented federal involvement and investment in health care, the new administration and a Republican-controlled Congress have proclaimed their intention to return this responsibility to the states. Early policies have included proposals to loosen federal health care regulations, increase flexibility in implementing certain provisions of the Affordable Care Act, and transition Medicaid to a block grant program. These proposals suggest that there will be an increase in states’ authority to set policy for the care of vulnerable populations, accompanied by a significant reduction in federal funds over time. As the primary insurer of long-term care through Medicaid, states already bear the responsibility for a portion of costs for their aging citizens; they also cover a significant percentage of care for seriously ill children through Medicaid and the Children’s Health Insurance Program. Therefore, it behooves states to identify proven strategies for improving care for these populations while reducing overall costs—strategies like palliative care and hospice. Over the past decade, more states have engaged in activities to create awareness of and expand and protect access to palliative care and hospice. In 2013, this trend was accelerated by the American Cancer Society Cancer Action Network’s grassroots efforts to introduce Palliative Care Advisory Council legislation in every state (as of submission, this legislation had been passed in 17 states, with several more states “in play”). As states have prioritized improving care for seriously ill patients, we have learned about the activities in which they are engaging, promising strategies, and early lessons learned. In this session, attendees will learn about these initiatives and identify potential opportunities to engage in palliative care and hospice advocacy in their own states.

Alzheimer’s Disease Legislation And Policy—Now And In The Future

Recent studies have pointed to the large and increasingly complex issues surrounding dementia in American society in general and health care in particular. The initial foray into the federal policy arena, the National Alzheimer's Project Act, is a good first step but remains limited in scope and resources. Seeing the need for greater effort, thirty-three states have convened advisory groups and published their own plans for coordinating state-level activity to address Alzheimer's disease across service systems. This article examines the current federal and state policy statements on dementia-related issues and offers an outlook and suggestions for next steps along with the imperative for action on a significant scale. This is necessary to address issues in a meaningful way today instead of simply holding out hope for a treatment or cure in the future. Dementia in general and Alzheimer's disease in particular affect individuals and every facet of families, health care, business, states, and communities. While public policy statements at all levels call for increased coordination of resources, better communication, awareness, and essential linkages, more effort is required.

Kids, Privacy, Free Speech & the Internet: Finding the Right Balance

In the field of Internet policy, 2011 has been the year of privacy. Congress has introduced six bills related to online privacy, and the Obama administration released two major reports recommending greater federal oversight of online markets. The Federal Trade Commission (FTC) appears poised to step up regulatory activity on this front. State-level activity is also percolating, led by California, which floated two major bills recently. These efforts would expand regulatory oversight of online activities in various ways. Some measures would institute Fair Information Practice Principles (FIPPS), governing the collection and use of personal information online. Others would limit some types data collection, ban certain data or advertising practices, or create new mechanisms to help consumers block online ad-targeting techniques. Another measure would mandate websites adopt a so-called Internet Eraser Button, which would allow users to purge unwanted personal information from online sites and services. Expansion of the Children's Privacy Protection Act of 1998 (COPPA), which already mandates certain online privacy protections for children under the age of 13, is also being considered. While well-intentioned, efforts to expand privacy regulation along these lines would cause a number of unintended consequences of both a legal and economic nature. In particular, expanding COPPA raises thorny issues about online free speech and anonymity. Ironically, it might also require more parental consent provisions. There are better ways to protect the privacy of children online than imposing burdensome new regulatory mandates on the Internet and online consumers. Education, empowerment, and targeted enforcement of unfair and deceptive practices represent the better way forward.

The enforcement of EU agreements: Bolstering the effectiveness of treaty law?

Many of the recent Court of Justice rulings concerning the relationship between the international legal order and the EU legal order have been on the receiving end of considerable criticism, with the EU level judicial commitment to international law being called into question. One dimension of that critique has concerned the treatment of EU concluded Agreements. An assessment of the extant EU level judicial enforcement practice provides evidence of the emergence of a twin-track approach. Member State level activity challenged for non-compliance with EU Agreements is generally subjected to the full force of those Agreements, whilst in contrast the tendency where EU level activity has been challenged before the Court of Justice appears to have become one of shielding such activity from meaningful review. Even if this trajectory were to be maintained, which remains to be seen, it can be argued that the medium of EU law nevertheless serves to bolster the effectiveness of this increasingly expanding body of Treaty law. For EU law has placed at the disposal of litigants, including the Commission via infringement proceedings, the most powerful of tools for policing the compliance of currently twenty-seven Member States with this growing number of agreements.

The Risks of a Quick Fix: A Case Against Mandatory Body Mass Index Reporting Laws

As the United States addresses obesity, a number of state legislatures are considering laws that require schools to track and report students' body mass index (BMI), a measurement of body weight (weight/height2). This article describes the state level activity on mandatory BMI reporting, offers numerous arguments against this practice, and suggests an alternative approach to promoting health in youth. Mandatory BMI reporting laws place a new and inappropriate responsibility on the schools. Proponents of such laws imply that BMI reporting will have positive outcomes, yet there is virtually no independent research to support this assumption. The authors argue that these laws could do significant harm, including an increased risk for children to develop eating disorder symptoms.

The Time-Series Relatedness of State and National Indexes of Leading Indicators and Implications for Regional Forecasting

This study investigates the time-series relatedness of state and national indexes of leading indicators and the implications of these results regarding state employment forecasting. Composite indexes of leading indicators are constructed for the United States and each of the fifty states based on housing permits, initial claims for state unemployment compensation, and average weekly hours in manufacturing. The three-component U.S. index (USLI3 ) is shown to reflect much of the cyclical variation in the U.S. composite of eleven leading indicators (USLI11 ). Final prediction error (FPE) causality tests and cointegration/long-memory components statistics show thatUSLI3 generally causes or “drives” the state indexes. These results suggest that national leading indicators may be more useful than similar state indicators in predicting state-level activity. Experimental forecasts confirm that bothUSLI3 andUSLI11 are generally more effective in improving forecasts of state nonfarm employment than the respective fifty state composite indexes.