State Health Care Reform Plans Offer Guidelines for Future

Article excerpt

With the appointment of Hillary Rodham Clinton to direct the national health care reform process and his vow to present a plan to Congress in 100 days, President Clinton has acknowledged the urgency of resolving the health care crisis.

The debates rage on over legislation to contain the explosive costs of health care, and ensure universal access to care. Underlying this lack of consensus in Washington, D.C., is a growing momentum of intellectual resources and energy on the state level to resolve the inefficient and inaccessible health care system.

As states take on resolution of the health care crisis within their own borders, two questions arise: Can reform on the state level be successful? What can we expect in the future of health care? By examining several examples of state reform plans and analyzing Oklahoma's own proposal, one can assess the viability of state health care reform plans and obtain some directive for the future.

Three states exemplify some of the diverse mechanisms for change in health care systems being pursued. Hawaii _ Considered a leader in health care reform, Hawaii has achieved wide insurance coverage through two pieces of legislation. Since 1974, employers in Hawaii have been required to provide insurance for all full-time workers through the Health Care Act.

Employers pay at least one half of the premiums, and the employee must not pay more than 1.5 percent of his or her wages. For smaller businesses, a premium supplementation fund was established. This coverage plan also requires insurers to accept all employees.

In 1988, the State Health Insurance Program was enacted to increase coverage opportunities by providing for those residents not included in the previous legislation. It subsidizes the costs of premiums to individuals on a sliding scale and offers low cost insurance to people with incomes below 300 percent of the poverty line.

These two major pieces of health care reform, in addition to Medicaid, have achieved almost 93 percent coverage of Hawaiian residents. A significant aspect of Hawaii's system is the fact that only two insurers exist: a local Blue Cross-Blue Shield affiliate and Kaiser Permanente, a health maintenance organization.

Both insurers favor primary and preventive care, which results in less time for patients in hospitals. This is the main reason for Hawaii's low health costs. The two competitors act as cost regulators as they compete for clients.

A final noteworthy aspect of Hawaii's plan is a health planning agency established to control medical technology in order to avoid duplication and waste. Problems exist in Hawaii's plan, especially with regard to cost shifting. Because hospitals are having a difficult time keeping up with costs, privately insured patients are often charged more to cover the insufficient reimbursements received through Medicaid patients. Employers shift increased cost to their employees in the form of higher copayments. Minnesota _ Another site for studying health care reform can be found in Minnesota, where half of the population belongs to health maintenance organizations. In this type of situation, the opportunity exists for health care providers to be major participants in leading the state through the reform measures mandated in April 1992 by the establishment of MinnesotaCare.

This law establishes a commission to advise, enforce and recommend cost containment measures. The commission is made up of providers, payers, employers and consumers and has set a goal of reaching an annual 10 percent decrease in the increment in health care spending. The law also enacts state-subsidized insurance for low income Minnesotans.

Payment is set by a sliding scale according to income. Coverage began for uninsured families with children that earn up to 185 percent of the federal poverty level on Oct. …