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February 2004 -- THE UNINSURED --  Part 2 -- Solutions to the Problem Coming in March -- Spinal Cord Injuries - New Resources, Research and Technology

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THE UNINSURED - POSSIBLE SOLUTIONS

After much research, it is clear that there are increasing discussions from a wide range of perspectives regarding this problem and its solutions.

Some of the proposed solutions are discussed below. However, it is impossible to offer a comprehensive overview of this complex subject in such a short space.

It is our recommendation that the references included here be used as a "stepping off" point for your own investigation into this pervasive problem.

Our research confirms the following 2 conclusions:

1. Many think they have THE answer to this problem.

Federal policy makers, professional and charitable associations and local government officials ALL consider themselves experts in solving this problem . . .

For example:

"To extend coverage to uninsured individuals, President Bush, Senate majority Leader Bill First (R-TN) and others favor increasing coverage in the private non-group market through individual tax credits.

Other policy makers favor building on the existing employer-sponsored system of health insurance through subsidies aimed at employers."

by Catherine McLaughlin, PhD
Professor at the University of Michigan
Director of ERIU

2. The solution is complex and requires a mult-faceted approach.

* * * * *

Some of the public policy components that NAHU (National Association of Health Underwriters) feels would ensure that all Americans have access to affordable health insurance coverage include:

1. The availability of advanceable health tax credits for low income individuals

2. The availability of a health care safety net for the lowest income segments of our population. For example, the health insurance flexibility and accountability waivers (HIFA).

3. Medicare Reform

4. Vibrant and competitive health insurance markets.

These topics and more are discussed in this month's newsletter.

The topics in BOLD (with links) are covered in this newsletter.

EMPLOYER SOLUTIONS

• Association Health Plans
• Employer-based Health Insurance

EMPLOYEE SOLUTIONS

• Tax Credits
• HIPAA - Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. Visit: http://cms.hhs.gov/hipaa/

OTHER SOLUTIONS

• Universal Coverage
• Indigent Medication Coverage (see January's newsletter)
• Health Insurance for Children
• Health Insurance Flexibility and Accountability Waivers (HIFA)
• MEDICARE Reform
• Vibrant and Competitive State Health Insurance Markets

ASSOCIATION HEALTH PLANS

AHPs are health plans created for individuals and groups who belong to an association related to their jobs, careers, hobbies or interest. By uniting many individuals and small groups with similar interests, AHPs could provide economies of scale to lower health costs for their members.

AHPs and could bring coverage to as many as 4.5M currently uninsured Americans, provided Congress creates the right regulatory environment.

Associated Health Plans: A Godsend, or a Recipe for Disaster?

Associated Health Plans Legislation: The Pros and Cons

EMPLOYER-BASED HEALTH INSURANCE
Understanding what motivates employers and workers is critical for determining the fate of new incentives or programs for expanded coverage, particularly as employers face challenges that could deter them from offering health insurance.

Can the Employer-Based health Insurance System Reduce America's Uninsured?

TAX CREDITS

The Council for Affordable Health Insurance's Issues and Answers: An Affordable Way to Help the Uninsured

RETURN TO TOP OF NEXT COLUMN FOR OTHER SOLUTIONS

BOOKS FOR SALE Coming SOON
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I would have gone to bed when I was sick instead of pretending the earth would go into a holding pattern if I weren't there for the day.

I would have burned the pink candle sculpted like a rose before it melted in storage.

I would have talked less and listened more.

I would have invited friends over to dinner even if the carpet was stained, or the sofa faded.

I would have eaten the popcorn in the 'good' living room and worried much less about the dirt when someone wanted to light a fire in the fireplace.

I would have taken the time to listen to my grandfather ramble about his youth.

I would have shared more of the responsibility carried by my husband.

I would never have insisted the car windows be rolled up on a summer day because my hair had just been teased and sprayed.

I would have cried and laughed less while watching television and more while watching life.

I would never have bought anything just because it was practical, wouldn't show soil, or was guaranteed to last a lifetime.

When my kids kissed me impetuously, I would never have said, "Later. Now go get washed up for dinner."

There would have been more "I love you's."
More "I'm sorry's."

But mostly, given another shot at life, I would seize every minute . . . look at it and really see i t . . . live it and never give it back. Stop sweating the small stuff.

Don't worry about who doesn't like you, who has more, or who's doing what.

Instead, let's cherish the relationships we have with those who do love us.

Let's think about what God HAS blessed us with. And what we are doing each day to promote ourselves mentally, physically, emotionally.

"By focusing on the health of the uninsured, universal coverage would actually save money while improving the health of the general population.

It costs more to provide crisis care than it would to reap the benefits of early detection and reduced morbidity and mortality by covering screening.

