Universal coverage gains traction for 2008

WASHINGTON, D.C.-The campaign to provide healthcare to all Americans is making headlines once more as business, labor and consumer groups join with healthcare insurers and providers to urge major changes in the nation's healthcare system.

Last month, a coalition of leading business, labor and consumer organizations unveiled a national campaign to spur congressional action on healthcare reform legislation. The Business Roundtable, AARP and the Service Employees International Union (SEIU) launched the "Divided We Fail" effort to urge bipartisan solutions to the nation's healthcare crisis. Although the partner-ship did not make specific legislative proposals, the group plans advertising and town meetings about healthcare issues to make healthcare reform a national campaign issue leading up to the presidential elections in 2008.

A few days later, the health insurance industry joined with physicians, hospitals, pharmaceutical companies, consumer and business organizations to release a consensus proposal to cover many of the nation's 47 million uninsured. Members of the Health Coverage Coalition for the Uninsured, which includes America's Health Insurance Plans (AHIP), BlueCross BlueShield Assn., Kaiser Permanente and United Health Foundation, have been meeting for two years to structure a common proposal designed to launch congressional debate on healthcare coverage.

All these coalitions avoid controversial proposals, such as switching to a government-run, single-payer system. The reform platforms would increase coverage by expanding public health programs, such as Medicaid and state children's health programs, and adopting policies to make private coverage more affordable. More prevention, health information systems, health effectiveness information and quality initiatives would improve the healthcare system and make care more efficient and affordable, according to proponents.

It remains to be seen whether the universal coverage campaign gains traction on Capitol Hill. The legislators generally have shied away from major health reform initiatives since the fight over the Clinton reform plan more than 10 years ago. Sen. Edward Kennedy (D-Mass.) sought to set the tone by announcing his intent to press for federal universal coverage initiatives as chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee. He urged extension of Medicare and Medicaid and establishment of more health plan options to provide broader coverage.

In his State of the Union speech January 23, President Bush promoted a federal tax deduction for individuals who obtain health insurance as a way to expand coverage. This represents a new tax on the value of employer-sponsored health insurance; although directed at "Cadillac" plans, the measure could hurt workers with high-cost coverage.

STATES TAKE LEAD

Meanwhile, health reform activity is heating up on the state level, spurred partly by Massachusetts' action last year and universal coverage plans passed in Vermont and Maine. A legislative proposal in Minnesota would cap health insurance premiums, require insurers to cover young adults under family plans and expand the state's MinnesotaCare program to small businesses and farmers. Pennsylvania Gov. Ed Rendell has proposed a comprehensive "Prescription for Pennsylvania" agenda in his second term to make coverage more affordable for adults and extend care to all children.

The most ambitious proposal has come from California Gov. Arnold Schwarzenegger, who seeks to extend coverage to some 6.5 million California residents who lack health insurance-nearly 20% of the state's population.

This $12 billion program would extend the state's Medi-Cal program to cover all children and more adults and also requires employers with 10 or more workers to offer health insurance or pay a 4% payroll fee to support a state insurance pool. Health insurers could not deny coverage based on pre-existing conditions, and individuals who fail to obtain coverage could face tax penalties or wage garnishment.

Opposition from some physicians to the added fee and from employers already has raised predictions that the proposal will never be adopted.

Even so, Schwarzenegger's plan has put "healthcare for the uninsured back on the agenda," commented Diane Rowland, executive vice president for the Kaiser Family Foundation.