Health Care Reform 3

There are 46 million Americans that are uninsured and this number is growing. This population tends to be poor, less educated, working in part-time jobs, and/or working for small firms. We are proposing that Congress pass legislation to offer refundable tax credits for health insurance for low-income individuals and families. Tax subsidies already exist, but are targeted towards people with middle to high incomes. These tax credits that are refundable are close to a voucher and are income based. They can also be applied to work or private non-group insurance. Currently uninsured individuals could get access to coverage and many could see the costs of health insurance go down.

Cost, access, and quality would all be affected by this. We believe that costs should not have to rise in order to have access to health care. We also believe that the uninsured should have equal access and improved outcomes as the insured. With tax credits, the cost for health care would not have to increase if flexible tax credits were used. For example, if there was a single-purpose tax credit per worker, expanding it into a flexible benefits tax credit would not increase government budget costs. There are greater benefits to using a flexible tax credit rather than a single-purpose tax credit. Access to health care would be influenced by this as well. Flexible tax credits could expand coverage for workers as well as children and it could protect employer-group insurance and retirement savings. Access to health care would greatly increase, especially for low-income individuals and families. When people are covered by health insurance, they are more likely to use health care services. Some improved outcomes would include less uninsured, more protection, and benefits for workers. Tax credits could help create economic security for Americans.

According to the article, A Flexible Benefits Tax Credit For Health Insurance And More, A flexible benefits tax credit could offer many families aid that they can use for their different situations and needs as times change. In the article it states that the lack of health insurance coverage is usually only a problem for a short-time, from six months to a year. It also stated that a flexible tax credit would achieve the broadest extension of health benefits and economic security for American workers. In the article it considered two options for flexible tax credit. The first option described how a flexible tax credit could achieve health insurance coverage for workers and their families. This is the reform we are proposing. The second option described how flexible benefits tax credit could also be expanded to include retirement savings, withdrawal options for higher education, first time home purchases and catastrophic medical expenses.

Our proposal is more important than competing proposals because it is solving one of the biggest problems that our nation faces, the unbelievably large amount of uninsured. The tax credit option would be available to over 40 million uninsured people. These people and families would have fewer visits to doctors for extreme medical cases, resulting in less money spent. This aligns with our teams view on wellness. The tax benefits are promoting healthier lives for families.

Some people may believe our stance is less important because of the word “tax.” It is the people’s money going towards other people problems. The word tax is usually not associated with anything good in our society. However, we believe that the benefits would out way the costs in the end. The number of families benefiting from the tax benefits would be enormous. Families would avoid bankruptcy due catastrophic medical problems. They not only would be able to afford health insurance but also to pay for education or to buy a new home.


References

Burman, Leonard E. and Gruber, Jonathan. (2005) Tax Credits for Health Insurance
http://www.urban.org/uploadedpdf/311189_IssuesOptions_11.pdf

Health Affairs: The Policy Journal of the Health Sphere. (2001).
A Flexible Benefits Tax Credit For Health Insurance and More. Retrieved March 23, 2009 from http://content.healthaffairs.org/cgi/content/full/hlthaff.w1.1v1/DC1

Lynn, E. (2001). A Flexible Benefits Tax Credit for Health Insurance and More. The Policy Journal of the Health Sphere.
http://content.healthaffairs.org/cgi/content/full/hlthaff.w1.1v1/DC1

Meara, E., Rosenthal, M., & Sinaiko, A. (2007). Comparing the Effects of Health Insurance Reform Proposals: Employer Mandates, Medicaid Expansions, and Tax Credits. Employment Policies Institute.
http://www.epionline.org/study_detail.cfm?sid=104

Shi, L., & Singh, D. A. (2008). Delivering Health Care in America: A Systems Approach (4th ed., pp. 441-443). Sudbury, MA: Jones and Barlett Publishers.

Health Care Reform 2

We are proposing that Congress should develop state-wide programs to create better connections between supportive and clinical care delivery systems to improve the care of those with chronic conditions. Chronic illness and disability are the major cause of illness, disability, and death in the U.S. By 2010, 141 million Americans are projected to have a chronic condition. The following chronic diseases cause over two-thirds of all deaths each year: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. With proper care, the onset and progression of these diseases can be contained for many years.

Care provided in the current system is not cost-effective and often leads to poor outcomes for patients with chronic conditions. The medical care costs of people with chronic diseases amount to an estimated $1.7 trillion annually. People with chronic conditions are the heaviest users of health care services in all major service categories. They account for 72 percent of all physician visits and the majority of dollars provided my Medicare and Medicaid. People who have chronic conditions have trouble receiving quality care from the current health care system. Many have trouble accessing needed services such as medical specialists, mental health services, and in-home health care. Necessary services frequently extend beyond the clinical setting to supportive services such as home health care and personal assistance.

Chronic conditions require continuous care and coordination across various health care settings and providers. An improved system for caring for people with chronic conditions will ensure that a connection is made between clinical and supportive services, with an individual’s specific needs in mind, and that these services are readily available and affordable. Chronic care management helps patients monitor their progress and coordinate with experts to identify and solve problems they encounter in their treatment.

Moving to a care model that emphasizes care management will not be an easy task, but it has been done. Providers, policymakers, payers, and patients can work together to change the current health care system. Sutter Health in northern California is an excellent example of how this can be effectively done. Special monitoring devices allow patients to input a variety of health information into a database that is observed by a team of nurses. When a patient fails to check in to the monitoring system the care team is notified and a call is made to the house. The outcomes of this system have been significant. Emergency visits for those enrolled in the program are about half of those for general patients. Sutter saves approximately $600 a month for each member. And, perhaps most important, quality of care is improving. Nearly 80 percent of patients say they are better able to manage their chronic illness.

