The U.S. has endured a decade of health care cost increases. Baby Boomers, the nation’s largest demographic sector, are crossing the threshold of age 60 and will need more costly health care as they age. The uninsured and underinsured population, now numbering over 62 million, continues to grow and struggle to access and afford adequate health care.
In response, numerous groups have intensified their focus on finding possible solutions. Alliances have formed, with some featuring unlikely partnerships. Due to the severity of the situation, many proposed actions are looking at radical changes to the existing health care system. Should the link between employment and health insurance be severed? Will universal health care solve our nation’s health care problems? How will these plans be funded? Who will take the lead, states or the federal government? The International Foundation has been monitoring the emerging platforms and proposals. This section will be updated periodically to reflect major initiatives. Here’s a look at today’s influential voices.
Barack Obama proposes to achieve universal health coverage through several measures. His proposal keeps the private health insurance system already in place but requires insurers to offer comprehensive coverage to any applicant at a stable, reasonable premium. Employers would contribute to the cost of coverage for all employees and there would be a national program available to individuals and small businesses. The proposal calls for income-based subsidies to aid those who cannot afford coverage. Plan for a Healthy America Plan for a Healthy America - Frequently Asked Questions Transition Health Policy Team Leader Asks Americans to Hold Health Care Community DiscussionsAdditional Resources on Obama's PlanObama Health Care Reform Plan Raises Host of Questions for Employers, Towers PerrinHealth Care: What to Expect from the Obama Presidency and the Next Congress, Pillsbury Withrop Shaw Pittman LLPObama to Set Health Goals, Tap Daschle, The Washington Times
Baucus ProposalSenator Max Baucas (D-Mont.), Chairman of the Senate Finance Committee, has released a health care reform proposal with a goal to mandate coverage for all Americans within ten years. The plan has similarities with Obama's plan and would rely on employer coverage for those working for larger employers and tax credits for small employers or for individuals without employer coverage.Call to Action, Health Reform 2009The United States Congress has introduced several bills that focus on major health care reforms.
The AFL-CIO is promoting an expansion of Medicare to achieve universal coverage. According to their Executive Council, acceptable health care reform should measured by the following tests: universal coverage; comprehensive, affordable coverage; a choice of providers; financing through shared responsibility; effective cost control; and a "do no harm" attitude.AFL-CIO Executive Council Statement Health Care Fix
AHIP’s reform proposal includes maintaining the current employer-based system and outlines strategies to achieve four main objectives: controlling costs with recommendations from a public-private advisory group; helping consumers and purchasers access affordable coverage; achieving universal coverage with an enforceable individual coverage mandate; and adding value through improving administrative efficiency and encouraging wellness. AHIP Reform Proposals
Four former senators (Baker, Daschle, Dole, Mitchell) are working together on The Leaders' Project on the State of American Health Care. They plan to sponsor targeted meetings and workshops involving practitioners and experts to develop a framework to accelerate discussion and implementation of policy solutions that will provide all Americans access to quality, affordable health coverage. Leaders' Project on the State of American Health Care Web Site
Over 40 corporations have joined this group to promote substantive health care reform on the state and federal levels by 2009. The coalition advocates five core principles: a market-based health care system with transparent information about costs and quality; universal coverage with individual responsibility; financial assistance for low-income individuals; incentives to adopt healthy behaviors; and equal tax treatment for individuals and businesses.Coalition to Advance Healthcare Reform Web Site
Three organizations, AARP, Service Employees International Union (SEIU) and the Business Roundtable have formed a partnership to foster universal health care coverage and financial security in retirement. They do not endorse one particular approach to universal health care but wish to encourage debate on this issue to find a long-term solution. Divided We Fail Web SiteDivided We Fail Platform
This coalition of 16 organizations proposes a two-phase plan. First, expand coverage for children through the State Children’s Health Insurance Program (SCHIP), Medicaid and a family tax credit. Second, provide coverage to uninsured adults through an expansion of Medicaid and private-sector tax credits. Health Coverage Coalition for the Uninsured Web SiteExpanding Health Care Coverage in the United States: A Historic Agreement
The coalition is an organization of nearly one hundred of large businesses, unions, health care providers, associations, pension and health funds, insurers, and groups representing patients and consumers working to achieve comprehensive health care reform. The coalition’s ideas for health care reform focus on five goals: health care coverage for all; cost management; improvement of health care quality and safety; equitable financing and simplified administration. National Coalition on Health Care Web SiteStudies and Reports on Reform
Several states have recently enacted or proposed health care reforms for their residents. The Employee Retirement Income Security Act (ERISA) has been a stumbling block for some states' health care reform efforts. Below are some of the state health care reforms that have passed or have been proposed.
