OCR Text |
Show AN ANALYSIS OF LEAVITT'S HEALTHPRINT by Roberta Herzberg PhD The bipartisan plan for health care reform based on Governor Leavitt's "Health Print" is designed around two major concerns: (1) broadening access to health insurance, and (2) increasing the information necessary to make efficient decisions in health reform. In creating this policy, Utah policy makers adhered to public service's ultimate rule: Don't make decisions that make public problems worse. Rather than pursuing radical health care reform without fully understanding the effects of those changes on the vast health care industry and the economy, Utah seems committed to reforming its health care system only after we have fully evaluated the expected consequences of such change. Recent legislation concentrates on expanding access where consensus to do so exists (SB 158) and establishing a mechanism to study those issues where consensus is lacking (HB226). SB158 is designed to expand access to health care financing. This bill proposes to increase the access to health care by expanding Medicaid benefits and eligibility. As federal funding allows us to cover more persons for the same state dollars, Medicaid expansion immediately increases the level of health insurance access for low-income Utahns, while maximizing the impact of Utah's health care dollar. However, moving the Medicaid population into a prepaid, capitated health care delivery system places at least one decision maker, the physician, at financial risk. Since efforts to hold Medicaid recipients financially responsible have proved impossible, at least capitating the care arrangement has the potential to bring financial discipline to Medicaid care. I am somewhat skeptical about the extent to which capitation will produce continued cost savings across the entire Medicaid population. However, the governor has promised that the expansion of care throughout the lower income brackets will only occur to the extent that it can be financed through cost savings from capitating care. If the governor can hold to this commitment, the Medicaid expansion could be a very positive step for Utah citizens. An aspect of the Medicaid expansion requiring careful consideration before further state commitment is the proposed demonstration project in which employers of low-income employees would be brought into the Medicaid program. The eligibility criteria for such a process is vague, so there is no way to determine how many small companies may be affected by it. Nevertheless, it is easy to see how such a plan might provide a disincentive for small firms to provide their employees with health insurance, insurance that they may have been willing to finance if the program did not exist. Such a program would also move a step closer to the introduction of a single, government-run, health care program for the private and public sectors alike, as well as create inequities between comparable firms in the state. Other insurance reforms accepted this year to facilitate wider access to health care include: (1) legislation changing age limits on dependents that allow insured parents to continue coverage for dependents to 26 years of age. Since young people just entering the workforce are some of those most likely to be uninsured, it is hoped that this will provide a low cost way to cover a significant group of the uninsured; (2) small group reform directed at creating greater consistency in rates; and (3) provisions that allow voluntary groups to form for the purpose of offering health insurance to its members intended to make affordable insurance available to small employers and individuals currently underserved. Small group reforms are designed to begin equalizing rates across similar rating categories of insured. Equality in this sense means increasing rates for those who have been advantaged in the existing system (i.e. the young and healthy) to offset the decrease in rates directed at those disadvantaged under the current system. We must carefully work for a balance, however. If increased insurance rates for employers currently providing insurance drives them out of the market, they will no longer offer their employees insurance. Thus, the reforms designed to increase access may actually reduce access. On this and other future insurance reforms intended to regularize the market, reformers must remain conscious of what the market will bear in a voluntary system without mandates. Voluntary groups are intended to make affordable insurance available to small employers and individuals currently underserved. The provisions intended to make voluntary groups more feasible are directed at the potential savings associated with economies of scale and administrative savings from broader marketing. This change is particularly relevant in light of the governor's desire to consider a mandatory purchasing cooperative as part of his future reform plan. In a voluntary arrangement, the cooperative will only survive if the savings are real and employers accrue tangible benefits. In this 116 HEALTHPRINT COMMENTARY |