HIAA, Families USA and AHA Announce Joint Proposal to Reduce the Number of Uninsured Americans
Putting aside several years of feuding, three "strange
bedfellows" -- the
Health Insurance Association of America, Families USA and the American Hospital Association
-- came together at a press conference Nov. 20 to unveil a joint
proposal to halve the number of uninsured Americans. The plan
takes a three-pronged approach, calling for expanding Medicaid to
people under 65 earning up to 133% of the federal poverty level;
allowing states to expand CHIP program coverage to certain
adults; and establishing tax credits for businesses to encourage
them to provide coverage to workers. "As organizations
representing the breadth of the health care community, we stand
together to forge common ground to end the gridlock over
extending health care coverage to the uninsured millions living
in America today," the three organizations announced in a joint
press release. Calling for an end to "partisan, ideological and
interest-group boundaries," Families USA Executive Director Ron
Pollack emphasized the need for cooperation in crafting proposals
that would give health coverage to more individuals. "Political
gridlock should no longer be an option in dealing with America's
uninsurance epidemic," he said. HIAA President Chip Kahn said,
"In the past, every group interested in extending coverage to the
uninsured held out for their favorite approach, and their second
choice always was the status quo. As a result, nothing was
accomplished." Rick Pollack, executive vice president of the
AHA, added, "With this step, we've laid a strong foundation we
hope to build upon to improve access and coverage for all"
(HIAA/Families USA/AHA release,
11/20). Although Kahn and Ron Pollack conceded that the new
proposal "is not the optimum strategy for either organization,"
they said that "past reform battles" have taught them that "an
ideal will only result in stalemate" (Health Affairs
release, 11/20). Pollack, Kahn and Rick Pollack also outlined
their proposal in a letter to House Speaker Dennis Hastert (R-Ill.), calling on the
government to "use good economic times to address this problem"
(Kahn et al., letter, 11/20).
At the Nov. 20 press conference, the three leaders outlined
five basic guiding principles on which their plan was founded:
- That providing universal coverage will be accomplished
"neither through modest increments nor through one comprehensive
package," but through a "step-by-step" approach;
- That the plan "cannot take away, or appear to take away"
coverage from those who currently have it;
- That the guidelines should build on existing health coverage
structures, both public and private; thus avoiding the creation
of new bureaucracies and "further fragmentation of the health
system;"
- That the plan should use public resources in a way that
"maximizes new health coverage;"
- That the proposal should focus on low-wage workers, their
families and other low-income individuals who are "least capable
of obtaining health coverage."
The proposal is composed of three parts and focuses mainly on
individuals and families earning below 200% of the federal
poverty level. The plan would first require an expansion of
Medicaid to include all people under 65 earning below 133% of the
FPL. Eligibility for this coverage would be based exclusively on
income; individuals would no longer need to belong to one of
"several prescribed categories," such as children, parents or the
disabled. Secondly, states would have the option of opening
"Medicaid or S-CHIP-type coverage" for adults under 65 earning
between 133% and 200% of the FPL. Eligibility for these programs
would also be based on income, not parental status.
"[S]ignificantly enhanced" federal matching funds would be made
available for these programs. Third, the plan would establish a
non-refundable tax credit for businesses to "encourage them to
make employment-based coverage more affordable for their low-
income workers." This credit "should be established in tandem"
with creation or expansion of the Medicaid-type programs for
people earning between 133% and 200% of the FPL, and would be
available to employers who pay a larger share of insurance
premiums for workers earning 133% to 200% of the FPL than they do
for other workers in the company. This would help defray the
cost of employer-sponsored insurance for those who cannot afford
the employee share. Pollack, Kahn and Pollack said they believe
the plan "achieves a reasonable balance between public sector and
private sector approaches" (Kahn et al., "Finding Common Ground
for Expanded Health Coverage to the Uninsured," 11/20). However,
they stressed that the guidelines are not meant to be concrete
legislative initiatives. "This agreement is a policy framework,
not a set of legislative specifications," Ron Pollack said. He
added that the plan has gotten a "very positive response" from
businesses concerning the tax credit option. Although a
supplemental survey estimated the cost of the plan at $250
billion, Kahn said yesterday that no definite cost has been
calculated yet for the proposal. "We haven't done a cost
estimate, and partly because ... this is a policy framework."
Kahn added that $250 billion was a figure "roughed out" for
survey purposes, but he "wouldn't stand by" those numbers. "I
think without any question, we are talking about a significant
magnitude of dollars," he said (Meredith McGroarty, Kaiser
Daily Health Policy Report, 11/21). To view a copy of the
proposal, please go to http://membership.hiaa.org/pdfs/001120CommonGround.pdf.
