Waiting For Health Care: Doctors and patients need state action on health and malpractice insurance

I wrote this for Dr. Valerie Arkoosh to sign. It was published in the Pittsburgh Post-Gazette on April 16, 2008

I am a physician. And like so many other physicians in Pennsylvania, I’m waiting for the General Assembly to restore the MCare abatement program. MCare was set up to reduce medical malpractice premiums, which had risen to the point that physicians were leaving the state in droves.

Since 2002, physicians in Pennsylvania have purchased half of their required malpractice insurance from the MCare program and the other half from private insurers. Most physicians get back half of their MCare costs while those of us in high-risk specialties receive a full abatement. But the abatement program expired in December and bills for MCare are due at the end of this month.

While we doctors wait for our abatements, about 750,000 adults in Pennsylvania, most of whom work full time, also are waiting — for affordable, quality health insurance. Hundreds of thousands of them have been waiting for a very long time.

A couple of weeks ago, the Pennsylvania House of Representatives took action that, if followed by the Senate, would end much of this waiting. We physicians would receive our abatements and at least 250,000 uninsured Pennsylvanians would be able to obtain health insurance.

Senate Bill 1137 would create a new program for the uninsured called Pennsylvania Access to Basic Care. It would provide subsidized insurance for adults with a family income of 200 percent of the federal poverty line, which today is $42,000 for a family of four. Those earning more could purchase insurance for $311 a month.

The ABC program would include coverage for prescription drugs, preventive and wellness care, and chronic-disease management. I would like to see mental illness have parity with other illnesses, but ABC would provide some behavioral health care.

Funding for the ABC program would not require an increase in income, business or sales taxes. One source would be part of the surplus in the Physician Retention Fund, from which Mcare abatements are paid. The surplus exists because, thankfully, malpractice claims and settlements have been declining. But this still would leave sufficient money under SB 1137 to provide many benefits for doctors and hospitals. The bill would:

ā€¢ Extend the MCare abatement program, which has been renewed annually, for 10 years.

ā€¢ Gradually give a full abatement of MCare premiums to physicians who have received only partial abatements previously.

ā€¢ Phase out the MCare program while providing a solution for its unfunded liability — the costs of satisfying malpractice claims from previous years after the program ends — that does not place the burden on doctors or hospitals.

ā€¢ Reduce the amount of uncompensated care provided by physicians and hospitals today.

The bill also would require all physicians who accept MCare abatements to provide medical care to patients insured through the ABC program and the State Children’s Health Insurance Program. Given that tax revenues fund abatements, this seems like a just arrangement.

Some organized groups of doctors and hospitals are expressing concern about or are opposing SB 1137. I, and thousands of my colleagues, want to help our uninsured patients by supporting increased access to affordable health care.

Pennsylvania physicians believe it is time to come up with a long-term solution to the medical malpractice problem. We don’t want to fight for MCare abatements year after year. We want to see MCare phased out, as private malpractice insurance is expected to continue to decline in cost.

Insuring the uninsured is not only a moral but also a practical necessity. Physicians are tired of seeing expensive emergency rooms become the last resort for the uninsured. We are frustrated by seeing patients come to us for expensive treatments that would have been unnecessary if they had received early and inexpensive preventive care. We see patients with chronic illnesses that could be managed — if they could afford treatment — unnecessarily wind up in expensive hospital rooms in great distress. We are weary of suspecting that a lack of health insurance is often a cause of death.

Both parts of SB 1137 are about expanding access to health care in Pennsylvania. It is not perfect, but it is a step in the right direction. The time for affordable health care for all Pennsylvanians has come. The time for action is now.

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Dr. Valerie Arkoosh is an obstetrical anesthesiologist in Philadelphia and a board member of the National Physicians Alliance (valerie.arkoosh@mac.com).
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First published on April 16, 2008 at 12:00 am

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