Alabama

IN THE STATES: Health Reform Wrap-Up

Joanne Kenen — Thu, 08 May 2008 20:16:00 -0400

Lots of health reform activity recently in states. Here's some help in catching up:

Connecticut. The state legislature has approved a Democratic bill permitting municipalities, nonprofits, and small businesses to join the state employee health insurance pool. Unclear whether Gov. Jodi Rell will support it. Some leading Republicans object to a "government-run" health system, while Democrats and labor backers say the greater buying power of the pool will save municipalities money. Not a comprehensive solution but we'll be interested in watching how this plays out.

Alabama. We posted a few weeks ago about Birmingham's plan to cover children—which we confess was a pleasant surprise to us given the state's history, poverty, and health status. Now we see the state has a new $3 million, five-year grant for the University of Alabama's initiative to reduce health disparities among older blacks.

"It's a huge agenda...There's lots of work to be done," said Dr. Richard Allman, who will head the new Deep South Resource Center for Minority Aging Research, noting that the elderly black rural population is growing fast. The program will start with a focus on three areas—how to help families make decisions about nursing home services, social support for patients with chronic heart failure, and cytomegalovirus infections in older blacks.

Minnesota. The legislature has approved a bill that would stop a hospital from using a patient's medical debt history to decide whether to treat the patient. The governor is expected to sign it.

"It hasn't been a problem here yet, but we do know that some companies were working on gathering that information to sell to health care providers," state Sen. Linda Scheid told the Star Tribune.

Under the bill, a health care provider can't share or obtain medical debt information about a patient seeking care until after the care is delivered.

Florida. This is the biggie, and the devil is in the details, which have yet to be figured out.

With nearly 4 million uninsured, Florida has one of the highest rates of uninsured in the nation, a bit more than 20 percent. Republican Governor Charlie Crist pushed hard this year for an affordable alternative health plan that people can purchase in the individual market, and state legislators gave him much of what he wanted.

The plans will be free of most state coverage mandates and regulations, and will be "no frills." And that's what we worry about. We appreciate Crist's effort to act—and the financial limits his state faces. And he's said the plan will cover prescription drugs, screening, even mental health. But for $150 a month,we're not yet sure how comprehensive these benefits can be. Will the young and healthy go for bare bones plans, making prices of more traditional insurance plans even more costly for the older and sicker? The details are going to be decided by the insurers, who will negotiate with the state. Still, we're sympathetic to states who are trying to help people even in economic tough times -- and one reason we're pushing a national comprehensive solution is that we recognize the states can't do it all on their own.

We've read several state newspaper accounts, (Here, among others) and called on an expert who tracks Florida but if our readers have any insights into where the Florida program is likely to go, please free to comment.

Thursday Round Up: Nader Hearts Signature Gatherers

Joe Mathews — Thu, 10 Apr 2008 12:44:00 -0400

I'll be out of pocket the rest of Thursday--in transit...

Ralph Nader's challenge to an Arizona law prohibiting non-residents from collecting signatures on presidential petitions has been scheduled for an April 15 hearing before the U.S. Ninth Circuit Court of Appeals.

RENEWABLE INITIATIVES: From a small paper in Missouri, a pretty good overview of renewable energy standards in different states, with some attention to those states that have imposed these by ballot initiative.

STILL NOTHING FROM COLORADO MEETING: Rocky Mountain News says the governor's attempt to head off labor-business initiative war didn't go well. And here's more evidence that the ill will is building.

SAN DIEGO PORT: Opposition mounts to a San Diego ballot measure that could lead to commercial development inside that city's struggling port.

ODDS AND ENDS: Gadsden, Alabama is to vote April 22 on whether to have an elected school board.

To Raise Standards For Early Educators, Look Beyond Pre-K

Sara Mead — Thu, 07 Feb 2008 00:00:00 -0500

Efforts to improve quality in early education frequently focus on raising requirements for pre-k teachers—to a BA or certification in early education. That’s a good thing, because teacher quality is key to high-quality early education, and the discrepancy that currently exists between standards for K-12 and pre-k teachers in many states, or between pre-k teachers in different settings, undermines quality early education. But policymakers must be thoughtful in how they implement new early education credential requirements.

Alabama offers a case in point: Governor Bob Riley's efforts to expand Alabama's tiny (but high-quality) pre-k program are coming up against an inadequate supply of certified pre-k teachers. Alabama requires pre-k teachers in public schools to hold state certification in "early childhood education," a credential that allows teachers to work in grades PK-3. But teachers in Alabama usually bypass the early childhood credential in favor of an "elementary education" credential that allows them to teach grades K-6, making them eligible for more jobs than the PK-3 credential does. Result: Too few certified pre-k teachers.

This is a good example of why efforts to raise standards for pre-k teachers can't just look at pre-k--they have to also take into account the existing state system of teacher certification and licensure, because pre-k and early elementary teachers are part of the same labor market and often work in the same schools. Simply layering a new credential on top of the existing (and already complicated) state credentialing system can lead to problems--as it is in Alabama.

Instead, early education advocates need to work together with K-12 school reformers to improve licensure and certification policies for both pre-k and early elementary school teachers, creating streamlined requirements that are the same for all early educators and based on solid evidence about how young children learn and what effective early educators do. We have the knowledge base in early education to support research-based, competency-based licensure for early educators, and that's what we should work towards--not just in pre-k, but across the early grades.

Alabama's experience also demonstrates the desperate need to pair new credentialing requirements with high-quality alternative certification programs. We have called on Congress to create a "Pathways to Pre-K Teaching" program, as part of NCLB reauthorization, that would provide incentives and funding for states, higher education institutions, and non-profit groups to create innovative, high-quality alternative pathways that offer accelerated and streamlined programs to prepare experienced pre-k teachers, recent college graduates, and elementary teachers without early childhood experience, to become certified as pre-k teachers. Such programs would go a long way to helping Alabama and other states address the shortage of qualified early educators.