Kahn and Ron Pollack have also outlined their proposal in an
article appearing in the January/February 2001 issue of
Health Affairs.
Finding Common Ground
The joint proposal makes strange bedfellows of the HIAA and
Families USA, since the two groups were once "archenemies in the
fight over national health care," the Washington Post reports. Their
differences came to a head in 1994, when the groups sparred over
President Clinton's plans for universal health care and became
involved in "some of the nastiest exchanges" over the issue.
HIAA staged a $15 million campaign, which included the "Harry and
Louise" television ads, to sink Clinton's plan, while Families
USA "championed" the measures. Pollack said, "Chip Kahn and I
can't recall ever agreeing to anything" (Pianin, Washington
Post, 11/21). HIAA, a trade group composed of health
insurance companies, has traditionally favored bolstering
coverage through the private sector and adopting more "modest"
Medicaid and CHIP expansions as a measure to reduce the number of
the uninsured. Families USA, a health care consumer advocacy
group, has "never favored tax incentives" as a way to combat the
problem, instead leaning instead toward shoring up Medicaid and
CHIP (Health
Affairs release, 11/20). Earlier this year, however,
Kahn and Pollack both participated in a conference sponsored by
the Robert Wood Johnson Foundation and realized they had some
ideas in common (Washington Post, 11/21). The
proposal put forward yesterday follows a year of efforts by the
organizations to forge feasible guidelines that incorporate
aspects of both groups' strategies (Kaiser Daily Health
Policy Report, 11/21).
Survey Shows Support for Efforts
Between Nov. 11 and 13, the polling firm Public Opinion
Strategies conducted a national survey on expanding health
coverage to the uninsured, the findings of which were released at
the conference yesterday. The poll, which surveyed 800 adults,
found that "[t]here is substantial public support for significant
reforms to help reduce the number of uninsured Americans." While
46% of the respondents "strongly favor" expanding Medicaid, 82%
generally favor augmenting the program. In addition, 48% of the
respondents "strongly favor" and 83% generally favor expanding
CHIP to "working poor adults." Eighty percent of participants
said they would recommend to their member of Congress to favor a
$250 billion program similar to the one proposed by the three
organizations and funded by the federal surplus. In addition,
55% of those surveyed said they would even support this program
at an increase of $200 per year per taxpayer (Public Opinion
Strategies survey, 11/20). The survey can be viewed as a Power
Point presentation on the HIAA Web site at http://www.hiaa.org/news/news-
state/001120mediakit.htm.
Feedback
The three leaders believe the plan "could garner support
from a broad spectrum of groups and legislators" (Health
Affairs release, 11/20). The plan has received support
from White House officials, including Clinton health care adviser
Chris Jennings, who called it "encouraging" (McGinley, Wall
Street Journal, 11/21). The collaborative approach of the
groups is also receiving "generally positive early reviews on
Capitol Hill," the New Orleans Times-Picayune
reports. Sen. John Breaux (D-La.) said, "This is more of a
political breakthrough than a policy breakthrough. It could be
very helpful to Congress. Traditionally, these groups have been
on opposite sides, and they have strong constituents" (Walsh, New Orleans
Times-Picayune, 11/21). Sen. Edward Kennedy
(D-Mass.) also lauded the groups' efforts. "The fact that these
three respected organizations agree on a plan to expand health
insurance coverage is an excellent sign that bipartisan
cooperation and progress are possible on this important issue
next year" (Pear,
New York Times, 11/21). But the plan is getting
its share of criticism as well. Neil Trautwein, director of
employment policy for the National Association of Manufacturers,
labeled the plan a "big-government approach" (Wall Street
Journal, 11/21). The California Nurses Association said
the plan has "serious flaws," with President Kay McVay saying,
"[T]his half-baked plan won't get us to universal health
coverage. It veers far off course by linking a sound program,
Medicaid, to flawed plans like CHIP and the highly risky use of
tax credits" (CNA release, 11/20). Don McCanne, a member of the
board of Physicians for a National Health Program, criticized
Pollack and Kahn for jettisoning their "ideal" strategies in
favor of a compromised approach. "The rejection of 'ideal'
reform based on political expediency must be challenged," he
said. McCanne also criticized HIAA for representing a "morally
corrupt industry" which "is designed specifically to divert our
health care dollars to their own coffers" (McCanne letter,
11/21). To view a Web cast of the press conference, please go to
http://www.kaisernetwork.org/health_cast/hcas
t_index.cfm?display=etail&hc=81d.
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