Post by aomalliance on Jan 23, 2007 14:11:00 GMT -5
Pool money for health care, panel suggests
By KATHIE DURBIN Columbian staff writer
OLYMPIA -- What if workers could buy health insurance from an insurance pool funded in part by their employers and tailored to their specific needs?
That's one idea to emerge from the Washington State Blue Ribbon Commission on Health Care Costs and Access. The bipartisan panel presented its five-year plan for making health care more affordable and accessible to two Senate committees last week.
The proposal to create a pool of state, federal and private insurance funds available to all Washington residents could address one of the biggest holes in the state's health care safety net: the fact that many small businesses can't afford health coverage for their workers.
The bipartisan panel, chaired by Gov. Chris Gregoire and former State Sen. Pat Thibaudeau, met from June to November 2005. Through a process of consensus, its members came up with the insurance pool concept and 15 other recommendations for controlling health care costs and improving access.
Their proposal for an insurance pool, known as an "exchange" or "connector" in insurance jargon, is short on specifics. But the basic idea is this: It would combine employers' contributions and workers' premiums with a state subsidy to buy insurance coverage that neither employees nor their employers could afford on their own.
Such a system could potentially cover as many as 500,000 Washington residents who currently buy individual insurance or are enrolled in small-group plans, according to the Washington Office of the Insurance Commissioner.
More options needed
Republican legislators pushed hard but unsuccessfully in the 2006 session for a bill that would give small business owners a broad selection of health insurance plans they could afford to offer their employees.
House Republican leader Richard DeBoldt, R-Chehalis, says the state eliminated options for affordable health insurance in the 1990s, when it mandated that private health insurance policies provide broad coverage. Many insurance carriers left Washington because they could not meet the state's coverage mandates, he said.
"Ten years ago, we had 20 health insurance carriers," DeBoldt said. "Now we have three."
Other states offer more health insurance options, said state Sen. Joe Zarelli, R-Ridgefield.
"My daughter and her husband can buy an individual policy for $300 a month in Oregon, but that policy is not available here," he remarked at a Senate Ways and Means Committee hearing last week.
What's needed, Zarelli said, is "a private market plan that provides a choice for the consumer so they have at least catastrophic insurance. If we had that, employers wouldn't have to provide health insurance."
Deputy Insurance Commissioner Peter Cutler said the reduction in insurance carriers had more to do with the consolidation of insurance companies during the rise and fall of managed care in the 1990s. "We used to have more small regional plans," he said.
In fact, he said, about 30 carriers, including three major companies, provide health insurance coverage in Washington today.
But Cutler agreed that state mandates have made it harder for some employers to afford health insurance in Washington.
For example, the state requires that if a policy covers a specific type of injury, such as a back injury, it must cover treatment for that injury by any state-licensed provider, whether a medical doctor, a chiropractor, a naturopath, acupuncturist or even a massage therapist.
The insurance commissioner's office is surveying insurance carriers to find out which mandates they would like to get rid of. That information will be presented to a joint meeting of the Senate and House health care committees Feb. 1.
Pooling resources
State Sen. Cheryl Pflug, R-Hobart, a nurse and a member of the health care commission, is enthusiastic about the idea of establishing a health insurance exchange. A background paper she distributed last week says the exchange "would a ct as a virtual stock market for health insurance in Washington state, with insurance companies of all sizes competing for one of the largest consumer consortiums in the country."
Pflug and other commission members are working with the governor to draft a bill that would address the insurance pool idea and other recommendations.
Under a scenario proposed to the commission by state Insurance Commissioner Mike Kreidler, employers would pay a fixed rate or health care access fee, ranging from $160 to $176 a month for a full-time employee, into a state-managed pool. Eligible individuals, those who are unemployed, self-employed or who do not receive coverage through their employer, would obtain coverage through the pool. The state would subsidize coverage on a sliding scale based on income.
"Collectively, employers, the public sector and individuals all have an obligation to contribute to the funding of health care coverage," Kreidler told the commission.
Under the proposal the commission recommended, participants could pick the policy that fit their needs from a list of participating insurance plans, using pre-tax income to pay the premiums. Policies would be portable, following workers when they changed jobs. Even part-time workers would be able to buy into the system.
