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Despite Difficulties, States Advance Healthcare Reform
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| Copyright: | Healthcare Financial Management Association | | Source: | Healthcare Financial Management | | Wordcount: | 831 |
HEADNOTE
State Watch
A new report from the Robert Wood Johnson Foundation's State Coverage Initiatives program, State of the States 2008: Rising to the Challenge, outlines 3007 efforts to expand health insurance coverage and find new tools to address healthcare reform at the state level. While many states have made progress in their efforts toward healthcare reform, key contributors to lack of insurance remain unchecked and historically difficult policy questions remain unanswered.
According to the report, steady increase in the number of uninsured has been a hallmark of the past decade, precipitated by unprecedented declines in employer-based coverage. In 3007, the trend continued and was exacerbated when public program funding remained flat, failing yet again to offset new losses. This one-two punch hits children particularly hard, swelling the ranks of uninsured kids by 700,000 in 3006 and accounting for more than one-quarter of the growth in the number of uninsured Americans.
States considering substantial or comprehensive healthcare reforms face a number of challenges, but State of the States lists several key policy design questions that can help shape the debate:
* What are the goals and priorities of reform?
* Will different populations require different solutions?
* Who will pay: Businesses? Government? Individuals?
* Who will benefit?
* Should health insurance coverage be required?
* If so, what constitutes affordable coverage?
* What is the most appropriate benefit design?
* How can risk be pooled?
* Do insurance markets need to be reformed or reorganized?
* What are the best mechanisms for cost containment and overall systems improvement?
"These are extraordinarily tough questions to answer-and each leads down a different path of policy discussion," said Enrique Martinez-Vidal, director of the State Coverage Initiatives program and a lead author of the report. "But states have shown an enormous capacity to work through different design scenarios and are determined to find answers. They don't really have a choice but to keep working on these problems. The status quo just isn't working and there isn't much hope of federal help in the immediate future."
State approaches to reform vary considerably, often depending on the political and fiscal environment; demographic characteristics, insurance market dynamics, and other economic variables also affect a state's capacity to act. Yet, according to the report, states almost universally are considering healthcare reform pragmatically.
"A single-payer system is generally not considered a politically viable option," said Martinez-Vidal, "but neither are reforms that rely completely on a free market, consumer-driven healthcare system. Instead, most state reforms look to politically feasible proposals that build on the current, mixed, public-private health insurance system."
Overall, states' reform activities can be grouped into three general categories:
* Comprehensive reforms like those passed in Massachusetts and Vermont in 25006, Maine's Dirige plan, and new proposals that California, New Mexico, and Pennsylvania have been working on this past year
* Substantial reforms that expand coverage; ensure private market reforms and/or launch new purchasing mechanisms, such as Washington's legislation providing access to coverage for all children by 2010; and begin a premium subsidy program for families
* Incremental strategies that expand health coverage for subpopulations within the uninsured, such as expansions aimed at children in Hawaii, Illinois, Missouri, and Texas; State Children's Health Insurance Program eligibility expansions in New York; and efforts in Connecticut, Idaho, Indiana, Maine, Maryland, Montana, and Washington that expanded coverage to young adults
In addition, a wealth of state activities took aim at systemwide improvements in quality, care coordination, and cost containment.
Increasingly, states are coupling coverage expansions with strategies that target chronic conditions, wellness and prevention, the uptake of health IT, and public reporting of information on cost and quality. With these efforts, states are working to improve quality, control costs, and improve the value of public and private programs.
"More and more often we're seeing states attempt to address health reform with a balance of coverage expansions, quality improvement efforts, and cost-containment strategies," said Martinez-Vidal. "They continue to take the lead in addressing the problems of the uninsured."
Pennsylvania House Passes Bill Limiting Insurers' Ability to Base Rates on Health History for Individual, Small-Business Plans
The Pennsylvania House on April 1 voted 181-72 to approve legislation (HB 2005) that would limit the ability of insurers to consider certain factors, such as health history, when setting rates for health plans offered to individuals and small businesses, the Pittsburgh Post-Gazette reported. The measure would allow insurers to set rates based on age and geographic region.
The bill also would require insurers to spend 85 percent of premiums on health care. Insurers violating the rule could be required to issue rebates to policyholders. In addition, the legislation would allow the Pennsylvania Department of Insurance to disapprove requests for rate increases if an insurer has not operated efficiently or has not controlled costs for avoidable hospital-acquired infections or chronic disease management.
The House also approved legislation (HB 2098) that would allow insurers to not pay hospitals for preventable medical errors that result in death or serious disability.
This is a news service of Thomson Business Intelligence Service ©2006. This content is for your personal use only, subject to Terms and Conditions. No redistribution allowed.
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