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Matt Singer on July 24, 2006 - 10:03am
Monday, July 24, 2006
In Today's Dispatch:
Also In This Issue
2006: Debate on Health Care for All Gets Real
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.
This Dispatch will outline the major features of these benchmark health care plans as they point the way forward for debates in other states in the coming year.
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:
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.
Still, San Francisco's plan looks like it should be a solid model for policymakers looking to deliver health care for all.
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 health 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.
Vermont: The Vermont "Catamount Health" law subsidizes private sector health plans that meet the following criteria (and if they don't do so within a couple of years for the state to directly create the plans):
As part of paying for the plan, the law includes an assessment on employers not providing health care of $355 per year, a low amount and not much of a deterrent to employers dropping coverage, but it at least establishes the principle of employer accountability. The law also cuts existing premiums for Medicaid and the state child health care programs dramatically-- a 50% cut in premiums for child health for example.
The Vermont Legislature has put together a very good analysis of the its plan here.
Massachusetts: The Massachusetts plan enacted this Spring is a complex amalgam of program changes, including:
The clearest gain for coverage from the law is the expansion of existing Medicaid and SCHIP child health programs, including expanding coverage to all children up to 300% of the poverty line. The big question mark is whether the "affordable" plans promised for the rest of the population will actually be delivered, since press accounts indicate that premiums may cost hundreds of dollars per month -- a prohibitive amount for many who may not qualify for subsidies but might be forced to buy a policy under the state's proposed individual mandate, so activists need to remain vigilant to ensure that the uninsured really do have access to affordable options. In many ways, the bill passed in the Massachusetts state house last fall is a better model, with stronger employer responsibility and no individual mandate.
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:
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
In fact, a few states like California and Wisconsin are actively debating proposals that would include all state residents within an integrated health care system.
California: 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. While the bill is an exploratory proposal and doesn't include a funding mechanism, the goal is that once employer, consumer and government funds are combined, no new revenues will be needed. Supporters suggest that a single 12% payroll fee paid jointly by employers and employees combined with existing state funds would be enough to replace all existing insurance premiums.
Wisconsin: This year, 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.
While neither plan is near final passage, they add to the models for states moving towards universal coverage around the country.
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 health 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 governments, a fair contribution to costs from all employers, and contributions from families based on their ability to pay.
Health Care for All
Legislative Summaries and Text
Eye on the Right
A bill in the U.S. House aims to preempt state taxation laws, costing some states as much as $600 million in business tax revenues -- or, to be more accurate, shifting hundreds of millions more in taxes from businesses to homeowners and working Americans. Ironically, the bill has the backing of the American Legislative Exchange Council (ALEC), the right-wing corporate conservative legislative network that claims to stand for Jeffersonian values like federalism. The truth clearly is that ALEC is willing to forget federalism when it comes to lining up tax breaks for their corporate backers.
Outrages of the Week
In last week's outrages, a Colorado legislator comes under fire for forwarding racist emails...again. An ousted lawmaker in Arizona argues that a consensual clean elections system he opted into violated his Constitutional right. And Indiana's Governor increased purchasing from Indiana businesses, by defining non-Indiana businesses as Indiana businesses.
It doesn't get better (worse?) than this. Check out our Outrages of the Week!
Three Steps Forward
Two Steps Back
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