The Challenge of Preserving and Expanding Affordable Health Care in Maine

Maine’s health care system is in crisis. The state’s health care expenditures represent the third highest percentage of Gross Domestic Product in the nation; state health care spending is projected to top $11 billion per year, or$8,291 per person per year, over the next seven years; businesses in Maine pay 12-23% more for coverage than the national and New England state averages; and, the state’s uninsured and vulnerable populations continue to grow. In this article, Wendy Wolf charts the rising cost of health care in Maine and the implications of these costs for all Mainers. In turn, she looks at each of the drivers of cost and calls for a comprehensive approach to solving the crisis. Only when all of the players agree to work together and, more importantly, to make changes will we be able to change directions

Solving Maine’s Health Care Crisis Requires “Tough Choices”

Wendy Wolf’s commentary discusses the “tough choices” process which invited selected Maine citizens to participate in town hall meeting sessions to provide input on the state’s health plan. She notes that it was easier for participants to agree on health promotion and healthcare delivery processes than for them to make choices about how to pay for healthcare

Honoring Community Voices to Enhance Health Grantmaking

Brief report on the National Meeting on Community Engagement and Effective Health Grantmaking held in Portland, Maine in May 2009. The meeting included participants from foundations, community advisory committees, and nonprofit/community representatives and discussed how health grantmaking can be better informed by the community at large. Includes findings from a GIH survey

The Role of Foundation Grantmakers in Responding to Community Aging: Maine Health Access Foundation

Wendy J. Wolf of the Maine Health Access Foundation responds to a series of questions about the role of grantmakers in responding to community aging

Playing God: The Legality of Plans Denying Scarce Resources to People with Disabilities in Public Health Emergencies

Public health emergencies can arise in a number of different ways. They can follow a natural disaster, such as Hurricane Katrina, the 2004 tsunami, and the recent earthquakes in Haiti and Chile. They may be man-made, such as the September 11 attacks and the anthrax scare. They may also be infectious. While no pandemic flu has yet reached the severity of the 1918 flu, there have been several scares, including avian flu and most recently H1N1. Few questions are more ethically or legally loaded than determining who will receive scarce medical resources in the event of a widespread public health emergency. The answer will often mean the difference between life and death for affected Americans. Despite this reality, or perhaps because of it, there has been little guidance from the federal and state governments on how to prioritize distribution of those resources among individuals. To fill this gap, some public health and medical organizations promulgated protocols that set forth a hierarchy of resource allocation in response to the predicted H1N1 pandemic. Although these efforts at advance planning are to be lauded, they raise a number of troubling civil rights issues. Several of the protocols exclude some people with disabilities from receiving care even when their disabilities do not affect the likely success of the medical interventions at issue. Both the legality of such plans and the ethical implications of promoting the health of the community at the expense of people with disabilities are highly problematic. This Article explores the legality of the proposed allocation protocols under the Americans with Disabilities Act (ADA) and the Rehabilitation Act. It also evaluates their compatibility with the ethical principles that guide public health decisions and discusses their implications for people with disabilities in the preplanning for public health emergencies

The Impact of Disability: A Comparative Approach to Medical Resource Allocation in Public Health Emergencies

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people. A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when demand exceeds supply. We previously evaluated the protocols public health and medical organizations have promulgated to guide allocation decisions in a public health emergency. We concluded that many of these protocols violate U.S. law and ethics with respect to people with disabilities, because they exclude some people with disabilities from receiving care altogether or because of a need for prolonged use of resources, poor “quality of life,” or limited long-term prognosis. Because the legal and social status of people with disabilities is tied to underlying societal attitudes toward impairments, cultural differences between populations may lead to significantly different distributive outcomes. In this paper, we examine other countries’ approaches to the allocation problem in public health emergencies, both to identify other approaches to these challenging problems and to provide insight into how to develop more equitable policies to guide allocation decisions during a public health emergency in the U.S

Drug Use, the Drug Environment, and Child Physical Abuse and Neglect

Although drug use is considered a risk factor for child maltreatment, very little work has examined how the drug environment may affect physical abuse and neglect by parents. Utilizing information from a telephone survey with 2,597 respondents from 43 cities with valid police data on narcotics incidents, we analyzed the relationship between drug use, drug availability, and child maltreatment using multilevel models. City-level rates of drug abuse and dependence were related to more frequent physical abuse. Parents who use drugs in areas with greater availability of drugs reported more physical abuse and physical neglect. Emotional support was protective of all types of maltreatment. While most child welfare interventions focus on reducing parental drug use in order to reduce child abuse, these findings suggest environmental prevention or neighborhood strengthening approaches designed to reduce the supply of illicit drugs may also reduce child abuse through multiple mechanisms

Charter School Funding: Support for Students with Disabilities

The subject of public charter schools and students with disabilities is both important and sensitive. These students have the potential to benefit greatly from the smaller size and specialized focus of many public charter schools, but questions persist regarding whether all or even most charters are as receptive to enrolling students with disabilities as they are to serving students who do not have disabilities. Furthermore, do differences in enrollment of students with disabilities explain differences in funding between the two sectors? To shine a brighter light on this vital question, we have conducted a careful study of the funding surrounding the education of students with disabilities in public charter schools using data from fiscal year 2018 in 18 cities where charters hold a substantial share of K-12 education enrollment. This report provides a summary of our findings. Additional details regarding how special education services are provided to students with disabilities in each of our 18 cities are provided in a separate Appendix of City Snapshots. As public schools, charter schools must adhere to the same federal legal requirements as their traditional public school (TPS) counterparts. When charters are their own local education agency (LEA), the charters themselves ultimately are responsible for ensuring that students with disabilities receive the special education and related services and supports to which they are entitled under the law. When charters are part of another LEA, through their home district or state, the other entity is ultimately responsible for providing services to students who have disabilities. These key realities are part of the context of how funding for special education flows to public charter schools across the country

The School to Family Pipeline: What Do Religious, Private, and Public Schooling Have to Do with Family Formation?

Private religious schools are widely seen as value-laden communities that mold the character of their students. Thus, we expect adults who attended religious schools as children to demonstrate more favorable family outcomes related to stable marriages and childbearing. We further expect Protestant schooling to have a more powerful effect on marital outcomes than Catholic schooling, given the heavier focus of Protestantism on marriage. Finally, we expect stronger positive associations between religious schooling and marital outcomes for adults who grew up in difficult circumstances compared to adults who grew up in advantaged circumstances. We test these hypotheses using survey data from the Understanding America Study. Our three outcome variables are ever marrying and never divorcing, ever divorcing, and conceiving a child out-of-wedlock. Most of the results confirm our hypotheses. Protestant schooling is associated with more positive marital outcomes across all three measures. Catholic schooling is significantly correlated with a lower likelihood of having a child outside of marriage. The associations between religious schooling and desirable marriage outcomes are strongest for adults who grew up poor and for those raised in intact families