States address reform
The insurance exchange concept is based on a model promoted by the conservative Heritage Foundation. A variation of it is being pioneered this year by the state of Massachusetts.
It isn't as flashy as California Gov. Arnold Schwarzenegger's plan to guarantee universal health insurance. His proposal, under consideration by the California Legislature, would require every California resident to buy health insurance. Those who could not afford it would be subsidized by a state-run pool funded in part by taxes on the revenue of doctors and hospitals and a 4 percent payroll tax on employers of 10 or more who don't provide insurance to their workers.
The Oregon Legislature is considering a health care reform plan developed by former Gov. John Kitzhaber that would pool state, federal and private dollars and use them more efficiently to provide health care to Oregon residents.
Gov. Gregoire is preparing an omnibus bill to reform the state's health care system. It will be introduced later in the 2007 session.
It's too soon to put a price tag on the reform proposals.
The governor's 2007-09 budget was written before the health care commission delivered its report, yet some of its recommendations dovetail with the commission's recommendations, said Jonathan Seib, a health policy advisor to Gregoire.
Those include:
$30.8 million in state funds to extend health care coverage to 32,000 more low-income children. The governor and Democratic legislative leaders have set a goal of ensuring that every Washington child has health insurance by 2010.
$8 million to launch a pilot project creating a computerized medical records bank.
$5 million to continue a pilot program that helps subsidize health insurance premiums for small business owners.
$2 million to expand statewide a regional health alliance that is working to improve the quality and efficiency of health care delivery in the Puget Sound area.
Education reform is Gregoire's top priority and the Legislature's, as well.
But Pflug said she's not worried that health care reform will be overshadowed by school reform in the competition for legislators' time and attention.
"We need a significant bill this year," she said. "I'm confident we can come up with some strong initiatives."
Did you know?
* Nearly 750,000 Washington residents are employed by businesses with 50 or fewer workers. Fewer than half those workers have health coverage.
* Only 60 percent of the nation's employers offered health care coverage in 2005, down from 69 percent in 2000.
* More than half of young adults age 19-34 in Washington are uninsured.
Commission recommendations
Recommendations of the Blue Ribbon Commission on Health Care Costs and Access Republicans have been pushing since the 2006 session for legislation to provide small business owners with a broad menu of affordable health insurance plans that they could afford to offer their employees.
1. Use the state's purchasing power to improve health care quality by rewarding positive results with higher state reimbursement rates.
2. Become a leader in the prevention and management of chronic illnesses like diabetes and heart disease by using proven medical techniques.
3. Provide health care consumers and providers with better cost and quality information.
4. Develop a system to provide health care providers with electronic access to patient information from anywhere in the state.
5. Reduce unnecessary emergency room visits by giving patients more information about alternatives to emergency room care.
6. Ask the Office of the Insurance Commissioner to review the factors contributing to high health care administrative costs.
7. Support community organizations that promote cost-effective care.
8. Give individuals and families more choice in selecting private insurance plans that work for them by changing state law to allow carriers to offer plans tailored to underinsured populations, such as young adults and the working poor.
9. Form a partnership with the federal government to improve coverage by making sure Medicaid and the state's Basic Health Plan cover as many eligible people as possible. Work with the state's congressional delegation to win legislation that encourages innovative state health care strategies.
10. Organize the insurance market to make it more accessible to consumers by allowing pooling of contributions from employees and employers, along with state subsidies, to pay for insurance that neither employers nor employees could afford on their own.
11. Address the high cost of coverage for about 3,000 Washington residents with severe, long-term conditions by restructuring an insurance pool that covers the costs of their care.
12. Ensure the health of the next generation through state subsidies and outreach programs that guarantee every child has health care coverage.
13. Improve childhood nutrition and physical activity by working with local public health agencies and schools. Pass legislation that encourages nutritious food options and exercise for student in grades K-12.
14. Fund a demonstration project to promote health literacy and educate new parents on what to do when their children get sick.
15. Adequately fund the state's public health system to strengthen illness prevention and health promotion programs.
16. Integrate prevention and health promotion into state-funded insurance programs.
For example, require enrollees in the Basic Health Plan to complete a health assessment and provide reimbursement for cost-effective illness prevention programs.
