DHFAC Meeting Minutes
December 28, 1999

Attending:

• Joseph DiPinto
• Charles Reinhardt
• Dennis Rochford
• Thomas Grabowski
• Gregg Sylvester
• Joseph Lieberman
• David McBride
• Patricia Blevins

Absent:

• Charles Simpson
• Deborah Capano
• Calvin Wilson
• Vivian Longo

Welcome and Introductions

Gregg Sylvester welcomed all to the meeting.

Review and Approval of Minutes and Agenda

The minutes from the December 14 meeting were approved, with the following change: correct typographical error in Thomas Grabowski's name in third paragraph under "New Business."

Next Meeting

HFAC's meeting is scheduled for Monday, January 10, 2000 at the University of Delaware's Wilmington Campus, Arsht Hall, Room 108. Beginning on January 10, HFAC meetings will be held every other Monday.

Tobacco Updates

Gregg Sylvester announced that the first allotment from the tobacco settlement was received on December 14, 1999. With that, applications were made available for the Prescription Assistance Program. This program should be in full swing by Jan 14, 2000. Moreover, Sec. Sylvester noted that it is possible that another allotment may be received this year, but could be reduced by 13% making the payment $8.5 million. The final payment for 2000 is scheduled for April 15. The tobacco companies may make further adjustments to the amount at that time.

Old Business

Written comments:

Each committee member has received a copy of the written comments. A summary will be provided to each member.

Delaware Health Fund Management Work Group:

A working group has been convened, at the suggestion of HFAC, to present the HFAC with fiscal management scenarios and recommendations. The group includes individuals identified by Rep. Capano and Sec. Sylvester. They are: Steve Golding, Myrna Whittington (tentatively), Mike McCabe, Lindsay Davis, Herb Nehrling, Jack Markell, Russ Larson and a representative from the Dept. of Finance. The group is hoping to hold an initial meeting during the week of 1/3 and have been requested to submit recommendations to HFAC during the month of January.

Presentations

Tobacco Prevention: Best Practices, Current Programs and Areas for Intervention

Fred Breukelman, DPH and Nancy Wilson, Department of Education

Mr. Breukelman reviewed the CDC's "best practices" for comprehensive tobacco control programs. Specifically reviewed were: community programs to reduce tobacco use; chronic disease programs to reduce the burden of tobacco-related diseases; school programs; enforcement; statewide programs; counter-marketing; cessation programs; surveillance and evaluation; and administration and management.

Nancy Wilson followed this presentation, briefly stating that health education in Delaware schools focuses on and should continue to focus on the concepts and skill development necessary to help minimize risk behaviors. As the Dept. of Education and the state continue to develop education standards, standards for health education will be developed that will focus on these areas. Moreover, Ms. Wilson stressed the need for research-based programs and community partnerships.

The following points were raised in response to these presentations: states such as California and Massachusetts funded prevention programs through tax increases on cigarettes (Grabowski); youth tobacco prevention is paramount, however HFAC and state need to also focus on adults (Grabowski); more specific information regarding "best practices" may be useful as may be an understanding of the supporting data used (DiPinto); decreasing the number of youths who smoke is the intent of the Master Settlement Agreement (McBride); enforcement is an important issue that may be related to personnel shortages (McBride, Blevins). HFAC asked that staff investigate the allotment of ABCC resources to tobacco v. alcohol, etc.

Uninsured in Delaware

Paula K. Roy, Delaware Health Care Commission

In her presentation, Ms. Roy asserted that there are insurance programs available for people in poverty, however the majority of the uninsured have incomes above the poverty line. Moreover, the availability of programs for both people in poverty and people above the poverty line does not ensure that the programs will be enrolled in or utilized. Following this, Ms. Roy further asserted that the number of Delawareans who are uninsured is "stable," and has been so since 1982. Long-term stability of these numbers, despite population growth, is attributable to programs implemented over this time. These programs include Medicaid expansions, the Diamond State Health Plan, the Nemours Children's Program, Tax Deductibility, the Health Plan Consortium and Network Plans, the Voluntary Initiative Program, the Delaware Healthy Children Program, the Small Employer Health Insurance Act, HIPAA Reforms, and Individual Market Reform. Following this review, Ms. Roy concluded, however, that some programs have been more effective than others, noting that the Small Employer Health Insurance Act, the Tax Deductibility program, and HIPAA reforms have all had marginal or no impact.

Regarding opportunities for intervention, Ms. Roy stated that the Health Care Commission would recommend at this time making existing programs better (including the Delaware Healthy Children Program and Community Health Centers that provide direct services for low-income uninsured), and that new concepts for covering the working uninsured be explored in the future.

The following points were raised following Ms. Roy's presentation: state needs to know if premiums are a barrier to enrollment in the Delaware Healthy Children Program (Blevins); outreach is an important issue, as many employers don't know about programs to which they may refer their employees (Grabowski).

Automatic External Defibrillators (AED's):

Equipment and Training Costs, Bill Stevenson, Division of Public Health

Mr. Stevenson presented the need for a Coordinated Chain of Survival Improvement Initiative, which includes a public awareness campaign, increased availability of AED's and of CPR/AED training. Mr. Stevenson argued that automatic external defibrillators are critical in the chain of survival when there is a cardiac event. There were 250,000 cardiac events in the US last year. 2/3 of them were not in a hospitals. Delaware had 760 in 1998 and 4% survived. Currently, the state of Delaware has AEDs in all ambulances, and in many first response vehicles (fire companies). However, the State has identified over 600 potential locations where AED's may be of benefit. The average cost of an AED is $3,000.

Moreover, the availability of AED's begs the need for increased education and training. Education and training for the use of AED's is minimal (approx. one hour). The goal is to train five providers for each AED placed, at a cost of $35 per provider. Finally, Mr. Stevenson noted that Good Samaritan legislation is also necessary to reduce liability concerns and thus broaden the accessibility of AED's in public places. Such legislation is expected to be introduced in the General Assembly in January.

The following points were raised following Mr. Stevenson's presentation: costs for this technology should decrease over time (Sylvester); AED's should be available in health facilities including nursing homes (Blevins, Grabowski).

Public Comments

Phil Pollner, a Newark physician, argued that additional Census Bureau figures indicate the numbers of the uninsured are increasing (published in NEJM). Moreover, Dr. Pollner argued that expanding CHIP will not help to decrease the numbers and that Delaware needs to look to additional states to identify ways to reduce the rising number of adults who are uninsured.

Debra Kaye expressed concerns about defibrillators being tampered with and the need for controlled access.

Chris Mann from the American Heart Association stated that the goal is to have the AED available for use by trained persons such as security guards or business personnel, not to be accessible to any member of the public.

Leonard Young, Stand for Children, suggested more outreach programs to increase the number of children who are insured. Moreover, he suggested more outreach staff in existing programs. Deborah Singletary from Rural Ministries commented that they have taken applications onsite at physician's offices and reached many people that way.

Regarding the placement of AED's in nursing homes, Denise McMullan-Powell. Governor's Council on Disabilities, commented on the need to transition persons out of nursing homes into the community.

The meeting was adjourned.

Next Meeting:
Monday January 10, 1999
University of Delaware, Wilmington Campus
Arsht Hall
Room 108