Health policy lessons from Indiana
Indiana passes health reforms, Medicaid pay boost for doctors
By Doug Trapp
American Medical News
May 21, 207
Indiana lawmakers approved a $206 million boost in the state’s cigarette tax to pay for various health initiatives late last month, including a health plan for low-income residents and a Medicaid pay raise for doctors.
About $155 million of the increase will pay for the Indiana Check-Up Plan, a health insurance program that will provide:
- Up to $500 annually in preventive care paid by the state.
- Personal Wellness Responsibility Accounts, similar to health savings accounts. Workers, the state and employers contribute $1,100 toward health expenses.
- Basic health coverage for enrollees who exhaust the $1,100 in their accounts in any one year.
Legislators used the same bill to expand eligibility for children in the State Children’s Health Insurance Program from 200% to 300% of the federal poverty level. The measure also creates tax credits for employers offering section 125 plans — those giving employees a choice between nontaxable benefits and cash — and for employers offering wellness benefits. Another provision allows small businesses to pool together to purchase health insurance.
Indiana Check-Up is expected to provide up to 130,000 low-income residents with health insurance. Although that is just a fraction of the 500,000 people in the state without insurance at any one time, lawmakers and others said the bill is one of the most significant pieces of health care legislation in many years.
“Even though it did not solve the problem of the uninsured in its entirety, most people felt this was the best they could get accomplished based on how much money was at the table,” Dr. Kora said (Vidya Kora, MD, president of the Indiana State Medical Assn.).
http://www.ama-assn.org/amednews/2007/05/21/gvsd0521.htm
And…
Health program may be hard sell
By Lesley Stedman Weidenbener
The Courier-Journal
May 20, 2007
An estimated 850,000 Hoosiers — about one in seven — are without health insurance.
But state officials and advocates for the poor acknowledge that finding the 350,000 or so who qualify for a new state health program — and persuading them to sign up — won’t be easy.
But one obstacle for participation could be the premium that clients must pay to join…
Also, the plan’s setup — a sort of health savings account for most initial medical costs — could be confusing to people who have little experience with insurance.
But there are a million details to work through and there will be some growing pains…
Adults with incomes between 23 percent and 200 percent of the federal poverty level are eligible for the program — as long as their employers don’t offer insurance.
Coverage is capped at $300,000 annually per participant, or $1 million over a participant’s lifetime.
The program — financed by a 44-cents-a-pack increase in the state cigarette tax — is not an entitlement. That means when the money runs out, no one else can sign up.
State officials estimate the plan can serve 140,000 people, but (Indiana Family and Social Services Secretary Mitch) Roob said he’ll be happy if 50,000 sign up the first year.
A participant’s contribution to the health-care account will come in the form of monthly premiums, which will be based on a sliding scale…
While that’s about the cheapest health plan available, (former state Health Commissioner Richard) Feldman said, it could still be a tough sell among low-income people already living paycheck to paycheck.
Under the program, companies can pay up to 50 percent of the premium for eligible employees. That could be attractive to small businesses that can’t afford to offer their own insurance plans…
The state still needs federal approval to offer the plan, which Roob expects is forthcoming. And he has met with insurance companies that will bid to administer the program.
“I’m not sure we’ll get this exactly right the first time,” Roob said.
http://www.courier-journal.com/apps/pbcs.dll/article?AID=/20070520/NEWS02/705200515
Comment:
By Don McCanne, MD
Each health policy principle used to patch together this program has serious flaws. Combined, they are a disaster.
Indiana likely will end up providing coverage for less than one-tenth of their uninsured residents, but with coverage that is inadequate and still unaffordable for most. Lack of a mechanism for automatic enrollment, continual changes in eligibility status, and a funding source which is capped will further destabilize the pool of individuals covered by this program. This patchwork program is not worthy of being labeled “reform.”
With all polls showing health care to be the number one domestic issue, doesn’t that mean that we want everyone to have access to all reasonable, beneficial health care services without the necessity of facing financial hardship? Doesn’t that mean we want truly effective, equitably-funded health insurance for everyone?
You know what? You don’t get there by patching together flawed policies and then pretending that these are incremental steps that will eventually get us to health care nirvana. We have been following that path, and all parameters are worse.
So how do we get there? (Whispered secret.) Oh, no. It couldn’t be that simple. If it were, our policymakers would have gotten us there long ago!