Lawmakers mulling health care reform

The Boston – Bay State Banner
July 28, 2005 – Vol. 40, No. 50

Lawmakers mulling health care reform
By Jeremy Schwab

With high health insurance costs plaguing state residents and businesses, Massachusetts lawmakers are considering four competing proposals to revamp the health insurance system.

The four plans have similar goals — increasing the number of insured residents while minimizing costs — but would achieve those goals in vastly different ways.

Supporters of a single-payer health care system that would eliminate most private insurance and give all Massachusetts residents government-funded health plans testified at the State House last week.

They said a single-payer system would be cost effective because it would have much lower administrative costs than HMO plans and would eliminate the need for the costly free care pool that funds care for the uninsured.

“Currently, 39 cents out of every dollar goes to overhead,” Sandy Eaton, chairman of the Mass-Care Coalition which supports the bill, told the Banner. “If we could cut back by, say, 10 percent, we would have billions more to cover everyone.”

In addition to saving administrative costs by streamlining and reducing paperwork such as means testing forms, the plan would create a statewide pool to negotiate with pharmaceutical companies for lower drug prices.

The plan would need federal approval, as federal Medicare money would be rolled into the health care trust established under the plan.

Gov. Mitt Romney’s plan, meanwhile, would put little pressure on the insurance industry. Under his plan, insurers could create cheaper insurance products that cut back on some services while maintaining core coverage such as doctor visits, emergency care and prescription coverage.

The state would eliminate the free care pool and use the money instead to subsidize insurance for lower-income people not covered by Medicaid. If state residents refused to purchase health insurance, they could lose their personal exemption on their income tax under Romney’s plan.

“Affordable insurance can be available to all citizens without a government takeover of the health care system,” said Romney in a press release.

Romney’s poke at advocates who support an expanded government role in providing health care was matched last week with rhetoric from the other side.

“The market-based proposals which are so popular right now simply violate ideas of social justice,” Arnold Relman, former editor of the New England Journal of Medicine, told the Joint Committee on Health Care Financing.

A third proposal, supported by a coalition including the Greater Boston Interfaith Coalition, Health Care for All and the Service Employees International Union, would also offer health coverage to all residents, say supporters.

Dubbed the Health Access and Affordability Act, it would expand access to MassHealth, allow individuals to join large group coverage plans and force more employers to cover their workers.

A fourth plan, offered by Senate President Robert Travaglini, would cover half of the 532,000 uninsured state residents over the next two years, according to a press release.

Travaglini’s plan would loosen restrictions on health care companies as an incentive to cover more low-income people and force insurers to offer plans for individuals under 25 years old.

The plan would also seek to expand Medicaid enrollment for those who are eligible but un-enrolled and force large employers that do not offer insurance to pay for the free care costs incurred by their employees.

Observers familiar with the workings of the State House expect the Legislature to ultimately adopt a plan incorporating elements of the different proposals.

The wave of new proposals to reform the medical insurance system was spurred in part by the increasing cost of health coverage. Soaring costs are hurting state residents and businesses and overburdening the free care pool.

A drive to put on the ballot a constitutional amendment giving every resident a right to health care has also helped spur lawmakers to act.

“Every politician to look real has to come up with something, because it looks like the movement to amend the constitution is unstoppable,” said Eaton of Mass-Care.

Supporters collected over 70,000 signatures in 2003 to move the proposal to the Legislature, which passed the proposal at its constitutional convention last year. Assuming legislators pass it again at the constitutional convention tentatively scheduled for next month, the question will appear on the ballot in 2006.

Immigrants' Health Care

PRESS RELEASE

Immigrants spend half as much on health care as native-born Americans
Study shows most immigrants have insurance, but use fewer services

LOS ANGELES (July 25) - Immigrants in the United States receive less than half the health-care services than do native-born Americans, according to study findings published in the August issue of the American Journal of Public Health.

Immigrant children get even lower levels of care, receiving 84 percent less than U.S.-born children, according to researchers at Harvard and Columbia universities and the Keck School of Medicine of the University of Southern California.

"Our study lays to rest the myth that expensive care for immigrants is responsible for our nation's high health costs," says Sarita Mohanty, M.D., M.P.H., assistant professor of medicine at the Keck School of Medicine, who led the study while at Harvard. "The truth is that immigrants get far less care than other Americans. Further restricting their eligibility for care would save little money and place many immigrants-particularly children-at grave risk. Already, many immigrant children fail to get regular checkups, and as a result more end up needing emergency care, or get no care at all."

