Illinois' dubious claim of first to cover all kids

State of Illinois
All Kids Illinois' Program to Provide Health Care for All Kids
Governor Rod R. Blagojevich ...more than a quarter of a million children right here in Illinois do not have health insurance. That means they can't see a doctor or get medicine when they need to. When they do get medical care, it's often in the emergency room, after a small problem has grown into a big problem. That's wrong. I believe every child should be able to get medical care when they need it, before it becomes an emergency. That's why I created the All Kids program: to make health care a reality for hundreds of thousands of families across the state. Illinois will be the first state in the nation to provide affordable, comprehensive health insurance for every child. Of the 250,000 children in Illinois without health insurance, more than half come from working and middle class families who earn too much to qualify for state programs like KidCare, but not enough to afford private health insurance. Through All Kids, comprehensive health insurance will be available to every uninsured child at rates their parents can afford...

Comment:
Gov. Blagojevich and the state of Illinois are to be commended for taking this initiative to become "the first state in the nation to provide affordable, comprehensive health insurance for every child." Although our one goal is to enact a single payer national health insurance program covering everyone, as individuals most of us support interim incremental measures that do expand access and coverage.

Dedicated advocates of universal health insurance, such as Sen. Ted Kennedy and Sen. Hillary Clinton, insist that adopting a single program of national health insurance is not politically feasible, so we should abandon that effort and direct our attention to incremental steps that will eventually result in universal coverage. One of the most radical steps that currently has some political traction is to provide universal coverage for all children.

Supporting health care for innocent little children is a political winner, not to mention that it is not much of a budget buster since most children are quite healthy and have only very modest health care needs. Although most incremental measures have been referred to as baby steps, covering all children would be a major giant step, even if incremental. So Illinois is the first state to enact universal coverage for children.

Let's look at some of the specifics.

* Current employer-sponsored and individually purchased insurance programs remain in place. Very low income families may qualify for a rebate if they follow a complex process. Adding administrative complexities to the current excessive administrative burden is flawed policy.

* In the future, individuals who wish to switch their children from private coverage to the All Kids program, primarily because of its premium structure, will have to wait one year without any coverage whatsoever before they can be enrolled (except for very low income families). Mandating a period of uninsurance is flawed policy.

* The program is means tested. Not only are premiums adjusted by income level, but also co-payments are tiered based on income, and even the total out-of-pocket maximum for cumulative co-payments is adjusted. This results in administrative complexities that are compounded by the fact that income levels change, creating instability in the benefit level for which the children qualify. Also, means tested programs are somewhat intrusive and demeaning and NEVER result in 100 percent participation. Means testing for a universal program is flawed policy.

* Failure to pay premiums results in cancellation of coverage. Reinstatement requires retroactive payment of all premiums plus a three month penalty of having no coverage. The majority of uninsured children are in families on tight budgets. Periodic problems paying bills are inevitable. Terminating coverage for personal financial difficulties is flawed policy.

* Under All Kids, physicians and pharmacies may refuse to provide services if co-payments are not paid. Including program requirements that obstruct access to care is flawed policy.

* The cost to the state is to be offset by the dubious savings theoretically attained by shifting state health insurance programs to a managed care system. Failure to establish a permanent, reliable source of funding is flawed policy.

* The application is eight pages and requires submission of various supporting documents. To improve enrollment rates, a large network of Application Agents has been established. Even with this costly administrative program, it is anticipated that only 50,000 of the 250,000 uninsured children will be enrolled this year. A true universal program should automatically enroll everyone. Even though all children uninsured for over a year are qualified for this program, administrative barriers will keep many out. Anything less than automatic enrollment is flawed policy.

* Physicians must contract with the state to provide services under this program. It is clear that many physicians are unwilling to do so, partly because of distrust due to a backlog of claims under the state's Medicaid program (which will be folded into All Kids). Parents may lose the option of taking their children to their current primary care physicians merely because of provider contracting considerations. Establishing restricted primary care provider lists is flawed policy.

* Primary care physicians will serve as the gatekeeper for specialized services. Although the specifics are not yet clear, presumably primary care providers will have to use restricted, in-network provider lists when referring children for specialty care, if such services are even covered. Such restrictions may not allow the primary care physician to use established, coordinated referral patterns, possibly resulting in fragmented, disruptive, and less accessible care. Not including all providers of health care services is flawed policy.

