A health plan for the rotating pool of uninsured
(In reading today's quote, please ignore the deficiencies of a verbatim transcript of a spontaneous response given during the Q&A segment of the presentation, but concentrate instead on the message.)
Alliance for Health Reform March 21, 2003 Washington, DC
"Dynamics of the Uninsured"
ED HOWARD: Let me just ask each of our panel members if we don't have any other questions from the floor if they care to take about 30 seconds and sum up what you think folks ought to take away from this discussion. We have a budget resolution that's making its way through at least one House of the Congress and probably the other House soon at least in some iterations it will have some money that is intended to address the problems of folks without insurance. How should that money get spent? How should we apply it to this discussion that we're having this afternoon? And what next steps ought to be at the highest priority in that context? Or you can tell us anything else you want.
PAMELA FARLEY SHORT, Ph.D., Professor of Health Policy and Administration and Director, Center for Health Care and Policy Research, Penn State: Well I guess one idea or thought that I'd like to share and I haven't had a chance to share so far is just that to say that one of the things that seems to me is really lacking in our patchwork kind of system of health insurance is a source of coverage that's reasonably priced and that people can hang onto as their personal circumstances change. So whether - and that is an impediment to - it complicates the issue and the problem of using almost any kind of financing strategy for example if we have tax credits you still have the problem of where are people going to buy reasonably priced insurance on terms that are just not as favorable as large employers offer at least closer to that than people can buy on the individual market. So one of the reasons why there's so much turning and so much turnover is that there really is no place that people can be insured as their incomes go up and down particularly as their incomes kind of float around some eligibility limit so that if we had whether it be and there are lots of different ideas on the table as to what such a universal source of individual health insurance might be ranging from expanding and allowing people to buy into public programs of Medicaid or Medicare at older age levels, purchasing cooperatives, the federal employees plan, the state employees plans and there's a lot of ideas about what that might be but at the moment nothing like that exists and so what happens is that as soon as people's income goes up so that the state will know and the federal government will no longer pay for them to have coverage for Medicaid they have to leave that source of coverage and find another it's not and if we could move towards the direction of some of a system where the coverage could stay put you just are covered from a given place and you keep that plan and your kids they're covered with you but what changes as your circumstances change is who's paying for it and that may be a way of getting ourselves out of some of the problems that we currently confront so that as your income rises you pay more, if you have a job your employer doesn't necessarily provide you with the coverage but pays into you know contributes towards your coverage you know this is kind of a system that you know in essence union employees have that sort of situation because their jobs change so much and maybe if we could figure out a way to get a place that everybody could buy then almost any financing strategy from you know tax credits to buying it yourself even for those high income people would be a lot easier.
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=806
Comment: There is growing recognition that the pool of uninsured is not a single relatively stable (though expanding) group of individuals. In fact, it is quite unstable as individuals rotate in and out of various programs based on eligibility or ability to pay. Change in employment status changes eligibility for employer-sponsored programs. Moving in and out of poverty status changes eligibility for public programs for low-income individuals. Change in health status affects eligibility for individual coverage. Change in age affects eligibility for SCHIP or Medicare coverage.
Dr. Short is quite correct. We need an affordable, comprehensive health insurance product that will always be ours, regardless of employment status, health, age, income level, or any other arbitrary determinant of insurance eligibility. But which insurer will offer that kind of product?
Why is there a deafening silence in response to this question?
It's quite clear that only a universal, public-insurance program can ever fill that bill. Once we accept this principle, it would be very easy to develop a strategy for equitably financing the system.