понедельник, 8 октября 2012 г.

States tackle the health insurance crisis. (State Policy Watch).(Brief Article) - Healthcare Financial Management

The problems just don't seem to want to go away. Small - employer health insurance premiums continue to skyrocket at double-digit rates. Individuals' health spending continues to rise through higher premium sharing, deductibles, and copayments. The number of uninsured individuals continues to grow.

And states continue to struggle to meet the challenges. State legislators are seeking policies that will make health insurance more affordable, particularly in the small-group market. According to results of the Health Policy Tracking Service's 2003 Health Care Priorities Survey, 38 states intend to make health insurance issues a top priority.

Enacted Legislation

Although the 2002 sessions focused primarily on balancing state budgets, a few states, such as Colorado and Maine, managed to enact significant reform measures. The Colorado bill allowed small-group carriers to sell high-deductible plans with medical savings accounts.

In Maine, Coy. Angus King signed into law bills establishing the Small Business Coverage Plan and Consumer Choice Health Plan. The Small Business Coverage Plan establishes a private-public partnership designed to provide healthcare coverage to small employers, self-employed individuals, and their employees and dependents. The Consumer Choice Health Plan is an independent executive agency charged with negotiating and purchasing healthcare coverage for both individuals and small employers. The plan's five-member board of directors is charged with contracting with participating health insurance carriers to offer at least three health benefit plans to enrollees-a fee-for-service plan, a managed care plan, and a point-of-service plan.

Legislation on the Table

To date in the 2003 legislative sessions, several states have introduced various proposals that address the current health insurance crisis.

Twelve states--California, Colorado, Georgia, Hawaii, Indiana, Maine, Missouri, Montana, New Hampshire, New Mexico, New York, and Pennsylvania--have introduced legislation establishing tax credits/tax deductions to offset the cost of rising health insurance premiums.

Five states have introduced purchasing alliance legislation. Montana introduced legislation that amends its current purchasing-pool provisions by decreasing the number of employees needed to form a voluntary purchasing pool from 1,000 to 51. The other states that have introduced legislation establishing purchasing alliances or amending existing requirements are Arkansas, New York, Tennessee, and Utah.

In his state-of-the-state address, Wisconsin governor Jim Doyle mentioned that he would establish a statewide health insurance purchasing pool, targeting small businesses and farmers. Details were not provided in his address.

Four states--Colorado, Oklahoma, South Dakota, and Vermont-introduced legislation establishing or changing the state's high-risk pool.

And although radical coverage bills are unlikely to be enacted, nine states--California, Connecticut, Hawaii, Maine, Massachusetts, Minnesota, Missouri, New York, and Vermont--introduced legislation that either establishes a publicly funded single-payer system or an employer-based healthcare coverage system that would provide health insurance coverage to every employee.


Regarding mandated-benefit legislation, HPTS anticipates that relatively few states will enact new coverage requirements for insurers during the 2003 sessions, compared with the results of past surveys. Instead, legislators may introduce bills that would allow insurers to sell 'bare-bones' or stripped-down policies-- policies that don't provide coverage for all the state-mandated health benefits-to create more affordable health insurance policies. Arkansas, North Dakota, and Utah have enacted bills that allow for the provision of 'barebones' health insurance policies in their respective health insurance markets.

State lawmakers may continue requiring cost-benefit analyses to accompany bills providing coverage for specified benefits and services. Since 2001, six states--California, Florida, Louisiana, North Dakota, South Carolina, and West Virginia--have enacted legislation to study the financial impact of assessing new coverage requirements and/or evaluating current coverage mandates.

While Congress continues to deliberate the various measures before it, state policymakers will continue to seek solutions and enact policies that will make health insurance more accessible and affordable for their constituents. State policymakers are in a better position to address innovative policies that will provide an overall decrease in the number of uninsured nationwide by taking quicker action on proposals that make it easier for individuals and small businesses to purchase affordable health insurance policies.


Following is a list of various on-line resources offering a wealth of information about state-level healthcare delivery and financing.

CMS Directories

State and Federal Medicaid Contacts (www.cms.hhs.gov/medicaid/mcontact.asp)

CMS Intermediary and Carrier Directory (cms.hhs.gov/contacts/ incardir.asp)

CMS: State Children's Health Insurance Program (SCHIP) Status Report and Contact Information (www.cms.hhs.gov/schip/ statepln.asp)

State Government Directories

State and Local Government on the Net (www.piperinfo.com/ state/index.cfm)

State Insurance Department Web Sites (www.naic.org/lregulator/ usamap.htm)

Federal Agencies and Research Organizations

Census Bureau (www.census.gov) provides national and state-level statistics on population, poverty, area profiles, and more.

Center for Studying Health System Change (www.hschange.com) offers reports on healthcare costs, coverage, emerging market trends, and more.

CMS Health Care Indicators (cms.hhs.gov/statistics/health-indicators/default.asp) contains data and analysis of recent trends in healthcare spending, employment, and prices and the anticipated direction and magnitude of healthcare cost changes.

Kaiser Family Foundation (www.kff.org) funds research to help inform policymakers and the public on key healthcare issues. Includes State Health Facts Online, a free resource that will be especially useful in identifying other key state resources (www.statehealthfacts.kff.org).

National Center for Health Statistics (www.cdc.gov/nchs) provides a wealth of healthcare-related data, including life expectancy, leading causes of death, hospital utilization, and key national indicators of well-being. Some data are available at the state level.

This report was prepared for hfm by the National Conference of State Legislatures' Health Policy Tracking Service (HPTS). For more information about HPTS, go to www.hpts.org/info.