Governor Arnold Schwarzenegger and the California legislature debated extensively in 2007 but no major reform was accomplished. Additional proposals for health care reform have been presented in 2008. The governor's plan focuses on universal coverage and wellness incentives. Universal coverage will be achieved through a requirement for individuals to have health insurance, an expansion of the state Medicaid program (Medi-Cal) and guaranteed issue for those buying individual insurance. Governor's Health Care Reform ProposalAdditional Proposals
The governor of Illinois, Rod Blagojevich, proposes a plan to expand health care access to every resident in the state. In 2006, Illinois extended coverage to every child in the state through a program called "All Kids." The new plan, "Illinois Covered" would expand coverage to adults who are currently uninsured. Private insurance companies in the state would offer a standardized, comprehensive coverage to individuals and small businesses at lower, more stable rates than currently available. To qualify for the coverage, small businesses must subsidize at least 70% of employees' premiums. Individuals with incomes below the poverty level who do not qualify for Medicaid and do not have access to employer-sponsored health benefits will receive free coverage with low co-pays. Another component of the plan provides assistance for working residents who cannot afford the premiums of employer-sponsored coverage.Illinois Covered: Plan Details
In 2005, the Maryland legislature passed the Fair Share Health Care Fund Act, also known as the “Wal-Mart bill,” which required very large for-profit companies (over 10,000 employees) to spend an amount equal to at least 8% of their total payroll on employee health coverage or contribute that amount to a state fund which provides health coverage to low-income residents. The governor vetoed the bill but the legislature overrode the veto in January 2006. The law was challenged in court on grounds of ERISA preemption. In January 2007, the U.S. Court of Appeals for the Fourth Circuit decided it was preempted by ERISA and cannot be enforced.
Fair Share Health Care Fund Act (H.B. 1284)Governor’s Veto MessageRetail Industry Leaders Association v. Fielder– U.S. Court of Appeals Fourth Circuit, January 17, 2007
Massachusetts passed universal health care legislation in April, 2006. It requires state residents with income levels over 300% of the federal poverty level to obtain health coverage either through their employer or on their own by July 1, 2007. As of October 1, 2006, employers with more than 10 employees must provide a specified level of health insurance coverage to employees or pay a $295 fee for each employee. These employers are also required to offer Section 125 plans to facilitate pre-tax employee contributions. An additional “free rider” surcharge is imposed on employers who do not provide coverage and whose employees use free coverage provided by the state. The law created an agency, the Commonwealth Connector, to connect individuals and small businesses with health insurance providers and products.
Text of the Law: An Act Providing Access to Affordable, Quality, Accountable Health CareCommonwealth Connector
Governor Edward Rendell has proposed a program to work with private health insurers to provide coverage to all state residents. The plan includes a health insurance requirement for all residents with incomes over 300% of the federal poverty level. For small businesses and low-income uninsured adults, the program would provide subsidized and discounted health insurance. Businesses with 50 or more employees that do not insure employees would have to pay a 3% of payroll fee. The plan also provides incentives to health care providers who offer evening and weekend services to decrease use of emergency rooms.
Prescription for PennsylvaniaGovernor’s Office of Health Care ReformNews Release
In 2006, Vermont passed the Health Care Affordability Act which seeks to decrease the number of uninsured individuals in the state. The law establishes the Catamount Health Plan which is available to the uninsured with premiums based on income. The law also imposes employer assessments, initially $365 per each uninsured employee. Initiatives focused on management of chronic health conditions are included too.
Catamount Health: The 2006 Health Care Affordability Act Vermont's Health Care ReformEmployer's Health Care Contributions Fund -- Vermont Department of Labor
Washington passed a health plan to expand health coverage for state residents based on recommendations of the state's Blue Ribbon Commission on Health Care Costs and Access. The plan establishes establishes a state purchasing pool to help small businesses obtain health insurance, expands coverage for unmarried dependents up to age 25, creates electronic health record banks to connect providers and patients with their health information and includes incentives for quality health care, prevention and disease management. Healthy Washington Initiative News ReleaseSenate Bill 5930 (passed by Senate and Assembly and partially vetoed by governor; effective July 22, 2007)Senate Bill 5093 (expands access to health care for children, signed into law on March 13, 2007; effective July 22, 2007)
National Conference of State Legislatures:Comprehensive State ReformsHealth Care Reform Bills Access to Healthcare and the Uninsured 2006-2007 Fair Share Health Care Fund or "Pay or Play" Bills The Robert Wood Johnson Foundation:State of the States National Academy of State Health Policy:Access for the Uninsured