Blue Shield Universal Health Coverage Proposal

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

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.

Purpose of health policy or idea

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

• Employers (except very small companies) would be required to offer coverage or contribute the financial equivalent toward an essential benefit package for all their employees. Employees would have the option to opt out and purchase coverage on the individual market.
• The state government and the private sector would work together to enrol Californian's participating in state welfare programs.
• Uninsured Californians would be required to purchase coverage in the individual market on a "guaranteed issue" basis, with no one denied coverage based on a pre-existing condition. Subsidies will be given to those who cannot afford the full payment.
• Individuals who can afford health insurance would have the option of buying affordable coverage and would help, through cost-sharing, to reduce barriers to coverage for other Californians.
• An essential benefits package defined by independent medical professionals would specify the minimum level of coverage, which would include preventive care, physician services, hospital care, and prescription drugs. All plans would be required to offer this minimum package of services.
• Financing methods may include a broad-based tax, personal income tax, sales tax, a health insurance premium tax, a healthcare provider fee or a reasonable combination of these contributions by the tax-payers of California.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

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.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

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.

Stakeholder positions

This idea affects several different groups and actors:

• Private insurance executives of health management organizations
• Uninsured people
• Employers and employees
• California's taxpayers and residents
• Government officials and agencies
• Health care providers.

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.

Influences in policy making and legislation

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.

Adoption and implementation

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.

Expected outcome

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.

References

Empfohlene Zitierweise für diesen Online-Artikel:

. "Blue Shield Universal Health Coverage Proposal". Health Policy Monitor, 20030501. Available at http://www.hpm.org/survey/us/d1/2