Health Insurance Reform

A Fresh Call For Health Insurance Reform

By ARIELLE LEVIN BECKER

It wasn't that Debbie Hunsinger didn't know about the lump in her breast. She did. And it wasn't that she didn't care about her health. Back when she had health insurance, she never missed a physical.

But a divorce left her without health coverage, and although she owned a deli in South Meriden, Hunsinger couldn't afford health insurance. She couldn't afford to see a doctor, either, so she decided not to deal with the lump. At the time, it was pretty small.

But by the time she finally got it checked out, about six months later at a free screening, it wasn't small. 

And the cancer had spread to her lymph nodes and right arm.

If the cancer had been caught earlier, if she hadn't been one of the more than 300,000 people in Connecticut without health insurance, Hunsinger, 47, figures she might be healthy and back at work by now. Instead, she's facing dozens more rounds of chemotherapy and radiation and an uncertain prognosis.

Hunsinger thinks something must change. "I would hate to have anybody have to go through this just because they don't have health insurance," she said.

Her struggle is one of the reasons advocates say that it is finally time to make broad changes — an effort that will get a jump-start today in Hartford when the Universal Health Care Foundation of Connecticut unveils its proposal calling for major changes in the health system and a plan that the group says could insure 98 percent of state residents by 2014.

It is the first of many proposals — both state and federal — expected to be aired in what many people say is the year for health reform. 

State legislators expect to address the issue in the current session, and the topic is expected to be a top priority for President-elect Barack Obama. Already, members of Obama's health care advisory team have been gathering input through meetings on health care reform, including one at the UConn Health Center last week.

It won't be an easy year, though. The prospect of new state spending or major federal reform might face tough obstacles as state legislators grapple with a projected $6 billion biennial budget gap and the Obama administration confronts an economy in shambles.

But advocates for reform say that the economic crisis and growing unemployment, with more Americans at risk of losing their health insurance, makes this precisely the time to tackle health reform.

"Fixing health care is about fixing the economy, that's sort of the bottom line," said Juan A. Figueroa, president of the Universal Health Care Foundation.

Figueroa said that the foundation's plan would put Connecticut in a strong position as the federal government addresses health reform, allowing the state to shape the national debate and be ready to tap into any resources that the federal government makes available for health reform.

The proposal calls for a new health program, called SustiNet after the Latin word for "sustains," that would extend health insurance to anyone who wants it while emphasizing preventive care and other changes.

The plan, which would begin enrollment in 2011, would create a gigantic health insurance pool by combining the existing pool of state employees and retirees with people now covered under state assistance programs.

The pool would also be open to the public, starting with those without access to employer-sponsored insurance, those whose employer-sponsored insurance is inadequate or unaffordable, and employees of small businesses, nonprofit groups and municipalities. 

Ultimately, any employer in the state could use the state's pool instead of their own insurance. Employers who wish to participate would pay in as they would any other health insurance plan.

Mid-size and large employers would not, however, be able to simply drop coverage and allow the state to pay the cost of their employees' care. Employers with payrolls above $318,000 that do not offer insurance or provide adequate coverage to their employees would be required to help pay the cost of the program.

The plan is for the pool to compete with, not replace, private insurance plans. The proposal would not require everyone to be covered, but would automatically enroll people without insurance unless they opt out of the plan.

The foundation believes that the size of the pool will lead to lower costs — a critical element of the plan. According to the foundation, the plan would save individuals and employers $1.7 billion by 2014, although it would require the state to spend an additional $950 million in 2014, the year that the plan is expected to be fully operating. 

That figure includes the cost of subsidizing coverage for previously uninsured people and increasing the notoriously low payments that doctors receive for seeing HUSKY and Medicaid patients.

The concept of expanding the state's employee insurance pool isn't entirely new. A proposal last year to open that pool to municipalities and small businesses passed the General Assembly, with strong support from Democratic leadership. But Gov. M. Jodi Rell vetoed the bill. 

Figueroa said that the foundation's proposal offers a far more comprehensive approach and that he hopes Rell and other state officials will be supportive.

"This is a time not to be weak-kneed about these issues," he said. "This is a time to exercise strong leadership."

The foundation's figures for 2014 are based on several assumptions, including:

•$570 million in premiums paid by individuals covered by the plan; premiums would be charged on a sliding scale, based on people's ability to pay.

•$80 million in "shared responsibility payments" from employers with payrolls over $318,000 that don't provide insurance coverage to their employees.

•$240 million in revenue from companies whose employees join SustiNet because their company-sponsored plan is inadequate.

•An additional $800 million in federal funding by expanding the federally subsidized HUSKY program.

Health Care for the Unemployed

Paying For Health Care is Difficult for the Unemployed

With California unemployment rates at an all-time high, people are facing a double whammy -- losing their job and their health care.  A new report finds it will take a big bite out of your unemployment check to keep your health insurance.  Kelley Weiss reports.

