Friday, May 26, 2006
Help states cover the uninsured
From the RoundTable blog
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Arthur Garson Jr.
Garson is vice president and dean at the University of Virginia School of Medicine in Charlottesville.
More than 1 million Virginians lack health insurance, more than the combined populations of Richmond, Charlottesville and Virginia Beach. Nationally, 46 million Americans are uninsured, more than the population of Canada and more than the total number of Medicare recipients.
As a nation we have paid little attention and offered few solutions as to how to help these members of our community with basic health insurance. If we continue to do little, nearly one in five Americans, some 53 million people, will be uninsured by 2013. Fortunately, there are efforts on state and national levels to finally provide some real solutions to this worsening situation.
A bipartisan bill, introduced recently in the U.S. Senate, is designed to expand health care coverage to millions of uninsured Americans. The Health Partnership Act empowers our states to continue their innovative approaches to increase health care coverage while curbing the growth of health care costs and improving quality.
How does the legislation work? It allows states to apply for renewable federal five-year grants that must target four areas: coverage, quality, efficiency and health information technology infrastructure. States can use a variety of mechanisms to reduce the number of uninsured by using the private system (such as tax credits or health savings accounts), creating purchasing pools or expanding public programs such as Medicaid or Children's Health Insurance Programs or a combination.
Every year, participating states would meet to review their outcomes and outline ways they could all work -- individually or collectively -- to improve their individual state plans. States could modify their plans as they learn from others, but could not change their goals. Ultimately, an increasing number of states will have these grants with the eventual goal of a few well-tested systems emerging as models.
What could it mean for Virginia? The commonwealth has long been a leader in health care innovation and could be an ideal state to apply for a federal grant under the Health Partnership Act. Whether it is expanding the state's existing insurance coverage, assisting small businesses with the creation of insurance pools, or a new innovative way to provide insurance coverage through Medicaid, the Health Partnership Act affords the flexibility for Virginia to take the lead nationally and create a model that other states can emulate.
Why should the more than 200 million Americans who have some form of health care insurance or coverage support the Health Partnership Act? This is not just a problem for the uninsured and their families. The sheer size of this rapidly mushrooming group, and the way they currently access and receive medical treatment, already costs the country more than $200 billion a year. Much of it is currently paid by those who are insured through cost-shifting. Each family insurance policy has more than $900 of premiums cost-shifted from the uninsured. Lacking coverage, the uninsured get about half as much health care as the insured. Tragically, they get almost no preventive care, and they wait much longer before seeking medical attention. For example, they have larger tumors when cancer is diagnosed; they have more heart attacks; they die earlier.
The legislation, introduced by Sens. George Voinovich, R-Ohio, and Jeff Bingaman, D-N.M., has already received the endorsement of the American Medical Association, the American College of Physicians, the American College of Cardiology, the Consumers Union, the General Board of Church and Society of the United Methodist Church, as well as more than 35 other state and national organizations.
Imposing a one-size-fits-all program will not work as all states face different challenges in reducing the number of uninsured residents. Massachusetts has taken the initiative to address this growing situation and seven other states have begun discussions on what solutions may work for them.
This is a way to start moving, one state at a time, toward improving our health care system. Different states have different approaches. The Health Partnership Act reinforces the idea that states, not the federal government, know what will work when it comes to innovative ideas.
