Tuesday, January 02, 2007

Health Care for all, by Nathan Newman

Health Care for All Debate Gets Real

Health care reform may be stalled in the DC swamp, but at least some states and local governments are getting real in debates and actions to deliver health care for all in our nation.

Last week, the San Francisco Board of Supervisors voted to create a health care plan to provide health care coverage for the 85,000 uninsured residents of that city. While there are additional votes needed to finalize the bill, with a unanimous vote and the endorsement of the mayor, the proposed ordinance is expected to become law with no problem. The San Francisco Health Access Plan is the first health care law in the nation that might actually achieve universal health coverage in a jurisdiction, but it caps a year when the debate to achieve health care for all became far more real in a number of states than in the past.

2006 became the year when Maryland kickstarted a national debate on employer responsibility for health care costs, Vermont and Massachusetts enacted new plans that each promised significantly expanded health care coverage, and Illinois finalized details on its AllKids program to provide affordable health care for all children in that state. And it was a year when serious campaigns in both California and Wisconsin to create integrated universal health care systems moved forward, emphasizing how states aren't waiting for the federal government to shake up our health care system.

San Francisco's Landmark Law

The ordinance approved by the San Francisco Board of Supervisors is the first law to pull together all the elements needed for universal coverage-- combining existing state and federal insurance funds, money already being spent on the uninsured showing up at public facilities, a solid employer contribution to cover costs, and reasonable fees paid by consumers based on their ability to pay. It's estimated that covering the 85,000 uninsured in the city will cost $200 million per year:

* A large chunk of that amount will come from the $104 million already spent by the city at city clinics and hospitals -- with the goal that the new system will contain costs better compared to the present disorganized and costly emergency care emphasis of most current help to the uninsured.
* Along with consumer premiums and copayments, additional funds for the new system will come from a new requirement that employers not providing health care pay into the public system. The legislation requires businesses with more than 50 employees to contribute $1.60 per hour worked by employees beginning in July, 2008. Businesses with from 20 to 50 workers would pay $1.06 per hour starting July, 2009. The ordinance caps employer contributions at $180 per month per worker.

It is still unclear how expensive premiums will be, although a key part of the ordinance requires that coverage be offered regardless of preexisting medical conditions. And the largest limitation on the plan is that all medical care will be provided only at city facilities, so no coverage under the plan will be available for health care needed when out-of-town. But it's a good foundation model for policy around the country.

Vermont and Massachusetts: Partial Steps to Universal Coverage

Vermont and Massachusetts both billed their plans as aiming for universal coverage. The Vermont plan has far clearer standards for heatlh care affordability and, while the Massachusetts plan had important provisions expanding coverage, it also has elements that policymakers probably should reject, especially the individual mandate Governor Romney insisted be part of the plan.

The new Vermont "Catamount Health" law subsidizes private sector health plans for the uninsured up to 300% of the poverty line ($29,400 for individuals, $60,000 for family of four) with a sliding scale of premiums from $60-$135 per month-- along with even lower premiums for children in that income range. The law also includes an assessment of $365 per employee per year on irresponsible employers who don't provide health care for employees, a low amount and not much of a deterrent to employers dropping coverage, but it at least establishes the principle of employer accountability.

The Massachusetts plan enacted this Spring is a more complex amalgam of program changes, including expansions of existing Medicaid and child health care programs, the promotion of a "Health Insurance Connector" to promote more affordable health plans, health care subsidies for citizens who earn up to 300% of the poverty line, a $295 charge per employee per year charge on employers not providing health care, and a potential mandate on all residents to get health care-- the last feature the biggest worry for middle class families if no affordable health plans get developed. But at least the state is aiming for universal coverage.

Illinois: Covering AllKids By expanding coverage for children, Massachusetts this year joined New Jersey, Connecticut, Maryland, New Hampshire, and Vermont which had already extended subsidized coverage to kids in families at 300% of the poverty level or higher.

Taking a step farther, Illinois enacted the AllKids program last year to extend health care coverage to children throughout Illinois. State officials this year finalized the table of premiums for families and launched the program on July 1-- and the results are an impressive model for affordability. Families of four making up to $30,000 per year will pay no premium for kids health care, while families making from more will pay from $25 for two kids (up to $40,000 annual income) to $100 per month per child for families making $99,000 per year.

What is impressive about the Illinois program is that it converts health care from a quasi-poverty program to a general health plan for all kids, much as Medicare is a general plan for the elderly. Which means that working families will no longer face the dilemma of a raise at work potentially meaning the loss of affordable health coverage for their children.

Exact funding sources for the AllKids program has to be worked out, but if there was a strong employer contribution included, there's no reason a similar model could not be extended to coverage of working adults, with a sliding scale of premiums for all families and with employers picking up part of those premiums.

California and Wisconsin: Proposals for Comprehensive Reform While not near passage, activists in both California and Wisconsin are promoting bold plans for integrated health care systems. Last year, California's State Senate approved SB 840, a Canadian-style "single payer" health plan, to create a single health care system for that state, an exploratory proposal that still needs a funding mechanism but it's opening up the debate in that state.

And this year in Wisconsin, Sen. Russ Decker (D-Schofield) and Rep. Terry Musser (R-Black River Falls), introduced SB 698, a plan to provide coverage for all working families in the state, including the 500,000 current residents without health insurance. The idea is to create an integrated plan that could better contain costs and deliver an affordable plan, including offering the same low-cost plan to small as to large firms, which would be financed jointly by employers and employees.

Most of these plans built on previous efforts that had expanded coverage in those states over many years. But what they have in common is an understanding that our current heatlh care system is not just punishing to working families but also incredibly wasteful. What is clear is that any viable solution will combine a more rational allocation of funds currently spent by governmenta, a fair contribution to costs from all employers, and contributions from families based on their ability to pay.

Nathan Newman is a lawyer, policy analyst and longtime community and labor activist. He is Policy Director for the Progressive States Network, a nonprofit that supports state legislative campaigns for economic and social justice. He can be contacted at nnewman@progressivestates.org.


Post a Comment

<< Home