This is that giant incremental step of covering all children that everyone is talking about. It is a truly beneficial program. But it fails to provide universal coverage. It fails to reduce costly administrative excesses but rather adds more to our fragmented system of funding care.
It fails to remove financial barriers to access. It fails to provide free choice of health care providers. Simply stated, it costs more than a single payer system and it fails to establish single payer policies that would ensure accessible, comprehensive health care for everyone.
The next legislator that tells you that single payer should be rejected because it's not politically feasible, tell him or her that the election of obstructionists to health care justice is no longer politically feasible. Then share the word with others and follow through on election day.
DMc-QOTD

HealthCast

Comment: The conservative policy community has long advocated for an end to employer-sponsored coverage. They believe that insurance should be an individual choice while recognizing that government has to play some role in funding care for low-income individuals.What are we hearing from these voices in the progressive community? They agree that the regressive tax policies are highly inequitable and must be changed.

Andrew Stern goes even further and states that the deterioration in employer-sponsored coverage, declining enrollment, and the financial burden placed on employers leaves no real option other than to replace it with a better system.The progressives acknowledge that the policy issues are well understood. In fact, single payer would certainly accomplish our goals (though Furman conjectures on the well-documented and irrefutable efficiency of single payer).

So what do they say? Let's adopt any better system, except single payer.The policy issues are well understood. Simply changing tax policy (Furman) or adopting a universal, multi-payer system (Stern) perpetuate and expand some of the crucial policy flaws that we face today.Single payer won't fix all of the problems in our health care system, but it will fix all of the problems with the financing of health care. And isn't that what the debate is all about?
QOTD 6/22



Click the title link for transcript and video

6/16/2006
Employment-Based Health Insurance: A Prominent Past, But Does It Have A
Future?
Hosts: Brookings Institution and the New America Foundation

Andrew Stern, president, Service Employees International Union:

...this is not a matter of policy. If we could solve this health care system
by policy it would have been solved every single year. There's more good
policy about health care in America than I can imagine. It is the most
studied, researched, you know, we have commissions and committees publicly
and privately all throughout Washington and the United States. It's really
about politics and leadership.

Our choice is we could keep making incremental changes in the health care
system. And I certainly appreciate that everyone would like to build a
better funding stream for the health care system but the truth is we're way
past incremental change. It's not going to work.

...so the fundamental change for me means one, you have to recognize that
employer based health care is ending, it's dying in front of our very eyes. The
charts say it there. It will not rebound, I believe, in the next economic
upturn in America. It was a good friend. It served America well in the 20th
Century. We love it dearly. Employers, to their credit, lived with it for a
long time despite all of the distortions that it created. But it's
collapsing in front of our eyes. It may still be breathing but anybody who
can look into the future says, "This employer based health care system is
over in America."

I'm here to also say I don't think we need to import Canada or any other
system. We're going to build an American system because we're Americans and
we don't like anybody else's system.

I think the single payer issue is kind of a stalking horse for I'm not sure
what, because we're going to have a multi-payer system or some kind of
system, you know, that it's built into the cost of goods in America.

Our Unhealthy Tax Code

Democracy: A Journal of Ideas
Issue #1, Summer 2006


Our Unhealthy Tax Code
By Jason Furman

American health care is beset by a well-known litany of problems.If this were a government-run health care system, the voting public and policymakers would be up in arms. Yet, perhaps because health care is largely perceived as a private-sector concern, there is relative quiet: while voters tell pollsters that it is a top priority, there appears not to be comparable political pressure for serious reform or any fundamental change in the government's involvement, either in the provision or funding of health care.

This is in part because much of the federal government's involvement with the health care system is through the hidden backdoor of the tax code. An important principle for modern progressives is that when the government has to intervene in the marketplace, it should not prop up failure. Yet the federal government is, in fact, deeply involved in perpetuating the current "private" health care system and all its flaws, spending approximately $200 billion annually in subsidizing employer-provided insurance. It is the single biggest subsidy in our tax system, more than twice as costly as the mortgage interest deduction.

The only government programs that cost more are Social Security, national defense, and Medicare.The fact that the tax subsidy, which supports the employer-sponsored system, is better than nothing is a feeble excuse for resisting any changes to the status quo. This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it.A single-payer national health care system would, by definition, remedy the problem, but it is unlikely to happen any time soon, if ever at all. Beyond the political limitations, it is also an open question whether a single-payer system would be the most efficient way to provide quality health care for all Americans.