Link: www.columbian.com/news/localNews/01212007news95480.cfm
By KATHIE DURBIN Columbian staff writer
OLYMPIA -- What if workers could buy health insurance from an insurance pool funded in part by their employers and tailored to their specific needs?
That's one idea to emerge from the Washington State Blue Ribbon Commission on Health Care Costs and Access. The bipartisan panel presented its five-year plan for making health care more affordable and accessible to two Senate committees last week.
The proposal to create a pool of state, federal and private insurance funds available to all Washington residents could address one of the biggest holes in the state's health care safety net: the fact that many small businesses can't afford health coverage for their workers.
The bipartisan panel, chaired by Gov. Chris Gregoire and former State Sen. Pat Thibaudeau, met from June to November 2005. Through a process of consensus, its members came up with the insurance pool concept and 15 other recommendations for controlling health care costs and improving access.
Their proposal for an insurance pool, known as an "exchange" or "connector" in insurance jargon, is short on specifics. But the basic idea is this: It would combine employers' contributions and workers' premiums with a state subsidy to buy insurance coverage that neither employees nor their employers could afford on their own.
Such a system could potentially cover as many as 500,000 Washington residents who currently buy individual insurance or are enrolled in small-group plans, according to the Washington Office of the Insurance Commissioner.
More options needed
Republican legislators pushed hard but unsuccessfully in the 2006 session for a bill that would give small business owners a broad selection of health insurance plans they could afford to offer their employees.
House Republican leader Richard DeBoldt, R-Chehalis, says the state eliminated options for affordable health insurance in the 1990s, when it mandated that private health insurance policies provide broad coverage. Many insurance carriers left Washington because they could not meet the state's coverage mandates, he said.
"Ten years ago, we had 20 health insurance carriers," DeBoldt said. "Now we have three."
Other states offer more health insurance options, said state Sen. Joe Zarelli, R-Ridgefield.
"My daughter and her husband can buy an individual policy for $300 a month in Oregon, but that policy is not available here," he remarked at a Senate Ways and Means Committee hearing last week.
What's needed, Zarelli said, is "a private market plan that provides a choice for the consumer so they have at least catastrophic insurance. If we had that, employers wouldn't have to provide health insurance."
Deputy Insurance Commissioner Peter Cutler said the reduction in insurance carriers had more to do with the consolidation of insurance companies during the rise and fall of managed care in the 1990s. "We used to have more small regional plans," he said.
In fact, he said, about 30 carriers, including three major companies, provide health insurance coverage in Washington today.
But Cutler agreed that state mandates have made it harder for some employers to afford health insurance in Washington.
For example, the state requires that if a policy covers a specific type of injury, such as a back injury, it must cover treatment for that injury by any state-licensed provider, whether a medical doctor, a chiropractor, a naturopath, acupuncturist or even a massage therapist.
The insurance commissioner's office is surveying insurance carriers to find out which mandates they would like to get rid of. That information will be presented to a joint meeting of the Senate and House health care committees Feb. 1.
Pooling resources
State Sen. Cheryl Pflug, R-Hobart, a nurse and a member of the health care commission, is enthusiastic about the idea of establishing a health insurance exchange. A background paper she distributed last week says the exchange "would a ct as a virtual stock market for health insurance in Washington state, with insurance companies of all sizes competing for one of the largest consumer consortiums in the country."
Pflug and other commission members are working with the governor to draft a bill that would address the insurance pool idea and other recommendations.
Under a scenario proposed to the commission by state Insurance Commissioner Mike Kreidler, employers would pay a fixed rate or health care access fee, ranging from $160 to $176 a month for a full-time employee, into a state-managed pool. Eligible individuals, those who are unemployed, self-employed or who do not receive coverage through their employer, would obtain coverage through the pool. The state would subsidize coverage on a sliding scale based on income.
"Collectively, employers, the public sector and individuals all have an obligation to contribute to the funding of health care coverage," Kreidler told the commission.
Under the proposal the commission recommended, participants could pick the policy that fit their needs from a list of participating insurance plans, using pre-tax income to pay the premiums. Policies would be portable, following workers when they changed jobs. Even part-time workers would be able to buy into the system.
