The act would establish a new bipartisan State Health Innovation Commission (SHIC), which would be part of the Department of Health and Human Services. This commission would review the state proposals and submit to Congress a list of recommended applications. It would also work with an established organization—possibly the Institute of Medicine—to develop performance measures and goals regarding coverage, quality, and cost of state programs.
Participating states would eventually report their progress to the SHIC, which would then report to Congress on whether each state was meeting the goals of the act and would then recommend further action.
Giving individual states the flexibility to create their own programs could generate new ideas and would ultimately reveal which programs work best. “We’re not expecting states to hit the ball out of the park the first time, but it’s a start,” says Dr. Siegal. “It’s a step in the right direction.”
SHM supports the Health Partnership Act and has sent a letter of support to Senate sponsors. “This [legislation] may or may not be the most expedient way to get it done,” says Dr. Siegal. “But SHM supports this legislation and is currently drafting a letter of support for the House version.”
The Healthy Americans Act
Another, more comprehensive, bill was introduced in the Senate by Ron Wyden (D-Ore.) in December 2006.
The Healthy Americans Act would require businesses to replace their current health benefits with an increase in wages equal to the amount spent on health insurance premiums. It would require all employees to use these increased wages to purchase their own health plans and would provide subsidies to low-income workers to help pay their premiums.
Those employers not currently providing any health benefits would be required to begin making phased-in “Employer Shared Responsibility Payments,” which would be used to ensure that everyone is able to afford their health plans by funding premium reductions.
Wyden’s bill would have each state establish a Health Help Agency to educate residents about private health plans, to administer enrollment, and to assist income-eligible enrollees with sliding scale premium reductions. These agencies would be funded by the federal government and insurance companies.
Finally, insurance companies would be required to cover every individual who chooses to enroll and would not be allowed to raise prices or deny coverage if individuals are sick.
Some State-Level Solutions
Some states—Massachusetts, for one—have already taken action, implementing their own innovative policies and programs to expand coverage for their populations. Maine, Massachusetts, and Vermont have instituted comprehensive healthcare reform; Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, and Utah have all implemented some form of public-private partnerships; and Illinois and Pennsylvania have initiatives that cover all children.
Maine, Massachusetts, and Vermont all use Medicaid funds to partially subsidize healthcare coverage for families with annual incomes as high as $53,000.
For details on all current state initiatives for healthcare coverage, download the report “State of the States 2007: Building Hope, Raising Expectations” from the Web site of the State Coverage Initiatives at www.statecoverage.net.
Why Hospitalists Should Care
Providing healthcare coverage to the uninsured is one of SHM’s public policy priorities. “There really is a crisis out there, and hospitalists are on the front line of it every day,” says Dr. Siegal.
As former SHM President Mary Jo Gorman states in SHM’s letter of support for the Senate’s Health Partnership Act: “Many hospitalist programs exist to manage the burgeoning population of uninsured and underinsured patients who require hospitalization. These patients are more likely to delay seeking care until their illnesses deteriorate to the point that they need emergency care. In many communities, hospitalists have become the safety net for this vulnerable patient population.”