The study is the first to analyze nationwide spending on immigrants' health care. Researchers analyzed data on 21,241 people in the Agency for Healthcare Research and Quality's 1998 Medical Expenditure Panel Survey, which collects detailed health-spending data on a representative cross-section of Americans. Researchers determined how much is spent per capita on health care among immigrants and non-immigrants by adjusting for differences between the two groups in age, income, health status and insurance status.

According to the study, immigrants comprised more than 10 percent of the U.S. population but accounted for less than 8 percent of total health spending and only 8 percent of government health spending.

Per capita health expenditures averaged $1,139 per immigrant, significantly less than the $2,564 expenditure for non-immigrants. And 30 percent of immigrants used no health care at all in the course of a year.

Most immigrants had health insurance coverage. Though uninsured immigrants used the least health care of any group-61 percent less than their uninsured counterparts who were born in the U.S.-even immigrants with insurance coverage used 52 percent less health care than insured non-immigrants.

Immigrant children received far less care in doctors' offices (71 percent less than non-immigrant children) and received 72 percent less prescription medications. However, their emergency room costs -$45 per child-were nearly three times greater than those for U.S.-born children, reflecting the high cost of foregoing routine care.

"Our data indicates that many immigrants are actually helping to subsidize care for the rest of us," says study co-author Steffie Woolhandler, M.D., associate professor of medicine at Harvard. "Immigrant families are paying taxes-including Medicare payroll taxes-and most pay health insurance premiums, but they're getting only half as much care as other families."

Study co-author Olveen Carrasquillo, M.D., M.P.H., of Columbia University's College of Physicians and Surgeons noted: "Latino immigrants had the lowest health expenditures -$962 per person-which is half those of US-born Latinos ($1,870) and less than one third those of U.S.-born whites ($3,117). The future economic success of the United States depends on a healthy immigrant workforce. Our findings suggest an urgent need for partnerships between health organizations and community groups to improve access to care, particularly for minority immigrants."

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Sairta A. Mohanty, Steffie Woolhandler, David U. Himmelstein, Susmita Pati, Olveen Carrasquillo and David H. Bor, "Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis," American Journal of Public Health. Vol 95, No. 8, August 2005, pp. 1-8.

Health Costs Overwhelm Local Budgets

Boston Globe Editorial
Healthy cooperation
July 25, 2005

A STUDY from the Massachusetts Taxpayers Foundation measures the stinging costs of providing health coverage to municipal workers. Changes in employee contributions and plan offerings may be necessary to keep rising healthcare costs from debilitating the operating budgets of cities and towns.

The study, conducted with the Massachusetts Municipal Association and released last week, found that taxpayer-funded healthcare costs for municipal workers rose 63 percent from 2001 to 2005, more than four times the overall rate of growth in local budgets. More than half of new revenues in cities and towns went to cover increases in healthcare costs, leaving little opportunity to improve basic services. And municipal managers are nearly helpless to deal with the problem.

There is a better way to provide quality healthcare at a reasonable cost to public employees. Municipal managers and union leaders need look no further than state government, where workers enjoy excellent, affordable health coverage. The annual increase in the cost of providing health coverage to state workers is about half that for municipal workers.

A quasi-independent body -- the Group Insurance Commission -- ensures that more than 250,000 state workers, dependents, and retirees receive quality health insurance and other benefits at a reasonable cost. Plan designs and price structures are discussed rationally among labor, management, and healthcare economists. The commission can be counted on to press private health plans for the best service for state workers. It can also take measures, such as adjusting workers' copayments, to protect taxpayers. The commission could be a model for local communities. Better yet, it could expand to take on the direct responsibility for overseeing healthcare benefits for municipal employees.

First, municipal unions must accept the need to seek solutions outside of the collective bargaining process. Even the most straightforward cost-saving proposals, such as requiring retirees to enroll in plans that bridge the gap between Medicare and the cost of medical service, often collapse under union resistance, according to Geoffrey Beckwith, head of the Municipal Association.

At the state level, the Legislature establishes the employee contribution for healthcare coverage. At the municipal level, the unions call the shots. Wisely, Senate President Robert Travaglini has proposed legislation that would provide city councils and town meetings with the same authority now enjoyed by the Legislature to set premium shares.Balance must be restored when the cost of workers' healthcare coverage cripples entire cities and towns.