Diabetes -- State Responses to the Epidemic of Our Time
Laura Lawlor [email protected] June 16, 2011
1 Today’s Agenda
1 Texas Diabetes Snapshot and Call to Action 2 No Cost Solutions vs. Solutions with Cost
3 The Texas Response to Diabetes: SB 796 4 Why Respond? Cost and Resource Requirements of Diabetes 5 Conclusions and Questions
2 Texas Snapshot
• 3.28 million or 13.3% of population already diagnosed; at least 1.5 million undiagnosed or have pre-diabetes
• Childhood obesity is more than 20% of child population
• Budget shortfall of 20% next biennium – need approximately $18 billion in cuts
• High growth counties with high prevalence of diabetes
3 Call to Action in Texas
• Texas Health Institute, Texas Diabetes Program and Council at DSHS, Texas Health Disparities Task Force, Texas Health and Human Services Commission, American Diabetes Association • Novo Nordisk and Roche Diagnostics (provided funding) • Series of roundtables across Texas leading to a report with legislative recommendations and new demographic projections • Resulted in strong interest among key legislators, broadly supported legislation unanimously passed both chambers -- awaiting the Governors’ signature
4 Call to Action in Texas
• New information released by the Texas Health Institute (THI) and State Demographer: • State to experience quadrupling of diabetes over the next 30 years without dramatic action • Impact on state budget to be sizable • Assuming medical inflation remains constant, the cost of managing the disease and its complications will quadruple over the same timeframe
• Legislative action steps – four key no-cost strategies and three strategies with costs
5 Call to Action in Texas
• The THI report generated substantial national, state and local media attention • Over 40 articles were written covering the story • National media – CNN, USA Today, Hispanic media • State media – Austin American Statesman, Houston Chronicle, television and radio statewide • Editorials – Austin American Statesman, Houston Chronicle and others published editorials calling for action and enactment of the recommendations contained in the THI report
6 USA Today
7 Austin American Statesman Editorial
8 Ahorasi
9 Action Steps from Texas to Consider
• No cost legislative solutions include: 1. Require agencies to assess the reach and scope of existing activities aimed at treating or preventing diabetes 2. Recalibrate agency activities to focus on those living with diabetes today (given that this population is driving Medicaid and other health costs) and plan for coming years 3. Ensure Medicaid biannually report to the Governor on priorities for battling diabetes 4. Require agencies with a financial role in managing diabetes to develop a budget blueprint to guide legislators
10 Action Steps from Texas to Consider
• Legislative solutions with a cost: • Implement a statewide screening program
• Expand self-management training for the diagnosed population in Medicaid
• Close benefit gap between Medicaid and CHIP for pregnant mothers covered by CHIP perinatal benefits to allow access to essential diabetes supplies to monitor and manage gestational diabetes
11 The Texas Response: SB 796
• Texas legislation calling for: • An assessment of state activities and identification of needs to battle diabetes in public programs • Charges state agencies with setting priorities and coming up with an actionable plan • Requires agencies to estimate annual cost of preventing and treating diabetes in the public and private sector • Legislation unanimously passed the Legislature and is awaiting the Governor’s signature • Support for proposal from across the political spectrum including Texas Medical Association, Texas Hospital Association, United Way, American Diabetes Association, teaching hospitals, children’s interests and others
12 The Texas Response
• Until recently, Texas was like most states in not recognizing the impact of diabetes on its budget, its population and the looming increase in those living with the disease
• Texas is in a difficult budget situation so any cost solutions remain off the table
• The attention among key Texas elected officials shifted substantially in 2010 when the Texas Health and Human Services Commission released the following data:
13 14 Cost of Diabetes in Texas
• Institute for Alternative Futures estimated cost at $29.6 billion to Texas in 2010
• Medical expenditures for people with diabetes are 2.3 times higher than for those who are not diabetic
• Some of fastest growing counties in Texas also have highest rates of diabetes
15 Resources to Address Diabetes in Texas
• During the last fiscal year, Texas received $976,813 from CDC to prevent diabetes and help those already diagnosed
• Last biennium the State appropriated approximately $6 million to fund efforts to prevent and address diabetes
• This biennium state funding will be cut by as much as 75% due to overall funding shortfall
16 Federal Resources for Diabetes
• Minimal resources -- $27.5 million nationwide -- are available to work towards preventing the disease
• Funding for diabetes prevention was cut about 5% at the federal level over the past three years
• All forms of diabetes are increasing in prevalence annually about 7 – 10% with over 26 million (8.3% of adult Americans) living with some type of diabetes today
17 Federal Resources for Other Conditions
Examples of federal response to other conditions: • Breast/Cervical Cancer – Federal government provides about $300 million to states for detection, education and prevention programs along with presumptive Medicaid eligibility • 192,300 diagnosed annually • HIV/AIDS – Federal government provides about $800 million to states for detection, education and prevention programs along with ADAP and other insurance program support • 1.1 million live with AIDS in America
18 Lessons Learned
• More data helps inform decisions and generate responses • Quadrupling of diabetes over the next 30 years without dramatic action • Diabetes is #1 reason Medicaid patients visit a health care provider
• Current costs are being driven by the diagnosed population
• Increased recognition that must have state and local efforts to control the reach, scope and cost of diabetes
19 Replicate in Other States
• The no-cost recommendations of the THI report were turned into legislation this year in KY, OR and TX
• The provision is now law in KY and sits on the Governor’s desk awaiting signature in TX
• The OR legislation resulted in the states first hearings on the impact of diabetes in years
20 Discussion and Questions Diabetes -- State Responses to the Epidemic of Our Time
Laura Lawlor [email protected] June 16, 2011
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