The report is by the consumer advocacy group Families USA. It shows most laid-off workers have to spend about three-quarters of their unemployment benefits to keep their health care insurance. That's if they opt to get COBRA insurance. It's a plan that lets you keep your health benefits for the short-term. But there's a catch. Since your employer is no longer chipping in, you have to pay the whole cost.  In California the report says COBRA insurance for a family, on average, is about $1,000 a month.

Betsy Imholtz is with the Consumers Union West Coast office.  She says whether to pay for COBRA is a tough decision.

Imholtz: "Once they see the price and the cost there is invariably sticker shock, it's a huge amount of money, so people are really scrambling."

Imholtz says if people are priced out, they'll go without health care. She says even if COBRA plans are expensive, it's probably the best option laid-off worker have.

SCHIPing away at the need for health insurance

When Bill Clinton's health care proposal was foundering in the summer of 1994, a group of senators suggested that the administration put off trying to get universal coverage and insist instead on insuring all children. The idea was to make, at least, a down payment on reform.

The White House said no and pressed on with its doomed effort to get a bigger bill. The Republicans won control of Congress in the fall. It wasn't until 1997, thanks to the unlikely duo of Sens. Ted Kennedy and Orrin Hatch, that a children's health care program was finally passed.

One of the clearest signals President-elect Barack Obama has sent is his determination to learn from the Clinton years, and particularly from the former president's failures on health care.

When Tom Daschle, Obama's pick to be secretary of health and human services, returned to the Senate last week for his first round of confirmation hearings, he offered a long list of criticisms that others had directed at the original health care reform effort. This time, he said, would be different.

And this week, the House of Representatives is determined to prove Daschle right. It is scheduled to take up an extension of the State Children's Health Insurance Program (SCHIP), as the Kennedy-Hatch initiative is called, so that 10 million kids can get health insurance. Getting more children covered before Congress starts wrangling over the larger health care bill is good politics, and the right thing to do. Congress needs to act anyway, because the program expires March 31. It might as well act fast, and act generously.

The SCHIP bill is unfinished business from the Bush years, and Democrats have no better way to show, and quickly, how different their approach to government will be from the style and priorities that prevailed during the outgoing president's term.

President Bush twice vetoed an extension of SCHIP. He opposed the additional $35 billion the Democrats wanted to spend to cover more children and also disliked the tobacco tax they proposed using to pay for it. There are many big things people hold against Bush, but this one has always stuck in my craw. If "compassionate conservatism" - remember that phrase? - means anything, surely it should mean helping more kids go to the doctor when they need to.

Some advocates of universal coverage have argued that an expansion of SCHIP should be delayed so that the issue of covering kids can be taken up as part of a larger health proposal. The worry is that passing the most popular part of reform now (is there a more sympathetic group to cover than children?) would make it easier to delay the broader effort.

These are good faith concerns, but Congress would be right to ignore them. The economic downturn has made the expansion of SCHIP all the more urgent.

It's not just that sharp increases in unemployment add to the ranks of the uninsured. State governments are hurting, too, and they are responding to revenue shortfalls by shrinking health care programs.

According to Families USA, a group that pushes for fundamental health care reform, states have enacted budget cuts that will leave some 275,000 people without health coverage, including 260,000 children in California. By the end of this year, if further proposed cuts go through, the number losing health coverage nationwide could rise to more than 1 million, almost half of them children. Other states have reduced benefits to those they still insure.

All this makes the case for fiscal relief to the states in a stimulus bill more compelling. It also makes clear that universal health insurance coverage should be an urgent priority. But getting the children's program done in the meantime could create momentum for the larger program and reduce the size of the problem that needs to be solved in a comprehensive bill - 10 million kids now, the rest later.

Senate Majority Leader Harry Reid has not made any commitments as to when he would take up children's health care, though he has listed it as a priority. It would do the new president and members of the Democrats' expanded congressional majority no harm to move expeditiously on a proposal that is simultaneously bipartisan - SCHIP has always enjoyed significant Republican support - and embodies Obama's oft-stated commitment to "programs that work." This one surely does.

How often did Obama promise to "turn the page," implying that his presidency would be very different from President Bush's while also taking lessons from President Bill Clinton's shortcomings? Winning a quick health care victory for children would prove he's determined to do both.

'No Insurance' Towing Filling Dallas Impound Lots

DALLAS: Drivers be warned!  Dallas police are on the lookout for a different kind of offender – those driving without insurance.

A new city ordinance mandates that cars be towed as a consequence for no coverage.  The ordinance has been in effect for nine days and police are already calling it successful.

Among the cars in the City of Dallas impound lots are those that were brought in because the driver didn't have insurance.  In fact, in just the first nine days of the New Year, Dallas police said they towed 256 cars and that another 56 we're towed from accident sites.

Saturday was another busy day at the impound lots, where there was no shortage of people coming to claim their cars.

The new uninsured motorist ordinance makes it mandatory to at least have liability auto coverage. If uninsured drivers in Dallas are pulled over, or get into an accident, their cars can be impounded with no questions asked.

Most drivers who spoke to CBS 11 News said it's an expensive lesson learned and one they wish they could have avoided.  "I didn't know it [the ordinance] was going to be enforced like that," said driver Demond Graves.  "I heard it a couple times on the news but I didn't know it's was gonna be all like that."