States address reform
The insurance exchange concept is based on a model promoted by the conservative Heritage Foundation. A variation of it is being pioneered this year by the state of Massachusetts.
It isn't as flashy as California Gov. Arnold Schwarzenegger's plan to guarantee universal health insurance. His proposal, under consideration by the California Legislature, would require every California resident to buy health insurance. Those who could not afford it would be subsidized by a state-run pool funded in part by taxes on the revenue of doctors and hospitals and a 4 percent payroll tax on employers of 10 or more who don't provide insurance to their workers.
The Oregon Legislature is considering a health care reform plan developed by former Gov. John Kitzhaber that would pool state, federal and private dollars and use them more efficiently to provide health care to Oregon residents.
Gov. Gregoire is preparing an omnibus bill to reform the state's health care system. It will be introduced later in the 2007 session.
It's too soon to put a price tag on the reform proposals.
The governor's 2007-09 budget was written before the health care commission delivered its report, yet some of its recommendations dovetail with the commission's recommendations, said Jonathan Seib, a health policy advisor to Gregoire.
Those include:
$30.8 million in state funds to extend health care coverage to 32,000 more low-income children. The governor and Democratic legislative leaders have set a goal of ensuring that every Washington child has health insurance by 2010.
$8 million to launch a pilot project creating a computerized medical records bank.
$5 million to continue a pilot program that helps subsidize health insurance premiums for small business owners.
$2 million to expand statewide a regional health alliance that is working to improve the quality and efficiency of health care delivery in the Puget Sound area.
Education reform is Gregoire's top priority and the Legislature's, as well.
But Pflug said she's not worried that health care reform will be overshadowed by school reform in the competition for legislators' time and attention.
"We need a significant bill this year," she said. "I'm confident we can come up with some strong initiatives."
Did you know?
* Nearly 750,000 Washington residents are employed by businesses with 50 or fewer workers. Fewer than half those workers have health coverage.
* Only 60 percent of the nation's employers offered health care coverage in 2005, down from 69 percent in 2000.
* More than half of young adults age 19-34 in Washington are uninsured.
Commission recommendations
Recommendations of the Blue Ribbon Commission on Health Care Costs and Access Republicans have been pushing since the 2006 session for legislation to provide small business owners with a broad menu of affordable health insurance plans that they could afford to offer their employees.
1. Use the state's purchasing power to improve health care quality by rewarding positive results with higher state reimbursement rates.
2. Become a leader in the prevention and management of chronic illnesses like diabetes and heart disease by using proven medical techniques.
3. Provide health care consumers and providers with better cost and quality information.
4. Develop a system to provide health care providers with electronic access to patient information from anywhere in the state.
5. Reduce unnecessary emergency room visits by giving patients more information about alternatives to emergency room care.
6. Ask the Office of the Insurance Commissioner to review the factors contributing to high health care administrative costs.
7. Support community organizations that promote cost-effective care.
8. Give individuals and families more choice in selecting private insurance plans that work for them by changing state law to allow carriers to offer plans tailored to underinsured populations, such as young adults and the working poor.
9. Form a partnership with the federal government to improve coverage by making sure Medicaid and the state's Basic Health Plan cover as many eligible people as possible. Work with the state's congressional delegation to win legislation that encourages innovative state health care strategies.
10. Organize the insurance market to make it more accessible to consumers by allowing pooling of contributions from employees and employers, along with state subsidies, to pay for insurance that neither employers nor employees could afford on their own.
11. Address the high cost of coverage for about 3,000 Washington residents with severe, long-term conditions by restructuring an insurance pool that covers the costs of their care.
12. Ensure the health of the next generation through state subsidies and outreach programs that guarantee every child has health care coverage.
13. Improve childhood nutrition and physical activity by working with local public health agencies and schools. Pass legislation that encourages nutritious food options and exercise for student in grades K-12.
14. Fund a demonstration project to promote health literacy and educate new parents on what to do when their children get sick.
15. Adequately fund the state's public health system to strengthen illness prevention and health promotion programs.
16. Integrate prevention and health promotion into state-funded insurance programs.
For example, require enrollees in the Basic Health Plan to complete a health assessment and provide reimbursement for cost-effective illness prevention programs.
Link: www.columbian.com/news/localNews/01212007news95480.cfm