|Implemented in this survey?|
The CEO of Blue Shield of California - a not for profit health plan with over 2 million members ? recently unveiled a proposal to offer a minimum benefit package to all Californians regardless of their employment status. The proposal would link the private and public health insurance systems and extend benefits to the 6 million uninsured Californians.
The CEO of Blue Shield of California - a not for profit health plan with over 2 million members - recently unveiled a proposal to offer a minimum benefit package to all Californians regardless of
their employment status. The proposal would link the private and public health insurance systems and extend benefits to the 6 million uninsured Californians.
Details of the Proposal
|Medienpräsenz||sehr gering||sehr hoch|
Addressing the problem of uninsured Americans has been on the national political agenda since the late 1990's. Various "universal coverage" plans have been submitted to the US Senate. However, no
plan to achieve this goal has been implemented as yet. President Bush has proposed tax cuts and credits, as well privatization options of federally-funded programs to expand coverage. Others have
proposed a "single payor system" (including, for example, former Vice President, and recent Presidential candidate, Al Gore).
A Single Payor system makes the government the central provider of coverage (compared to the current system of employer based coverage) and is structured similarly to the Medicare program for the elderly. However, implementing a single payor system would require significant change in the current system and is considered less palatable to consumers and lawmakers than the employer based Universal Coverage idea proposed in California.
|Implemented in this survey?|
This idea of Employer-based Universal Health Coverage was proposed publicly at the Commonwealth Club in San Francisco on December 3rd, 2002 by Bruce Bodaken, CEO of Blue Shield of California. Blue
Shield is a Not-for-Profit health plan that has approximately 2.3 million members. This proposal is in response to the growing number of uninsured, both in California and in the country, as well as
rapidly rising healthcare costs for both consumers and health plan providers. Mr. Bodaken's idea also presents an opportunity for the private sector health insurance providers to increase their
enrollment in California by close to 4 million members who are uninsured and do not qualify for state-sponsored coverage.
The Universal Coverage idea is innovative in that it is the first time a health plan has taken charge of presenting a solution to the problem, though various solutions have been proposed previously. This plan requires considerable coordination and cooperation between the private and public sectors of the healthcare system. Stakeholders as well as government officials must participate in the development of this idea if it is to be successful. However, is it not as politically unpalatable to the private sector health care industry as a single payor system. The Single Payor proposal has been defeated in Oregon and has not gained significant support among consumers, wary of more government involvement and control, as well as politicians and lawmakers who are concerned about the significant costs associated with this system.
This idea affects several different groups and actors:
The idea has been accepted by some actors, such as health plan executives who benefit from increasing the insurance pool and their enrollment numbers through affordable benefits packages, interest
groups representing the uninsured, liberal lawmakers, labor unions, hospitals and healthcare providers and several employee groups.
A policy paper has not yet been formed. Leadership and promotion of this idea has mainly been through Mr. Bodaken and his supporters. Since there are several stakeholders, some alliances have been made in favor and in opposition to this idea. Mr. Bodaken has attempted to mediate conflicts of interest taking into account different stakeholders' positions on this idea and by leaving the financing portion of the proposal for more rigorous research to be released in the spring.
The most significant source of resistance to this program has been from businesses and employers who fear increased health insurance costs to their expenses. Individuals who may be able to afford health insurance packages but are uninsured may also resist the mandate to buy coverage out of their own pockets. In addition, the tax increases on items such income, cigarettes, or alcohol mentioned as a source of funding for this program be opposed by tax-payers or businesses negatively affected by taxes that makes their goods more expensive.
The idea has not yet been modified by the source. No legislation has yet been proposed but a formal bill will most likely be introduced in the state legislature.
Implementation of this idea will require formal legislation be presented and passed by the two Houses of state legislature (Assembly and Senate) as well as approval of the Governor of California.
It will also require cooperation and action by all California health plans, employers, and health care providers to negotiate rates and accept members in need of the essential benefits package. In
addition, increased efficiencies in enrolling Californians who qualify for the state-funded Medi-Cal, Healthy Families, or Medicare programs proposed in this plan will require coordination between
health plans, state officials, and county officials.
Most directly affected by this program will be Californians who are not insured under any coverage plan (either by choice or unwillingly). Government agencies will need to dedicate resources to enforcing the mandate and may not currently have such personnel or systems in place. Indirectly affected will be healthcare providers who will have to treat an additional 6.3 million Californians and may not be equipped to do so. Hospitals currently face significant nursing shortages. Also, the increase in enrollment for state-funded coverage may strain the healthcare system in that there are very few physicians who currently accept Medi-Cal (government insurance for the poor). Currently there are only 38 physicians accepting Medi-Cal for every 100,000 members. Consumers will also be affected since they will have to pay additional taxes to support this program.
The chances of implementation are difficult to estimate. Though universal coverage has received wide-spread public support, bills proposing a Single Payor system have thus far been rejected. Mr. Bodaken's idea spreads the burden of health care costs across public and private segments in California unlike Single Payor, so it may be more acceptable to consumers and politicians. However, strong opposition from California's business community and employers is likely since their costs increase as a mandate to provide affordable health insurance to their employees is enforced. Another obstacle may be interest groups who oppose the private sector health plan involvement as they stand to benefit financially from the implementation of this idea.
The key incentive offered to all stakeholders is that insuring the uninsured, would decrease health care costs across the board since insurance risk would be spread throughout a more diverse population, and expensive emergency room treatments for the uninsured would be eliminated. Better disease management and primary care provide huge cost savings to the state and tax-payers who currently pay for health services used by the uninsured. Market trends predict a continued increase in health care costs and insurance premiums unless some control over sources of rising costs, such as the uninsured, is achieved.
This policy will achieve its objective if the state mandates that every Californian must have coverage, either through a public program, a subsidized plan, or through purchase of a health plan
insurance product. The expected effect is an overall reduction on the costs of healthcare through expanded access of preventive services, more cost-effective treatment, and increasing the number of
insured to spread risk. This plans hopes to increase quality and equity for the uninsured of California.
Undesirable effects may be increased taxes and costs for those who with higher incomes, employer resistance to providing insurance and decreased hiring, moral hazard of services provided at a low cost, or providers refusing to serve members of low-cost health insurance.