Writing in the July 25th Erie Times-News, Richard McVay from Penn Action encourages Republicans not to stand in the way of long-overdue reform in our health care system.  Here is McVay’s letter.

“Pennsylvania Access to Basic Care would reverse (the decline in employment-based health coverage) by providing a privately issued alternative that is affordable for many employers. While $150 per employee per month might be too much for one of the businesses featured in your article, it looks pretty reasonable compared to the $450 per employee per month paid by the other employer your article featured.

“The main contribution to this discussion by Ralph Pontillo, president of the Manufacturers and Business Association, was to spout anti-government ideology.  Could it be that his association’s financial interest in the health insurance business prompts his dismissal of Access to Basic Care, which is plainly a positive solution for many small businesses?

“Old practices of demonizing health-care reform are not applicable today.  Gove. Ed Rendell has provided the leadership.

“The Republican response must not stand in the way of long-overdue reform.”

“The health care picture of the future isn’t (just) cloudy.  There will be devastating financial consequences if we don’t hunger down and prepare for a severe fiscal storm.” 

So writes John Wasik, a Bloomberg News columnist, in the Boston Globe.  Unless we get costs under control, health care spending will consume 20 percent of U.S. income by 2017.

The road to a solution will merge private and public interests, says Wasik.  It will ensure unviersal access to care, cost control, and long-term financing. 

A July 6th Associated Press article published by the Houston Chronicle focuses attention on the impact John McCain’s health plan would have on employment-based health insurance.

“How many employers would drop insurance coverage for their workers because of (McCain’s) tax policies?

“The Republican presidential nominee-in-waiting has proposed that everyone buying health insurance get a refundable tax credit, $2,500 for individuals and $5,000 for families.  At the same time, he would treat employer contributions toward health insurance like income, meaning workers would have to pay income, but not payroll, taxes on it.”

Most analysts agree that this would cause a major restructuring of the health insurance market.

“Younger, healthier (workers) are most likely to buy a policy on the individual market for less than their tax credit, said Paulo Fronstin, a senior research associate at the Employee Benefit Research Institute, which studies employee benefits.  To the degree that happens, the employer-based market will become less healthy as sicker, older workers stay with their employer-based coverage while more of the healthier workers move to the individual market.

“‘What you’ll see happening is average cost in the employer-market will go up and average cost in the individual market will go down,’ Fronstin said. ‘You’ll start to get into a cycle where people at the margins start to leave employer coverage for individual coverage.  At some point, employers will start to ask:  Why am I doing this if my workers don’t value it anymore?  If I don’t need to do this to be competitive in the labor market, why should I do it?’”

 To read the full article, follow the link above.

At the grassroots level, those who are passionate about health system reform fall into two camps:  the purists and the incrementalists.  The purists are working for a single-payer system in which private insurers would play no  part and everyone would have access to health care via a national health care program similar to Medicare.  The incrementalists are working to reform our existing system so that the current players (including the insurance companies) play a more constructive role and everyone has health care coverage.  

PHAN is on the incrementalist side of things.  We support changes that will improve health access and bring health costs under control.  Senate Bill 1137 and House Bill 2005 are examples of the incremental changes we support. 

HealthCare4ALLPA is on the purist side of things.  Its members support single-payer legislation. To date, they have not supported SB 1137 or HB 2005 because both bills assume a continuing role for private insurance companies.

PHAN includes people who straddle this division.  These individuals support the goal of a single-payer system and also are working to achieve incremental gains that move our society in that general direction.  However, most single-payer activists have not been willing to join reform efforts (such as PHAN) that retain a role for private insurance companies.  This has weakened the broader reform effort.

As we approach the general elections and the sitting of a new Congress in January, 2009, it will become increasingly important to heal this rift between the purists and the incrementalists.  Certainly health system reform will be on the agenda of the next Congress. For it to succeed, it will need to attract the support of 60 senators, including all moderate Democratic members and some moderate Republican members.  So long as health reform activists fail to work together, the chance of winning the support of 60 senators is greatly diminished. 