In the meantime, reforming health care will come down to a set of incremental changes that build on the current system. But that does not mean that change cannot be ambitious. As Massachusetts has shown, achieving a plan for universal health insurance coverage need not wait for the establishment of single-payer government insurance like Medicare or a national health care system like the United Kingdom's.

APA President Advocates for Single-Payer

Psychiatr News June 16, 2006
Volume 41, Number 12, page 1
© 2006
American Psychiatric Association


Association News
APA President Urges Support For Single-Payer Insurance System Catherine F. Brown
Steven Sharfstein, M.D., ends his year as president of APA in the same way that he began it: by urging APA members to become or stay involved in advocating for psychiatric patients.


Steven Sharfstein, M.D., presents his presidential address last month in Toronto. David Hathcox
Psychiatrists need to "tirelessly advocate" for a single-payer, universal health care system so every American has access to care as a right, not a privilege.
That was the message that outgoing APA President Steven Sharfstein, M.D., delivered to those attending the Opening Session of APA's 2006 annual meeting last month in Toronto.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes," said Sharfstein, president and CEO of the Sheppard Pratt Health System in Maryland.

Sharfstein reminded his audience that in the speech he had delivered at last year's Opening Session, he challenged fellow APA members to become involved in advocating for patients and the profession of psychiatry at the local, state, and national levels.
His challenge did not end with his presidency, however. "We cannot slow down," he said. "Advocacy is not just calling on others to do what we want; it is a shining light for others to follow." ....

Psychiatrists must be vigilant over other core values of the profession as well, he said. After reading in the New England Journal of Medicine that psychiatrists were participating in the interrogation of detainees at the U.S. Naval Station at Guantanamo Bay, Sharfstein expressed his concern in a letter to the assistant secretary for health in the Department of Defense. That letter led to an invitation to tour Guantanamo with the top health leaders in the military and other leaders of medical and psychological organizations. They were briefed on the involvement of "behavioral science consultation teams" and were told that while stress techniques had been used in the past, current techniques focused on building rapport with detainees because the development of positive relationships was found to be more effective. That wasn't an acceptable alternative for Sharfstein, however.
"It is the thinnest of thin lines that separate such consultation from involvement in facilitating deception and cruel and degrading treatment," he said. The detainees, being held as enemy combatants with no legal rights, live in despair, and multiple suicide attempts and hunger strikes are common. "Our profession is lost if we play any role in inflicting these wounds."
Psychologists have taken a position allowing them to provide consultations in interrogations, Sharfstein noted, "and if you ever wondered what makes us different from psychologists, here it is." Earlier that day, he announced, the Assembly, and then the Board of Trustees, voted in favor of a position statement reconfirming that psychiatrists should not participate in prisoner interrogations .

Two other major events during Sharfstein's presidential year demonstrated the Bush administration's failure to take care of the poor and disadvantaged in this country, he said. The first was Hurricane Katrina late last summer, and the second was the launching of the Medicare Part D prescription drug benefit on January 1.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes."

Regarding Katrina, he praised the many APA members who helped traumatized survivors—some of whom were survivors themselves—but expressed outrage over the government's failure to follow through on promises to provide health care and other assistance to them. Many survivors were poor and had lost everything to the violence of the storm and flooding.
Four months later, APA had a front-row seat for the train wreck that occurred when Medicare Part D went into effect. APA and other advocacy groups had warned the government about the serious flaws and limitations of Part D, Sharfstein said, but these warnings went largely unheeded. In particular, APA and its partners were concerned about the 6.5 million patients dually eligible for both Medicaid and Medicare; beginning January 1, their drug coverage was moved from Medicaid to Medicare. Within days of the new year, reports proliferated about patients who could not get the medications they needed for a variety of reasons, from confusion over which plan they had been enrolled in to high copays they could not afford, he noted.
The program's unreasonably complex design and rocky start, said Sharfstein, represented "another abandonment of the most poor and vulnerable of our patients, another shocking insight into the failure to care for the less fortunate."

The federal government needs to address Part D's many inadequacies, but more than modest tinkering is required, said Sharfstein. "The solution is for the federal government to establish a basic drug plan that works for those who fail in the private Part D plans," he advised. "This is a concept so obvious that it is easy to be pessimistic that it will ever be adopted."
The events that Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his fellow APA members to join him. He left them with this simple but weighty message:

"We must tirelessly advocate for [single-payer universal health reform]. As the health care crisis extends and mushrooms, with more and more Americans without adequate coverage, the opportunity for such change will come at national, state, and local levels. And we must be there as advocates for our patients."