Andrew Delara was among those busted for driving without insurance.  "I was going to get insurance today, but they beat me to it!" he said.

Enforcement of the new ordinance has caught many off guard.  "I'm sure some are still surprised when it happens to them, because it is something new," explained Lt. Andy Harvey with the Dallas Police Department.

Drivers are not only responsible for the cost of the tow, but also receive a $350 fine and are charged $20 a day, for every day their car is kept at the impound lot.  The average cost of basic liability coverage is $36 a month.

The new ordinance could be making a difference.  One North Texas insurance agent said she has seen an increase in the number of drivers getting policies since the end of last year.

The largest federal health insurance program

A focused remedy is best cure for healthcare crisis

As the Senate considers the nomination of former Sen. Tom Daschle as secretary of health and human services—and as the nation looks forward to health reform—it is important that policymakers focus on what it means to “fix” health care and ask some hard questions about how we deliver medical care.

First off, everyone should agree that we must strive to get every American the health care coverage they need. 

Second, we can all agree that getting health care costs under control is both a health and economic imperative. Despite the “good news” this week that health care spending rose 6.1% to $2.2 trillion in 2007, that slowdown from previous years is still substantially higher than general inflation and health care now gobbles up 16.2 % of gross domestic product.

But high costs and the uninsured are only the visible problems with health care. The invisible problem is poor-quality care. Our third area of agreement must go beyond getting people care, to getting them the right care. 

Poor quality care and the uninsured are inextricably linked, even though few understand the link. Poor quality care robs the system of precious resources—dollars and services—that could be used to expand access and coverage.

Lawmakers need look no farther than their own back yard to ask questions about the quality and inefficiency problems. Medicare is the largest federal health insurance program, so lawmakers should ask why an elderly person spends about 11 days in the hospital in Bend, Oregon in the last two years of life, compared to 23 in Detroit or nearly 35 in Manhattan. Or why they see doctors about 15 times in Ogden, Utah in the last six months of life compared to 42 in Detroit or 60 in Los Angeles. 

They should ask why researchers found that only 57 percent of female patients aged 65–69 in Mississippi got regular mammograms, compared to 70 percent in Michigan or 74 percent in Maine, the top state. Or why in Alaska, only 71 percent of patients with diabetes got important blood tests in 2003–2005, compared to 86 percent in Michigan or 92 percent in Vermont. Or most tragically, why more than 1.6 out of every 1,000 Medicare beneficiaries in Louisiana lost a leg to amputation, compared to 0.9 in Michigan or 0.50 in Utah, a more than three-fold difference from top to bottom?

They should also ask hard questions about why people get care they may not need. Why are antibiotics prescribed inappropriately for children’s ear infections 13 million times a year, when more than 80 percent of infections get better within three days without antibiotics? 

Why in a decade did spending for back surgery called lumbar fusion rise 500 percent—from $75 million to $482 million—despite a lack of evidence supporting the effectiveness. And why do some regions of the country use vastly more resources to treat patients with similar illnesses without achieving better outcomes. 

They will find what Dartmouth researchers found, that a whopping 30 percent of health care spending—nearly $700 billion a year—pays for services that may not improve people’s health.

That’s money that could be used to cover the uninsured—if we can figure out how.

A good place to start is improving the information we have about the actual performance of doctors and hospitals with wider spread use of reports such as those Medicare has begun to make available on hospitals and a few pioneering community organizations, such as the Greater Detroit Area Health Council (GDAHC), have made available on both hospitals and doctors’ practices in their communities (www.SaveLivesSaveDollars.org). Patients need this information to make informed choices about their own care. Doctors and hospitals need this information to help them improve care. And both consumers and purchasers need information about the value they are getting for their health-care dollars. 

A second step is to put serious dollars into quality improvement efforts, building on Medicare pilot programs that spur hospitals and physician group practices to improve care and launch experiments that encourage disparate medical providers to work in teams to coordinate care and deliver it efficiently.

Finally, our payment system must reward providers for giving patients the right care at the right time, the right way. 

Now we pay providers for “doing things”: the more treatments and procedures they provide and the more they use expensive technology, the more they get paid. We need to reward, not punish, providers who deliver high-quality, cost-effective care. Moreover, providers should be fairly compensated for preventive care, for time spent coaching patients and for coordinating care for those with chronic conditions.

Many of these concepts are being tested on the ground in living laboratories such as GDAHC’s Save Dollars Save Lives campaign, one of 14 communities working with the Robert Wood Johnson Foundation’s Aligning Forces for Quality program to bring together those who get care, give care and pay for care to improve the quality of care.

As Washington turns it eye to health care reform, by all means let’s start with getting everyone access to care, but everyone should also understand that what happens to them once they get inside the hospital or doctors’ office is just as important as getting them in the door.

Dr. Risa Lavizzo-Mourey is president and CEO of the Robert Wood Johnson Foundation, and Vernice Davis Anthony is president and CEO of the Greater Detroit Area Health Council