Ka Wai Ola - Office of Hawaiian Affairs, Volume 11, Number 2, 1 February 1994 — Health care reform: providing choice and affordability for all [ARTICLE+ILLUSTRATION]

Health care reform: providing choice and affordability for all

by Patrick Johnston The ultimate goal of the Clinton Administration's health reform plan is to provide affordable heahh care for all Americans. It would do this by keeping some of the current system such as Medicare and Medicaid in plaee while introducing new programs to help target the more than 30 million uninsured Americans. Of special interest to Hawaiians is that pan of the plan ipcludes support of health services for underserved, high-risk populations - such as native Hawaiians - in rural and urban areas. Central to the heakh plan is the

creation of "regional heahh alliances" established in eaeh state. Small to medium-sized companies, government employees, the self-employed and the unemployed would be required to get insurance through the allianee unless they qualified for Medicaid. Employers would have to make contributions to the allianee and pay no less than 80 percent of the premium for eaeh employee. Employers would also be ^required to cover part-time workers, although the amount paid would be less than that for fulltime workers. Subsidies would be available for smaller companies if they had 50 or fewer employ-

ees and their average wage was less than $24,000/year. There would also be subsidies for families with incomes up to 150 percent of the official poverty rate (no more than $21,514 total ineome for a family of four). Alliances would be non-profit groups run by a board of directors and would be primarily responsible for negotiating premiums with health plans. They would ensure that all individuals enroll and that all plans provide the minimum benefit package. Health plans would contract with alliances and would have to follow federal standards. Plans could not vary premiums by category of employee. A seven-member national health board, selected by the president with the advice and consent of the Senate, would oversee the program. They would be responsible for establishing requirements for state plans and making sure states follow these regulations. Benefxts offered would be similar to those presently provided by employer programs. The state would be responsible to submit its plan to the national health board for review. In its plan the state would have to show how it will administer subsidies, monitor programs, collect data, and establish governance for the allianee. The state would also have to approve all heakh plans offered by alliances. Companies with more than 5,000 people would be able to bypass the allianee and create their own heahh plans. Employees in these plans would not be able to receive public subsidies but corporate alliances would have to keep costs within limits set by the national heakh board. The program would contain

costs by putting limits on Medicare and Medicaid spending beginning in 1996 and limit the amount heahh premiums could rise to the same rate as the annual growth. The national health board would determine the cost per person of eaeh heakh package and set targets for eaeh of the heakh insurance purchasing groups across the country. Mechanisms would be put in

plaee if alliances exceeded targets set by the naūonal heakh board. A one-dollar-per-pack cigarette tax would is proposed to help pay for the system as well as cutbacks in various Medicaid and Medicare programs. The federal government would also get money from an anticipated increase in ineome taxes resulting from employer savings from

Hawai'i Health Quest: reform at the state level

There is a lot of eoneem now in Hawai'i about how President Clinton's health proposals are going to affect the state's health care system whieh is relatively progressive compared to the rest of the country and has actually heen used as a model for the present reform legislation. With this in mind, the state is trying to get a jump on health reform with the introduction of its Hawai'i Heakh Quest project. Quest is a demonstration project and is similar to the regional alliances that are central to the Clinton pian. Administered by the state Department of Human Services, it would act as an umbrella organization for some Medicaid programs and SHIP (the State Health Insurance Plan) by facilitating the bidding process for statewide health plans, and making sure everyone eligible is enrol!ed and receiving a complete set of benefits. Health plans would submit proposals to Quest and the bidders whieh meet technical requirements and are the most competitively priced would heome insurers in the programs. State planners anticipate that on heavily popu-

lated islands, Quest wou!d be able to offer a ehoiee of up to four insurers, ensuring ehoiee as well as affordability. Medicaid members wou!d have not have to pay for the service and only SHIP members whose ineome was above 133 percent of the poverty rate ($21,514 total ineome for a family of four) would have to pay. That would not be too many people, according to Dr. Peter Sybinsky, Deputy Director at the state Department of Health and manager of a working group looking into health reform. "There aren't many people on SHIP who could make payments. Right now 85 percent do not pay." Sybinsky believes the plan is iine with the health reform that is likely to take plaee in the future at the federal level. It represents a "privatization" of the present state programs and is designed to maintain Hawai'i's high level of heakh coverage but also bring about competition and better management, hopefully keeping down the skyrocketing cost of health care.

Underlying principles of Clinton's health care reform

1. The guarantee of comprehensive benefits for all. 2. Effective steps to control rising health care costs for consumers, businesses, and our nation. 3. Improvement in the quality of health care; 4. Increased ehoiee for consumers. 5. Reductions in paperwork and a simplified system. 6. Making everyone responsib!e for health care.

Hawai'i's congressional team tackles health care

Patsy Mink Congresswoman Patsy Mink was an active proponent of heakh care reform before President Clinton introduced his recent package. Prior to the most recent session she was a co-sponsor of the McDermott/Wellstone bill whieh proposed a 'single payer' system similar to that found in Canada. The McDermott/Wellstone bill would establish a state-administered universal comprehensive heakh insurance program to replace all other private and public coverage. Since the president introduced his reforms, Mink has chosen to back thems although she does not agree with all its proposals. For example, she feels the co-payments required for mental illness coverage plaee too mueh of a burden on users. She also is concerned that the new proposals would put more burden on the poor than the present Hawai'i system does. The heakh care reforms recommend that employees pay no more 20 percent of their insurance costs. Presently in Hawai'i employees cannot pay more than 1 .5 percent of their paycheck on health insurance. The new system would put an added burden on low-ineome wage earners. Mink also wants to make sure that the level of coverage in Hawai'i - close to 100 percent - is not adversely affected by the new plan. Neil Abercrombie Like Mink, Congressman Neil Abercrombie is an advocate of the 'single payer' system. However, realizing that the legislation proposing such a system would have a very difficult time getting through the House he has put his support behind Clinton's heakh care paekage. His major eoneem is that the package should not hurt the progressive coverage that Hawaiians already enjoy. In its present form, the package would not adversely affect Hawaiian residents, but the legislation is very likely to get modified as it goes through Congress. (Ka Wai Ola was unable to obtain Senators Inouye and Akaka's position on Clinton's health care package due to the weather conditions that had closed down most of Washington before the newspaper went to print. A statement from Senator Inouye's Honolulu office did not give Inouye's position on the issue but said that the senator has been very active in promoting health care reform and that, as Chairman of the Committee on Indian Affairs, is working with the Native Hawaiian Heakh Care Systems in studying the Clinton administration reform proposals.)

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