Writing in the May issue of The American Prospect, Ezra Klein describes “The Elusive Politics of Reform“, including the two plans that have a realistic shot at attracting 60 votes in the next United States Senate. 

The first plan Klein describes is “single-payer by stealth”.  If you like your current health insurance plan, you could keep it.  If you don’t like it, or if you don’t have access to health insurance, you could buy coverage from a program modeled after Medicare.  Experts who have analyzed this plan estimate that participation in the two options would initially be roughly equal.  Over time, people would gradually shift toward the option that proved most cost-effective.  If that were the public health plan, then eventually our society would adopt a single-payer system like Medicare for all.

Currently, this hybrid plan is supported mainly by Democrats (including Senator Barack Obama).  The second plan that Klein thinks has a realistic chance of success in the next Congress is supported by Republican and Democratic senators.  Klein calls it the “bipartisan reform” plan.  According to its primary proponent, Senator Ron Wyden of Oregon, everyone would purchase his/her own health insurance from a “Health Help Agency” in each state.  These HHAs would be highly regulated entities that make sure all insurance plans offered to consumers meet minimum requirements.  There would be no denials of coverage or high premiums because of pre-existing conditions; everyone who bought the same policy would pay the same price.  And there would be subsidies for those with low incomes and penalties for those who failed to purchase coverage.

As we approach this national debate about health system reform, can the purists and the incrementalists more fully join forces?  Perhaps; there are a few encouraging signs at the national level.  While the purists continue to criticize the incrementalists (given the philosophical differences, they probably always will), the tone of recent criticism has become more respectful.  Once we tone down the criticism and begin showing respect for one another’s intentions, won’t the opportunity to make a positive impact in the lives of millions of Americans bring us together? 

I hope so.  Our success depends on it.

Berry Friesen, Public Affairs Manager, PA Health Access Network

In Pennsylvania, most uninsured adults (70 percent) have jobs and are working.  Half of these individuals work for small companies that have fewer than 25 employees. Public policies designed to reduce the number of the uninsured must find a way to expand group health coverage among these small employers.

A July 10th article in the New York Times describes what other states are doing about this.

Two bills passed by the Pennsylvania House of Representatives (and awaiting action in the Pennsylvania Senate) would help small employers provide coverage to their employees. 

Senate Bill 1137 would provide a group health insurance plan (Pennsylvania Access to basic Care) that small employers paying an average wage of $15 an hour or less could purchase at a monthly cost of $150 - $311 per employee.  If such employers already have a health plan in place for their employees, then they could qualify for an annual CARE grant to help defray the cost.  This grant would provide up to 25 percent of the cost of each employee covered by the plan but not more than the employer’s tax liability.

House Bill 2005 would adopt new rules for insurance companies selling group health insurance plans to employers with 50 or fewer employees.  First, when pricing coverage for a group, insurance companies would be required to use a “communty rating” that reflected the age of the employees and where the employees work but not their medical histories or gender mix.  Consideration of pre-existing medical conditions would not be permitted.  Second, insurance companies would be permitted to use only 15 percent of premium dollars to cover their costs and profits.  

For more information about either of these bills, or to become a member of PHAN’s Small Business Network, return to the homepage on this site. 

“Health insurance is what people want and need, the dollars are there, and the plan the House has assembled is cost-effective.  It’s past time  to get the job done.”

The General Assembly has left Harrisburg for the summer without addressing the needs of adults for health insurance, without authorizing payments to hospitals to help them with medical malpractice costs, and without authorizing the Pennsylvania Health Care Cost Containment Council (PHC4) to continue its mission.   The process broke down over the health insurance piece.  The House wouldn’t act on the medical malpractice insurance unless health insurance expansion was included.  Senate leaders showed little interest in the House plan for health insurance expansion and wouldn’t reauthorize the PHC4 unless medical malpractice insurance was included.  In the end, none of it got done. What happened?  Read the full analysis here.

