HealthCare access Resolution - House Concurrent Resolution 99
America's Health Together (<www.healthtogether.org">http://www.healthtogether.org>www.healthtogether.org)
April 30, 2002
Washington, DC
Rima Cohen,Vice President at the Greater New York Hospital Foundation and Director of the Insurance Options for the Uninsured Project, whose mission is to devise and implement strategies for expanding health insurance coverage in New York:
... we know for sure that the market has not taken care of the problem. Indeed, about a million people every single year since the census began collecting these statistics, have been added to the ranks of the uninsured. So, that's a difficult thing for me to grapple with looking back on so many years working on health insurance coverage.
So, I jumped at the chance to move into the state health policy arena, thinking that this is where the action is going to be in the coming years, and to a certain extent, I was right. And I was very fortunate when I moved to New York to be involved with an effort that started off with a coalition of organizations where we developed a health insurance plan that was meant to build on our Child Health Plus Program. It was for parents and childless adults, and within a couple of years of my arrival in New York, that legislation passed into law. And, it was the single biggest expansion in New York's history since--or I should say, since the creation of Medicare and Medicaid in 1965.
So, having been through that experience, you would think that I might be a big advocate of states as the laboratories of democracy, states experimenting with health insurance coverage initiatives, maximum state flexibility to develop locally tailored solutions to the health insurance crisis, but actually, I came away with exactly the opposite sense.
... health insurance coverage is really something that should not be thrown onto the states. And indeed, New York, with all the fanfare of this huge health insurance expansion, we really have not seen a drop in the uninsured. I think all we've done is managed to keep people--more people from losing their coverage.
So, let me just tie this all together with a couple of pearls of wisdom that I think can be used to think about strategies going forward. And the most important one is the one that I call, "Bigger is better when it comes to health insurance coverage." And what I mean by that is, the lens through which I look at every health reform solution is always, "Does it pool the greatest number of people in the largest pool and the greatest number and the most diverse in terms of their ages and illnesses and so forth?" Because that's the only way that health insurance works.
Health insurance does not work when people can segment themselves into tiny groups and divide themselves based on their illnesses or even geography or their age. And the system now really divides people, and what we really should be doing is pooling people. That's the principle of health insurance and that's why--one of the reasons why I think a resolution like this is so important. It's saying, "Everybody needs health insurance coverage. Let's pool the largest number of people together," and a corollary of that is, "Don't be fooled by calls for more choice." I think all Americans want choice of their health care providers. I don't see individuals clamoring as much for their choice of health plans, their--lots of other kinds of choices that you hear set up. Choices of benefit packages. That only allows people to segment themselves again. We need to be thinking about large solutions, comprehensive solutions. That's the only way we're really going to--to see a real program for all Americans.
And that's why I think a Resolution like this is so important (H Con Res 99). Because it doesn't say that this is exactly the way the health--the health care solution has to be built, but it says, regardless of the method, it has to be done. And the appropriate place to start is in the U.S. Congress passing this resolution, saying that by a date certain, the feds will come up, hopefully in partnership with the states and with lots of organizations that care about this issue, will come up with a solution but it cannot be done by states alone.
For the transcript: <http://www.kaisernetwork.org/health_cast/uploaded_files/Transcript_HealthTogether.pdf>http://www.kaisernetwork.org/health_cast/uploaded_files/Transcript_HealthTogether.pdf (cut and paste to rest of link)
For House Concurrent Resolution 99: <http://www.house.gov/conyers/hr99.PDF>http://www.house.gov/conyers/hr99.PDF
The resolution calls for legislation by October 2004 that would guarantee that every person has access to health care that meets fourteen specific criteria that we all support. Read it, and then contact your Congressional representative to enlist his or her endorsement.