Coverage for uninsured tops wish list
Coverage for uninsured tops wish list
A new Commonwealth Fund survey of opinion leaders found that coverage for the uninsured should be the top health care priority for Congress over the next five years. Some 88% of poll respondents ranked coverage for the uninsured as "absolutely essential" or "very important." Other top priorities included moderating rising health care costs (81%), reforming Medicare to ensure long-term solvency (80%), and increasing use of information technology to improve the quality and safety of patient care (80%).
Opinion leaders surveyed included experts from four broad health care sectors — academia and research organizations; health care delivery; business, insurance, and other health industry; and government and advocacy groups, excluding elected officials and the news media.
"When this many of our nation's health care experts, who don't always agree about priorities, name the same few critical issues, we have an excellent starting point for action on the health care agenda for the next few years," said Commonwealth Fund president Karen Davis. "Covering the uninsured is a key component of a high performance health system for the United States, and the experts' opinions reflect this great need."
The opinion leaders said they believe substantial changes are achievable and desirable in several health care policy areas. In addition to saying that the proportion of uninsured could and should be significantly reduced over the next 10 years, respondents said (on average) that the proportion of households spending more than 10% of income (5% for those with low incomes) on health care costs could be reduced from the current 17% to 10%. And respondents said that the total cost of health care as a percentage of gross domestic product should and could be held to the current level of 16% over the next 10 years. There have been projections from the Centers for Medicare & Medicaid Services that health spending will grow to 20% of the nation's gross domestic product by 2015.
Agreement on best approaches
Opinion leaders agree on the importance of expanding health coverage for the uninsured and, in large measure, on the approaches that would be effective in reaching that goal. Majorities said effective strategies include 1) mandating that all individuals buy coverage, combined with subsidies and an insurance pooling mechanism for the uninsured to purchase affordable coverage (57%); 2) providing states with matching funds for expanded Medicaid/SCHIP coverage for low-income children and adults (57%); creating a single-payer insurance system (54%); or covering everyone under Medicare (53%).
Half of all respondents said that requiring employers who don't provide coverage to contribute to a fund would be an effective way to improve coverage, and 62% of respondents from government and advocacy groups believe that approach would be effective. Half of all respondents also said allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program or similar group option would be an effective way to expand coverage.
Experts were less confident that these strategies would be effective: 1) providing tax credits or subsidies to low-wage workers (25%); promoting tax-free health savings accounts (14%); or 2) allowing association health plans to provide coverage without state licensing restrictions (13%).
Respondents differed about which reforms would be extremely or very effective strategies to expand coverage for the uninsured. Those from academia and research organizations believe that a single-payer insurance system would be effective (66%), while most respondents from the health care delivery sector (62%) and business, insurance, and other health industry leaders (57%) believe that an individual mandate to buy coverage would be effective.
Commenting on the survey results, Rep. Pete Stark (D-CA) said he expects the Democratically controlled 110th Congress to have new priorities but a realistic expectation given that President George Bush has two more years in the White House.
"Instead of working toward quality health care for everyone, President Bush wants to dismantle the parts of our health care system that work — Medicare, Medicaid, and the coverage that most of us receive through our jobs," Stark said. "We can't expect too much from a president who ignores the overwhelming majority of Americans who support life-saving stem cell therapy. That doesn't mean Congress will be at a standstill on health care. On the contrary, we will be working to make much needed improvements in our health system, helping to control rising costs and slow the loss of insurance coverage. But for the next two years, our efforts will be more incremental than some of us, me included, would prefer."
Stark said Democrats would initially address the "Six for 06" agenda presented last year by now Speaker Nancy Pelosi (D-CA), which includes two health care-related items — authorizing the Department of Health and Human Services to negotiate discount drug prices for the Medicare Part D program and legislation to promote stem cell research.
Once those items are enacted, he said, he will focus his attention on 1) Medicare oversight through the House Ways and Means Committee's Health Subcommittee, expanding coverage for children through an SCHIP expansion; and 2) efforts at bipartisan cooperation on health care issues.
Sen. Mike Enzi (R-WY), ranking minority member on the Senate Health, Education, Labor, and Pensions Committee, said he expects the committee will address these issues in the next two years — health information technology, biodefense/pandemic flu preparedness, drug safety and FDA reform, small business health plans, and stem cell research.
"During the Congress just completed, the HELP Committee set a benchmark for working in a bipartisan, bicameral fashion, and I do not expect that standard to slip as Sen. Edward Kennedy (D-MA) takes the gavel next year," Enzi said. "Sen. Kennedy and I sometimes disagree on certain issues, but we have worked hard to find common ground on health care issues and share a commitment to improving the health, education, work, and retirement security of all Americans….The bottom line is that I expect the 110th Congress to be even more productive in focusing the Senate and the entire Congress on key health care issues facing American families. Without exception, the HELP Committee's members understand that American families need relief from the burden of rising health care costs and a renewed sense of assurance that health care services, treatments, drugs and devices are safe and reliable."
