A “Blueprint” for health care reform

Check it out — the Center for American Progress and the Institute on Medicine as a Profession have partnered to develop the book, The Health Care Delivery System: A Blueprint for Reform.

The blueprint it lays out is a vision of how different parts of the system should be structured and how they should function. Even more specifically, it proposes policies that the next administration and Congress could enact over the next five years to improve our health system.

The existence of a Public Insurance Plan would increase competition faced by private insurance companies

Democratic candidate Barack Obama has proposed as part of his health care platform a public insurance plan, modeled after the Federal Employees Health Benefits Plan and the Medicare program, that would give individuals the option of purchasing insurance through a public pool, thus providing greater competition to private insurers.

“The intent of the competing public plan is to use the administrative efficiencies of government-run health insurance plans, as well as the purchasing power of government to control costs. The underlying argument is that individual insurers do not have (or are unwilling to use) the market power to counter the pricing power of many hospital systems or physician specialties. This seems likely to remain true even if reforms lead to more aggressive competition in insurance/managed care markets. Thus, the power of a larger purchaser motivated to contain costs is needed to control rising health care expenditures.

The concerns over the use of a public plan are that its purchasing power will be overused and will lead to the elimination of the private market and to a government-run health care system. The overuse of monopsony power, seen by some as inevitable because of budgeting constraints, could then lead to reduced access, lower quality, and the explicit rationing of health care due to constraints on supply and financing.”

A study by the Urban Institute concludes that the existence of a public plan would lower administrative costs and provider payment rates, although not to the extent that is often claimed.

Read the full report here.

NYT on women’s higher cost for same quality of health insurance

The New York Times ran an important article yesterday about the astonishing disparities in health care costs among men and women of the same age and for identical coverage.

In this economy, more and more Americans are shopping for health insurance on the individual market after having lost jobs that previously provided them coverage.  Additionally, both candidates for the presidency have proposed health care plans that expand the role of the individual market, promising tax credits for those who purchase insurance not through their employers.  BUT:

“‘Women often fare worse than men in the individual insurance market,’ said Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee.

Insurers say they have a sound reason for charging different premiums: Women ages 19 to 55 tend to cost more than men because they typically use more health care, especially in the childbearing years.

But women still pay more than men for insurance that does not cover maternity care. In the individual market, maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.”

 Please read this extremely important article in its entirety here.

Health care policy regarding care for our undocumented immigrants

The federal government holds an ambiguous stance on the  provision of health care to undocumented immigrants, so the range and nature of health (and other) benefits available to them is extremely variable across state lines.  In 1986, the federal government ruled against providing the same care to undocumented immigrants as it does to poor citizens, with the exception of treatment in the case of “emergency.”  Of course, this term is open to wide interpretation.  States’ policies toward providing care to their undocumented inhabitants “reflect the nation’s conflicting attitudes toward its estimated 12 million [undocumented] immigrants.”

For the full story behind this post, see the article from Oct. 29 in the Los Angeles Times.

Our own Amy Allina, of National Women’s Health Network, has written a piece for the National Council for Research on Women’s blog connected to their “The Big Five” campaign.  The article discusses how 40% of people surveyed in October cited health care as the primary concern for their families.  And women hold an even greater stake in the campaign for health reform:

“Women feel the squeeze first as health care becomes more expensive because of the cumulative effects of gender differences in health care needs and persistent economic discrimination.”

With the economy in crisis, millions of Americans are struggling with health care affordability, but women’s (especially women of color’s) particularized economic vulnerability places them at the front of the line when a slack economy forces families and individuals to cut down on expenses.

Mass. plan’s successes and unexpected bumps are a test for Obama’s health care platform

While Obama’s national health plan has a lot in common with the plan being implemented in Massachusetts for the past 31 months, there are some important distinctions among which is a mandate requiring most adults in the state to carry health insurance – Obama’s plan does not include such a measure.  His platform does, however, share a vision for fundamental system reform with the Massachusetts plan:

“Obama says he would keep the familiar arrangement in which most Americans get health insurance through their jobs, as Massachusetts is doing. Yet he also favors profound — and controversial — changes that Massachusetts also is putting in place: Expanding government insurance programs and subsidies. Requiring employers to offer their workers coverage or face penalties if they do not. Forbidding insurance companies to reject anyone or charging more if they are sick. Creating a national health insurance exchange to help people to find and compare private insurance policies on their own.”

The big question on health reformers minds is whether or not this type of plan can be replicated at the national level.  While the rate of uninsured working-age people in Massachusetts has declined from 13% to 7% since the plan was enacted in 2006, there have been significant unexpected costs and shortages of family physicians and other primary-care doctors.

See the full article here.

County clinics forced to cut hours of service; the low-income uninsured suffer

County medical clinics are suffering from decreased tax revenue and cuts in funding from Federal and State governments.  As the number of uninsured Americans grows, in concert with rising unemployment, these County clinics are forced to cut down on capacity and services as the demand for them increases.

A scary number: for each one-percent increase in the national unemployment rate, another 1.1 million Americans become uninsured (the Kaiser Family Foundation).

See the article here.

Massachusetts plan does not “crowd out” employer-based options

A study researching the effects of the 2.5-year-old Massachusetts health care reform plan on employer-based coverage options found – contrary to critics’ predictions – that the number of companies offering insurance to their employees did not change.  Moreover:

“No changes were seen in the share of workers’ premiums or in the scope of services covered, the range of provider choices, or the quality of care available under employer plans.”

Find an overview and the full text of the report here.

Health Care Premiums Rose 5 Times Faster than Earnings

Healthcare premiums from 2000 to 2007 rose 5.4 times faster than earnings, a sign that more people are at risk of losing their health insurance, a state-by-state analysis released by Families USA concluded.

The analysis, which includes 50 state-specific reports and a report for the District of Columbia, compared insurance premiums with wages during this time period. The advocacy group found that family insurance premiums for employer-sponsored coverage rose from $6,772 to $12,075, an increase of more than $5,300 or 78.3%, said Ron Pollack, executive director of Families USA, at a teleconference.

Median earnings by comparison increased at a much slower rate, from $25,024 in 2000 to $28,640 in 2007, an increase of only 14.5%. Taking these two results together, this is why people feel their insurance costs are taking a “bigger and bigger bite out of their family budgets,” Pollack said.

Not only are premiums skyrocketing, but the portion paid by workers is increasing faster than the portion paid by employers, Pollack said. While employer’s portions rose by more than 74% during this time period, the worker’s portion rose by more than 90%.

These findings prove escalating healthcare costs were a problem even before the economic downturn, even though the recent crisis has made it worse, Pollack said. “If this troubling trend continues, many Americans may end up becoming uninsured or underinsured.”

By Jennifer Lubell

Documentation Requirements Affect Low-Income Citizens’ Access to Health Care

A report released October 21 by the George Washington University School of Public Health and Health Services states that 75% of community health centers are finding that citizenship documentation requirements are negatively impacting low-income citizens’ access to care.

See an overview of the report here.