Originally published in The Harrisburg Post-Gazette, June 17, 2008
In January 2007, Governor Rendell introduced Cover All Pennsylvanians, a plan to provide health insurance coverage for the uninsured.
In March 2008, the Democratic House leadership introduced a new plan, called Pennsylvania Access to Better Care, (PA ABC), to insure about 275,000 uninsured adults over the next five years. That plan passed with substantial Republican support soon after.
Since March, the Senate Republican leadership has blocked consideration of this legislation.
Now, in June, only weeks before the summer recess, a small group of Senate Republicans have come forward with their own proposal for providing health care for the uninsured.
Their presentation yesterday shows why it is time to enact PA ABC.
To meet the needs of the uninsured, the Republican Senators have cobbled together a package of more money for health clinics; a new network of volunteer physicians to provide primary care for the uninsured; Continuing Medical Education incentives for other doctors to provide voluntary care; and a new voluntary program to provide free drugs for the uninsured.
And why do we need this complicated—and, in fact, costly—mélange of voluntary programs? Because, as the star speaker at the Republican press conference, Dr. Zane Gates, put it, “We must find a way to care for people until we can figure out a solution to the health insurance problem.”
There is the rub. Voluntary care for the uninsured should be welcomed. But it is only a palliative. The cure, as Dr. Gates says, is to insure the uninsured.
No government in the world has relied on volunteerism to provide primary health care for over 500,000 people. Most primary care physicians are in large practices, often affiliated with hospitals. They are under pressure to see more and more paying patients. How will they be able to see thousands of new non-paying patients?
But even if the plan works, uninsured Pennsylvanians will still have inadequate health care.
• They will have to wait at already overcrowded health clinics.
• They will not have access to advanced medical tests and outpatient procedures not performed at health clinics.
• They will not have access to medical specialists.
• They will not have access to hospitals.
• They will not have coverage for all prescriptions.
• They will not have mental health care.
Under PA ABC, however, uninsured adults—over 70% of whom work full time—will be able to pay reasonable rates to purchase health insurance that gives them first class medical care covering all that is missing in the Republican program. Those making less than 200% of the Federal Poverty Line ($20,800 for an individual and 42,400 for a family of 4) will pay on a sliding scale $10 to $50 a month.
Moreover, the costs of PA ABC to the state would not be much greater than the costs of the voluntary programs proposed by the Republican Senators. Cost estimates are missing for some elements of their program. But the enumerated costs total $95 million in new state spending. The PA ABC program will require only $179 million in new state spending by 2013, at which time 275,000 more adults will be receiving health insurance.
Why can PA ABC do so much more without spending so much more? Because it draws on $414 million in Federal matching funds and rightly asks the recipients of health insurance to pay for a portion of their insurance.
Extending coverage to the uninsured under PA ABC has another advantage: Today, over six percent of our health premiums go to cover medical care for the uninsured. Voluntary primary care will not do enough to reduce the burden on those who have health insurance.
There are some good elements in the Republican proposal: funding electronic medical records; denying payment for medical errors; providing Cobra coverage for small businesses; and allowing parents to purchase insurance for their children under the age of 30.
In addition, the Republican Senators took a controversial issue off the table. They said that a likely source of funding for their proposal is the surplus in the MCare provider retention account, the same source the House plan uses to fund part of PA ABC. This is an important recognition that a portion of the surplus in this MCare account, which is funded by taxpayer dollars, should go to providing health care for the uninsured.
It is not too late for the useful elements in the Republican proposal to be folded into PA ABC and enacted this month. But a good look at that proposal shows us what we should have known already: The direct route is the best solution to the problem of the uninsured: help them purchase health insurance.
Marc Stier is the Health Care Campaign Manager for SEIU PA State Council and a member of the leadership team of the Pennsylvania Health Access Network.