In the coming years, our health care system will devote increasing amounts of resources to the care for people with chronic conditions. Our reform proposal aims to make sure the chronically ill receive the care that is necessary for their daily functioning. This concept is important to ensure that these resources are spent wisely to maintain the health and functioning of this large segment of our population.

References:

Anderson, G., Knickman, J. (2001). Changing The Chronic Care System To Meet People’s Needs” Health Affairs, Vol. 20 No. 6, pp:146-159.

Anderson, Gerard, Robert Herbert, Timothy Zeffiro, and Nikia Johnson. (2004) Chronic Conditions: Making the Case for Ongoing Care. Retrieved March 10, 2009 from http://www.partnershipforsolutions.org/DMS/files/chronicbook2002.pdf

Bodenheimer, Thomas, Kate MacGregor, and Claire Sharifi. (2005).Helping Patients Manage Their Chronic Conditions. Retrieved March 13, 2009 from http://www.chcf.org/documents/chronicdisease/HelpingPatientsManageTheirChronicConditions.pdf

Center for Disease Control and Prevention. (2008) Chronic Diseases Overview. Retrieved March 9, 2009 from http://www.cdc.gov/nccdphp/overview.htm

Center for Disease Control and Prevention. (2008) Chronic Disease Press Room. Retrieved March 12, 2009 from http://www.cdc.gov/nccdphp/press/index.htm

Shi, Leiyu, and Singh, Doughlas A. (2008) Delivering Health Care in America: A Systems Approach. p. 460-462

Health Care Reform I

We are proposing that Congress should pass legislation requiring all 50 states to offer non-profit insurance plans, or HIPs. Approximately 2.5 million people in the U.S. suffer from pre-existing medical conditions and more than 90 million Americans live with chronic conditions. This makes it likely that their medical expenses can be extremely high or that they will not be able to acquire coverage from an insurance company. A state-chartered, not-for-profit health insurance plan can provide access to health care for people with special medical needs.

Typically insurance companies keep between 15 to 25 percent of premiums they collect to cover administrative and marketing costs, plus profit. With our reform, states would have to offer insurance for these people and the money would be used for services and administrative costs only, none for big profits. HIPs would be financed by small assessments on premiums paid to private insurers, thus being able to spread the cost of covering the uninsured over a broader base than what is done currently.

Premiums for employer-based health insurance rose 5 percent in 2008. Workers on average are paying 12 percent more than they did in 2008. With non-profit insurance plans these increases would cease and premiums would be lowered. With cheaper premiums available more people would be able to afford health care. In 2006, the insurance industry made more than $15 billion in profit. With non-profit insurance plans in place, that $15 billion dollars could be kept in the hands of the people. Also, capping HIP premiums and imposing assessments on premiums provided by private insurers can keep HIPs affordable.

HIPs can increase access to health insurance by allowing the insurers to put people with pre-existing medical conditions into pools and subsidizing their premium. Currently, states that do not offer HIPs require private insurers to write policies for the medically uninsurable that creates problems for the insured majority, such as higher premiums, and maintains a larger number of uninsured. Access to quality medical care can be maintained with HIPs since there will still be free-market principles applied to health care and continued limited government involvement.

According to an article from the Alliance for Advancing Nonprofit Health Care, nonprofit health care plans act differently than for profit plans in regards to performance, efficiency, and contribution to safety net programs. A study was done on the New York State insurance market because it provides both for-profit and nonprofit environments (currently 28 states offer HIPs). This study helped to evaluate the two types and concluded that nonprofit health care can insure more people at a lower cost. If the country can gear toward nonprofit health care, premium and administrative costs will be lower, and there can be an increased access to health care for the at-risk population.

People may find that our health care reform will not work due to some increase in costs and more influence from the government. Although non-profit Health Care Plans are becoming more popular, it is unlikely the U.S. will eliminate all private health care groups in the near future so people can choose which one. However, in the long run we believe the benefits will outweigh the cost factor.

It is unfair that many health care plans turn down people in the special population’s category. Our reform proposal aims to make sure this population is covered by health insurance. Ordinary health insurance usually does not work for people with pre-existing conditions. However, HIPs provide affordable health insurance to a much larger group of people. Moving to nonprofit care would eventually create fairness in the world of health care. Also, we would have a system that ultimately insures the uninsurable. This is an important concept in order to prevent the sick population from getting sicker.

American Federation of Labor-Congress of Industrial Organizations. (2009). Pharmaceutical and Health Insurance Companies are Pulling in Huge Profits. Retrieved February 26, 2009, from http://www.aflcio.org/issues/healthcare/facts_insurancecompanyprofits.cfm

Benefits of Nonprofit Health Plans to a Region (2008). Alliance for Advancing Nonprofit Health Care. Retrieved February 27, 2009 from, http://nonprofithealthcare.evancms.com/documentView.asp?docid=171

Meier, C. (1999). Extending Affordable Health Insurance to the Uninsurable. Medical Sentinel, vol. 4, 6 ed., 216-217. Retrieved February 27, 2009 from http://www.jpands.org/hacienda/meier.html

National Coalition on Health Care. (2009). Health Insurance Cost. Retrieved February 26,2009, from http://www.nchc.org/facts/cost.shtml

Shi, Leiyu, and Singh, Doughlas A. (2008) Delivering Health Care in America: A Systems Approach. p. 460-462