By providing universal coverage, we'll ensure universal access to preventive care. We'll also eliminate much of the administrative trivia involved in getting authorization and precertification to establish eligibility before taking care of the patient."

by John Queenan, MD
 Member of American College of Obstetricians and Gynecologists Committee for th Undeserved

• individually funded using tax incentives
• tax breaks for the self-employed
• medical savings accounts
• purchasing pools
• single-payer system
• tax credits

Medical Institute calls for universal coverage Washington - The Institute of Medicine on Wednesday recommended for the first time that the government provide universal health insurance, attempting to spark an election-year debate on a decades-old problem that keeps getting worse.

The Universal Health Care Action Network (UHCAN) is a national resource and strategic center supporting organizations and advocates working for comprehensive, affordable and publicly accountable health care for all in the U.S.

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10 PROPORALS TO EXPAND HEALTH INSURANCE COVERAGE
Excerpt from: Covering America - Real Remedies for the Uninsured

In 2001, the Economic and Social Research Institute, as part of the Covering America project sponsored by The Robert Wood Johnson Foundation (RWJF), published 10 proposals to expand health insurance coverage.

Prepared by major experts in the field, these proposals range from expanding eligibility under Medicaid to adopting a tax-financed health care system for the entire non-Medicare population. All of these proposals provide some form of subsidy to lower-income groups. Several are also designed to strengthen consumer incentives to enroll in costefficient health plans

The Lewin Group was engaged to develop a detailed analysis of the cost and coverage impacts of these proposals. For each proposal we estimated the reduction in the number of uninsured, the net cost to the federal government, and the financial impact on major stakeholder groups, including providers, employers, consumers, and state and local governments.

To facilitate discussion, we classified the 10 proposals into 5 categories of proposals with similar approaches.

1. Incremental Reforms: There are two proposals to expand coverage through existing sources, including Medicaid/S-CHIP expansions, and tax credits for private coverage.
2. Voluntary Insurance Pool Proposals: Three proposalswould establish voluntary insurance pools offering a selection of health plans and would provide subsidies for coverage for low- and moderate-income people.
3. Employer Contribution Requirement, that is, “Pay-or- Play,” Proposals: Two proposals would require employers to either provide insurance to their workers or pay a payroll tax that automatically covers their workers under a newly created public plan.
4. Replace the Employer Health Benefits Tax Exclusion with a Tax Credit: Two proposals would provide refundable tax credits to purchase insurance while making employer contributions for health benefits taxable to the worker.
5. Tax-financed Health Care System: One proposal would replace the current premium-financed system with a state-administered payroll tax-financed system covering the entire non-Medicare population.

Changes in Coverage and National Health Spending
We estimate that there was an average of 41.9 million uninsured people at any given time during 2002. All 10 of the proposals analyzed would substantially reduce the number of people without health insurance.

The Wicks et al. and Kronick and Rice proposals are the only ones that require all people to have insurance. However, despite the mandate for universal coverage, we estimate that about 1.6 million undocumented persons and “hard-to-reach” people would remain uninsured .

The two “pay-or-play” proposals introduced by Hacker and Weil would achieve near-universal coverage by requiring all employers to provide insurance for their workers. This reduces the number of uninsured by about 37 million people. However, nearly 5 million non-working uninsured people would still be without coverage.

The remaining six proposals would encourage voluntary increases in coverage with premium subsidies, tax credits, and automatic enrollment mechanisms. We estimated the effect of these inducements to obtain coverage based primarily on studies of how changes in the price of insurance and/or the use of automatic enrollment affect the likelihood of obtaining coverage.

Our estimates of the reduction in the number of uninsured under these proposals range from about 11.8 million people under the Singer et al. proposal to 26.9 million people under the Butler proposal.

Cost and Coverage:   Analysis of Ten Proposals to Expand Health Insurance Coverage

Covering America - Real Remedies for the Uninsured - Volume III

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HEALTH INSURANCE FLEXIBILITY AND ACCOUNTABILITY WAIVERS (HIFA)
The primary goal of the HIFA demonstration initiative is to encourage new comprehensive state approaches that will increase the number of individuals with health insurance coverage within current-level Medicaid and SCHIP resources.

HIFA: Opportunities and Issues for States

CMS's Health Insurance Flexibility and Accountability Waivers - Demonstration Initiative

www.CEUs4CaseManagers.com ADVISORY BOARD Toni Cesta, PhD, RN, FAAN Elaine Cohen, EdD, RN, FAAN Connie Commander,RN,CCM,CPUR CMSA's Case Manager of the Year 2003 Vivian Campagna, Director , Case Management St. Clare's Hospital & Health Center, NY, NY Interested on being part of our Advisory Board? Contact us - 1-866-543-2273 Want to review past issues of our newsletter?

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