The editors of the Uniontown Herald Standard didn’t mince any words in their assessment of the Pennsylvania legislature’s recent performance:

“Hold the champagne.  Legislative leaders may have been able to strike a deal on the budget, but did not address one of the most important issues facing Pennsylvania:  health care.  The good portions of the budget threaten to be overshadowed by this monumental failure.” 

“The inability of the Legislature to address the health care crisis is not only disappointing - it’s an outrage, considering that they are the same folks who are entitled to free health care for life after just 10 years of service.”

Lawmakers will be returning to Harrisburg in September to try again.  They will have 12 days to pass health care access reform before again recessing for the November election.

Activists have been showing up at district offices of state senators recently with a sober message:  delay in acting on Senate Bill 1137, the House-passed plan for Pennsylvania Access to Basic Care (PA ABC), will cause more Pennsylvanians to die because of inadequate access to health care.

To illustrate the seriousness of the matter, activists have been displaying shoes outside the offices of senators and on the steps of the Capitol.

“We just want to point out that people in the Commonwealth and the county are dying because they don’t have health insurance,” said John Meyerson, political director of the United Food and Commercial Workers Local 1776.  Meyerson was part of a group that gathered outside the Newtown office of Senator Ted Erickson on July 2nd.  For a full report, click here. 

Earlier, another group assembled outside the office of Bucks County Senator Tommy Tomlinson with a similar message. 

On June 24th, 200 pairs of shoes were arranged on the Capitol steps, each pair bearing witness to one Pennsylvanian who had died during the 100 days since the March 17th passage by the Pennsylvania House of PA ABC.  Among the advocates calling for the Senate to act on the House-passed bill were Rev. Neil Harrison of Lutheran Advocacy Ministry of Pennsylvania and Jacqueline Rucker, executive director of Christian Churches United of Harrisubrg. 

According to a report from Families USA, and based on data collected by the national Institute of Medicine, an estimated 710 Pennsylvanians between the ages of 25 and 64 died in 2006 because they lacked health insurance.  That was approximately two Pennsyvlanians each day.

Marc Stier, health care campaign manager for the Service Employees International Union - Pennsylvania State Council, has drawn an analogy between HealthNetPA, the health access plan unveiled by Senate Republicans June 10th, and the barefoot doctor program launched by Chairman Mao in the People’s Republic of China in the mid-’60s.

Writing in the June 23rd edition of the Allentown Morning Call, Marc wrote: 

“In 2008, we live in the world’s richest country.  Yet the Pennsylvania Senate Republicans have taken a page from Chairman Mao.  Rather than help the uninsured purchase affordable health insurance, they are calling on volunteer physicians and oversubscribed health clinics to give medical care to 334,000 Pennsylvanians.”

“The barefoot doctor plan insults the uninsured, 70 percent of whom work full-time and pay taxes, because it treats their health needs with contempt.  Rather than offering an opportunitiy to buy affordable heatlh insurance, it tells them to get in  line at a health clinic and then, if they needs a specialist’s care, testing, prescription drugs, medical equipment or a hospital bed, to beg for freebies.  This is dismissive and demeaning.”

Marc goes on to discuss Pennsylvania Access to Basic Care (PA ABC), the program that gained bi-partisan support in the House in March.  “It would take us nearly half-way to our goal of providing affordable health insurance to the uninsured.  Under it, uninsured adults would pay reasonable rates for health insurance that gives them access to the medical care missing in the Republican program.”

A growing number of medical professionals are asking the Pennsylvania Senate to support Senate Bill 1137, including Pennsylvania Access to Basic Care (PA ABC).

In a May 29th letter to Senate Majority Leader Dominic Pileggi, the Pennsylvania Association of Licensed Midwives wrote:  “We believe that this bill is critical to the immediate need for access to health care for the uninsured and under-insureed citizens of the Commonwealth.”

The Pennsylvania State Nurses Association is also on board.  In a June 18th statement, it strongly supported PA ABC  and urged the Senate to get behind the plan. 

 In an petition effort organized by the National Physicians Alliance, over 60 physicians have requested passage of SB 1137.