Non-Profit Group Helps Make Sense of Government-Sponsored Health Coverage

A press release issued today by the Foundation for Health Coverage Education (FHCE) noted that studies have shown that nearly 33% of the 47 million uninsured in America are eligible for government-sponsored health insurance but aren’t signed up for them. Why? The number of bureaucratic steps needed to apply for government-paid health coverage is simply overwhelming.

“In Los Angeles County, for example, it usually requires two scheduled appointments at a social services agency and the time and ability of an applicant to answer a 100-question document as a first step to getting enrolled in California’s Medi-Cal program. This arduous process in addition to possible transportation issues and literacy challenges keep thousands of people from enrolling,” said Phil Lebherz, founder and executive director of FHCE in the press release.

The solution initiated by FHCE is ambitious. They are providing access to online applications for every state in the country though a website (http://www.coverageforall.org/). According to the news release, visitors can go to the FHCE website and click on the State by State application link where they can identify government health coverage offerings for the three federal programs (Medicaid, Medicare and Veterans) in addition to each state’s individual program applications.

Website visitors can first take a simple 5-Question Eligibility Quiz or phone the U.S. Uninsured Help Line at 800-234-1317 and talk with a live counselor to learn about their health coverage options. The series of questions is used as a starting point for the Fresno, California-based call center’s staff who then guides each caller through their options and to the appropriate state-sponsored program.

It is interesting that government-sponsored programs already in place could provide healthcare to 15.5 of the 47 million uninsured, but rather than making these programs more accessible, we debate the creation of even more government-sponsored programs to solve the problem – including the idea of making us all get our healthcare coverage in this fashion through a single payer system.

Wasn’t it Einstein who said that repeating the same action over again expecting different results is the definition of insanity?

We should all applaud the work of groups like the non-profit FHCE who are trying to break the insanity cycle and make sense of the crazy patchwork of existing government programs to the effect of actually delivering promised healthcare to people in need.

Likewise, we should all take note of the failure of the current government-sponsored programs to provide promised care and be wary of repeating this action while expecting different results.

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A Majority of Americans Support Health Insurance Mandates, but Why?

According to a survey by The Commonwealth Fund, an independent foundation working toward health policy reform, health insurance mandates are supported by 80 percent of Democrats, 52 percent of Republicans and 68 percent of Independents who were polled. Any way you split it this comes out to be a majority of Americans.

Reading these numbers, it is not surprising that all of the leading Democratic presidential candidates have come out in support of some form of employer and or individual mandate. Senator Hillary Clinton would require all Americans to have health insurance and would require that all large employers provide their employees with coverage or contribute to the system. Former Senator John Edwards would require all Americans to have coverage by the year 2012 and would have employers either provide coverage or pay 6% of wages into a pool to provide coverage. Senator Barack Obama would require that only children have coverage and would require employers to provide “meaningful” coverage to their employees.

I am often puzzled by these kinds of survey results and want to dig for more information. I want to ask those surveyed, “What are you really thinking?” I presume that the thought process goes kind of like this. In our country employers provide health insurance. They always have, haven’t they? So, in order to make sure everyone has coverage, we should make all employers provide coverage. Simple. Problem solved. Next Question.

After all, those answering the survey do not have to answer the tough questions like what role will the current insurance markets play? Who would enforce the mandate, especially for individuals? How do we make sure that risks are broadly pooled? And more importantly, what will be achieved? At the end of the day will we really have better healthcare in America? That really is the question, isn’t it?

I notice the Republicans are shying away from calling for mandates, even though a slim majority of Republican voters have answered the survey question saying that they support mandates. Why? Is it because they recognize that making sure that everyone has health insurance really does not address the issue of providing healthcare? I would like to think so. I would like to think that there are some candidates (and maybe they are not all Republicans) who recognize that the healthcare system is essentially broken and that by simply making sure everyone has insurance coverage does not address the underlying brokenness of the system. In fact, it could exacerbate it.

I would also like to think that these candidates are smart enough to know that no form of government intervention can fix the problem. The fix must come from rebalancing the healthcare economics in the country. It starts by shifting the power to control delivery and pricing of healthcare services from the current provider/payor/government complex to the free, open, and transparent market where innovation and entrepreneurship can be applied to solve the problems of access, quality, and cost. By setting up the right incentives, change will happen faster and with better results than any scheme that comes out of central planning. Not only will healthcare become more affordable for all, it will be a better quality meaning better outcomes and better patient experiences.

A good example of this course of action is a new website announced today by Regence, the largest health insurer in the Northwest/Intermountain Region. This spring they will launch a member feedback feature that enables the health plan’s three million members to share information with each other about their provider experiences. The site will provide the means to evaluate and review information on physicians, dentists and other healthcare professionals, and to see comments and ratings posted by other members.

The free and open distribution of information about cost, quality and the patient experiences coupled with the incentive to seek out this information will lead to a more efficient value-based healthcare system.

