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Adam Thompson on March 15, 2007 - 8:22am
Illinois gained headlines in 2005 for its first-in-the-nation plan to provide health care for all children in the state, called AllKids. Pennsylvania followed suit in 2006 with its own Cover All Kids plan. Now the Governors of each state have proposed comprehensive health care reform packages with the goal of universal access to health care. The plans build on reforms in Maine, Vermont and Massachusetts, but go further in key areas of affordability and system reform.
Illinois Covered: Illinois Governor Rod Blagojevich announced Illinois Covered, a blend of Medicaid expansions for adults, employer "pay or play" mandates, and premium assistance to help the state's 1.4 million uninsured obtain quality and affordable health care within three years. Illinois Covered stands out because of its proposals to ensure affordable access for the uninsured:
- First, the program provides premium subsidies to individuals and small business employees with incomes up to 400% of the poverty line, or $80,000 for a family of four, far more extensive subsidies than in Massachusetts and other proposed programs.
- Second, the plan limits premium payments to a percentage of annual income. For instance, premiums for participants up to 400% of poverty are capped at 2.5% to 3.5% of income for an individual and 5% to 7% of family coverage. Directly tying premium payments to income is a model for other states to replicate.
Gov. Blagojevich estimates his package of reforms will cost $2.1 billion, including fees for firms not providing health care and other taxes on business transactions. Although numerous polls show that Americans are willing to pay more in taxes for universal health care, few politicians have been willing to act, so Gov. Blagojevich deserves credit for putting real money on the table for reform.
Prescription for Pennsylvania: Governor Ed Rendell's Prescription for Pennsylvania is one of the most detailed and comprehensive packages to achieve universal access to quality and affordable health care and to improve the health care delivery system. By one count, it includes 47 different ideas to cut health care costs. The Governor's plan aims to take on the estimated $7.6 billion in unnecessary and avoidable health care costs to help expand coverage for the state's 767,000 uninsured.
Key provisions include:
- Premiums for low income individuals and employees of small businesses, provided on a sliding scale below 300% of the poverty line, in a program called "Cover All Pennsylvanians".
- Requiring insurers in the small group market spend at least 85% of premiums on medical care, versus profits and administration, helping to ensure affordable insurance.
- Adding adjusted-community-rating to the small group and individual markets, which prevents insurers from including factors other than age, family or firm size and geographic region when setting premium rates.
- Requiring insurers to provide dependent coverage up to age 30, because 49% of the state's uninsured are between the ages of 18 and 34.
What sets the plan apart from other states is its array of aggressive proposals to improve quality and reduce the costs of the health care delivery system, from requiring hospitals to implement infection control programs to improved management of chronic diseases, like Vermont's Blueprint for Health. Additionally, Gov. Rendell wants to establish pay for performance and will start by requiring state programs to identify "Preferred Providers" who meet evidence-based standards for care, all part of his cost control plan.
Elsewhere: Going beyond plans that build on the current system of employer-based coverage, a plan to create a single-payer health care system in Connecticut made it through the state legislature's typically conservative Insurance and Real Estate Committee. And in Oregon, the Senate Special Committee on Health Care Reform is currently holding town hall meetings on a number of health care reforms, including the committee's own SB 329 and former Governor John Kitzhaber's SB 27, the Oregon Better Health Act, which seeks federal authority to allocate Medicaid, Medicare and other public dollars being spent in the state in a way that provides health care to all Oregonians.