Meanwhile, USA Today reported that governors and state legislators in both parties and most states have pledged to make health care a priority for their upcoming state legislative sessions, giving the issue more of a priority than Congress seems to want. The newspaper said states might find it easier to pass healthcare reform because state legislatures generally tend toward greater bipartisanship, avoiding the deadlock between Congressional Democrats and Republicans. Also, the analysis said, states tend to have budget surpluses, flexible federal rules for Medicaid spending, and successful reforms in other states to use as models, all of which make it easier to expand programs.
Many state health care plans feature proposals including expanded insurance to cover all children; tax incentives to businesses and individuals to increase money available for insurance coverage; medical insurance subsidies for small businesses; improved access to preventive care; and increased price competition for health-related costs.
"The states, as we've done on other issues such as welfare reform, are acting as the real innovators and making changes that will affect national policy," Missouri Gov. Matt Blunt told USA Today.
The top priorities listed by health care experts and stakeholders for 2007 are in many ways the same issues that attracted attention in 2006. The Commonwealth Fund said the top 10 health policy stories of 2006 were:
1. Democrats taking Congress in the November midterm elections.
2. An increase in the number of uninsured from about 46 million to more than 47 million.
3. Passage of the Massachusetts universal coverage law stimulating interest in other states.
4. Implementation of the Medicare Part D prescription drug benefit.
5. Incentives enacted by the outgoing Congress for health savings accounts.
6. Recognition that U.S. primary care is underdeveloped relative to other countries and the nation continues to lag in using health information technology, care coordination, and more.
7. The U.S. health system is well below benchmark performance on measures related to access, quality, and efficiency.
8. Progress is seen in pay-for-performance initiatives, with the Institute of Medicine calling for pay-for-performance in Medicare and a Centers for Medicare & Medicaid Services/Premier Inc. demonstration showing that incentives leading to better care also cut costs.
9. The Institute for Healthcare Improvement declares its 100,000 Lives campaign exceeded its 18-month goal of preventing 100,000 deaths and launched a 5 Million Lives Campaign to protect patients from 5 million incidents of medical harm over the next two years.
10. The push for health care transparency continues at the national and state levels.
Seven health industry trends
PricewaterhouseCoopers surveyed 1,000 consumers in October 2006 and early in 2007 issued a report identifying seven top industry issues for the year. Interestingly, consumers have different thoughts on several of the issues from those advanced by the stakeholders interviewed by the Commonwealth Fund.
1. States take the initiative. In the presence of federal gridlock, states are taking the lead on such divisive issues as covering the uninsured, funding stem cell research, and regulating pharmaceutical marketing. But consumers don't always support the state actions. PricewaterhouseCoopers found that only 10% of those surveyed believe states can solve issues such as coverage for the uninsured and only 25% think states should fund stem cell research. Consumers are more apt to favor federal action on these issues, although the states currently are taking the lead.
2. Transparency could be revealing. PricewaterhouseCoopers says that to help consumers make more informed health care decisions, health organizations will need to disclose more information about the cost and quality of the services they provide.
3. Time to walk the talk on technology. Only one-third of consumers surveyed thought electronic health records would increase the quality of care they receive, signaling the need, the report said, for a massive public education effort.
4. Consumers take the wheel. Employers are embracing consumer-driven health plans as a way to restrain health care costs. The survey found that of a variety of steps that could be taken to control health care costs, people are least supportive of paying more out of pocket. Early results on consumer-driven plans have been mixed and the analysts said that as more individuals enroll in the plans this year, word-of-mouth about them could determine their future success or failure.
5. Price check. Generic drugs pose a major challenge to innovator drug companies and Pricewaterhouse found that few survey respondents are loyal or brand name drugs over generics or are shielded from drug costs by their insurance company. Generics account for more than 50% of all prescriptions written and that percentage could increase as Medicare beneficiaries become more sensitive to drug prices through their Part D drug plan, the company said.
6. Obesity is the new smoking. Obesity is projected to lead to 400,000 deaths annually and individuals classified as obese have 30% to 50% more chronic medical problems than those who smoke or drink heavily. However, while employers and health plans are offering many weight loss programs and incentives, consumers are less supportive of financial incentives targeting obesity than they are of measures that discourage smoking.
7. Small is big. Pricewater-houseCoopers says the nearly $1 trillion health care service business will continue to operate like a cottage industry. The report says private equity investors will fund the next generation of innovation in services and treatments, challenging larger competitors that lack market agility.
The report concludes that everyone agrees that the current state of the health industry isn't sustainable and major changes are required. "Now more than ever before, health leaders will need to enhance their operations and their reputations," the report says. "Failure to close the gap between how consumers view the industry and how the industry views itself could be devastating to both. There are a myriad of issues facing health organizations and opportunities for executives to address them, but solutions must move beyond business issues. Rather, health care is a people business. To be sustainable, health organizations must communicate and connect with their customers through innovative approaches and fresh perspectives — beginning in 2007."
Download Commonwealth Fund information and the congressional responses from www.cmwf.org. Congressional information also is available through www.house.gov and www.senate.gov. Download the PricewaterhouseCoopers study at www.pwc.com/extweb/pwcpublications.nsf/docid/E8A194168C19DE678525726100550B91.
A new Commonwealth Fund survey of opinion leaders found that coverage for the uninsured should be the top health care priority for Congress over the next five years.Subscribe Now for Access
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