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Patients and Doctors Respond to Economic Incentives. Right?

I ran across the John Goodman Health Blog published on Monday of this week where he laments that health policy learning that he gleaned from the RAND Health Insurance Experiment conducted 25 years ago has been lost in the recently published study.

Specifically, Goodman says that he took away from the study two very important policy implication:

  • First, the study put the final nail in the coffin (at least for several decades) of naive national health insurance (NHI). If health care were completely free, spending would soar, with no improvement in health status (NHI, by the way, was a principal motivation behind the entire experiment.)
  • Second, the study opened the door to a myriad of market-based solutions to health policy problems. For instance, we could have full-service diabetes centers vigorously competing for diabetic patients, each managing his own risk-adjusted Health Savings Account.

I commented on that blog that what I have found interesting from an experience working in a staff model HMO setting is that costs, as well as quality of patient care — as measured by the Healthcare Effectiveness Data and Information Set (HEDIS) — can certainly be positively impacted through proper economic incentives applied to providers.

The problem with this model is that it is so unpopular with most of the public who have gotten used to the co-pay mentality and do not react well to the “insurance company control” that they say they experience in an HMO setting.

The good news is that consumer-directed plans seem to be showing that consumers who have a financial stake in their health care will also make rational decisions. Now all we need to make it happen on a wide-spread basis are more provider models like the full-service diabetes centers envisioned in the blog piece that will vigorously compete for patients.

Thousands Enroll in Indiana’s HSAs for the Poor Program

A few weeks ago in that space I posted a piece about how Indiana was testing Health Savings Accounts (HSAs) for the poor. The test, which is part of a program approved by the Bush administration, allows eligible residents to pay up to 5 percent of their incomes into state-subsidized “Personal Wellness and Responsibility Accounts” that cover their initial medical expenses up to $1,100. Once that deductible is reached, private insurance purchased by the state kicks in.

I recently saw an update on the program reporting that 4,500 people applied for the benefit in the first week it was available and the state expects 50,000 to enroll during the first year. According to Gov. Mitch Daniels, the vast majority of those who applied were granted benefits. The report also said that many of the applications are coming from people who work but do not make enough to buy their own insurance. Indiana’s plan is available for individuals who have been uninsured for the past six months and have no access to insurance through any other avenue.

Watch here for more updates on this interesting test.

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Mandatory Health Insurance Myth Buster

It is now January 5th, and time to climb back into the saddle and start looking once again for health plan innovations.

One of the so called innovations that we are hearing about from some of the leading presidential candidates is a federal mandate which would require everyone not in Medicaid or another government program to buy health insurance. In an op-ed piece in yesterday’s Wall Street Journal, Betsy McCaughey, a former lieutenant governor of New York, and an adjunct senior fellow at the Hudson Institute, writes that many of the augments used to promote mandatory coverage are based on “myths.”

She then goes on to systematically debunk, as myths, three arguments she says are used often by mandate proponents:

  1. It’s fair to make everyone pay the same price for health insurance.
  2. Lack of insurance forces people into the emergency room for routine health care.
  3. A system that leaves 47 million Americans without health care is a moral disgrace.

In the process, she argue that mandating the 56% of the uninsured who are adults aged 18-34 to buy insurance at prices that are geared not to reflect their risk, but to help subsidize older, more at risk, buyers is grossly unfair. (A point that I note has distinguished Senator Obama’s plans from Senator Clinton’s and may, in some small way, play a role in his popularity with younger voters.)

As for emergency room use, she says that federal data (the Medical Expenditure Panel Survey provided by the Agency for Healthcare Research and Quality) show that the elderly are most inclined to go to the emergency room, though they are universally covered by Medicare. Other repeat users, she points out citing an Institute of Medicine study, are the “frequent flyers” who are in the ER repeatedly because of mental illness or substance abuse. Enacting a mandate isn’t going to eradicate the behavioral problems that land them in the ER.

Finally, the moral issue of having 47 million uninsured in this country. That does sound awful, but here are some fact that Ms. McCaughey included in her piece that changes the picture quite a bit.

“According to the Census Bureau, of the 47 million uninsured, nearly 10 million have household incomes of at least $75,000. They probably can afford coverage but have chosen not to buy it. Another 14 million of the uninsured are already eligible for government programs such as Medicaid (for low income adults) and the State Children’s Health Insurance Program (for children) and simply need to sign up.”

That leaves about 23.7 million people — some citizens, others newcomers — who cannot afford coverage.

Now that is seems like half of the problem has been solved — or is really not a problem — does a mandate still seem like such a good idea? Or, does it make more sense to go after the problem of how to provide coverage for uninsured immigrants and those who, for what ever reason, are falling though the safety net of existing government programs?

Thanks to insightful pieces like the one written by Ms. McCaughey, we can take some of the emotionalism out of the debate, look at the facts, and then develop innovative solutions based on reality, not myths.

 

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