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News and Notes   |    
News Briefs
Psychiatric Services 2012; doi: 10.1176/appi.ps.1012
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CBO reduces Medicare and Medicaid spending estimates: The nonpartisan Congressional Budget Office (CBO) has reduced its spending forecasts for Medicare by $19 billion for 2012 and by $169 billion over the coming decade. The program will account for $550 billion in federal spending in 2012, and total spending is projected at $7.7 trillion for the ten years ending in 2022. The change reflects the lower growth in health care costs since the U.S. economic recession began in 2007. Medicare, which provides benefits to nearly 50 million elderly and disabled people, represents 15.4% of current federal spending. CBO has also predicted that Medicaid spending will be 7% lower than expected over the coming decade largely as a result of the Supreme Court’s decision on the health care reform law. CBO lowered an earlier spending estimate by $288 billion to reflect the likelihood that some states will either not participate in the expansion or expand Medicaid coverage to lower levels than authorized in the law. The 66-page report, An Update to the Budget and Economic Outlook: Fiscal Years 2012 to 2022, is available on the CBO Web site at www.cbo.gov.

AHRQ review finds few differences between first- and second-generation antipsychotics: In a new review of the comparative effectiveness of individual antipsychotics for treating adults with schizophrenia spectrum disorders or bipolar disorder, the Agency for Healthcare Research and Quality (AHRQ) found few differences of clinical importance in most outcomes, including functional outcomes and health care system use and health-related quality of life. Included in the review were 113 studies of schizophrenia and 11 studies of bipolar disorder. In terms of core illness symptoms, clozapine was more efficacious than chlorpromazine for patients with schizophrenia on the basis of the single reported scale. Results for haloperidol versus olanzapine were conflicting, with olanzapine favored on one scale but no differences on two other scales. Haloperidol was favored over quetiapine on the basis of four scales. No differences were found for haloperidol versus aripiprazole, clozapine, risperidone, and ziprasidone. The most frequently reported adverse events with significant differences were extrapyramidal symptoms; in most cases, the second-generation agent had fewer extrapyramidal symptoms than haloperidol. The review found that outcomes such as death and quality of life were rarely assessed and that data comparing side effects were sparse. Inconsistencies across studies made drawing firm conclusions difficult. The review is available on the AHRQ Web site at www.effectivehealthcare.ahrq.gov.

Bazelon Center’s resources on voting rights: To help people with mental illness exercise their right to vote in the November elections, the Bazelon Center for Mental Health Law has updated its resources on voting rights for people with mental disabilities. The new resources include charts providing state-by-state breakdowns of laws that affect voting rights and of requirements for absentee ballots. A 20-page document, “Restoring the Voting Rights of People Under Guardianship,” provides three model motions asking the court to revise a guardianship order, three model affidavits to persuade the judge, and a model proposed order clarifying the right to vote for an individual under guardianship. A model letter to state election officials can be used to alert officials to voting problems faced by people with mental disabilities and describes federal laws that protect the voting rights of people with mental disabilities. These and other resources can be downloaded from the Bazelon Center Web site at http://www.bazelon.org/Where-We-Stand/Self-Determination/Voting/Voting-Policy-Documents.aspx.

Kaiser Commission brief summarizes characteristics of uninsured low-income adults: In January 2014, the Affordable Care Act establishes a minimum Medicaid eligibility level of 138% of the federal poverty level for nondisabled adults who were not previously eligible for the program. The Kaiser Commission on Medicaid and the Uninsured has released a six-page brief that uses data from the American Community Survey to describe the low-income uninsured adult population—the target group for the Medicaid expansion —by state. Nationally, 21.5 million nonelderly adults who are currently uninsured are potentially eligible for Medicaid after the expansion. Over 70% are adults without dependent children, a group that has historically been excluded from public coverage, and 29% are parents. Forty-seven percent are white, 30% are Hispanic, and 17% are black. Many people in this target population have substantial health needs and face barriers to care. The brief is available on the Kaiser Commission Web site at www.kff.org/uninsured/upload/8350.pdf.

Kaiser Commission’s review of states’ response to the availability of federal funds for health coverage: The expansion of state Medicaid programs authorized in the Affordable Care Act (ACA) is 100% federally funded for the first three years (2014–2016) and at least 90% federally funded thereafter. A historical review released by the Kaiser Commission shows that the availability of federal funds has historically served as an effective incentive for states to provide health coverage to meet the needs of their low-income residents. In the mid-1960s, more than half of states implemented a Medicaid program within the first year that federal funding became available, and nearly all states were participating within four years, even though participation required substantial state investment. The ACA Medicaid expansion provides states a significantly higher share of federal funding for state dollars. For states that implement the ACA’s provisions, expansion will mean significant returns in federal revenues, increased coverage for low-income individuals, lower costs for uncompensated care, and improved health care access and outcomes. The eight-page brief (www.kff.org/medicaid/upload/8349.pdf) provides important context for how states may respond as they weigh the costs and benefits of expanding their Medicaid programs in 2014.




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