EQUAL Statements on Public Insurance Plan

The President should support and

Congress should pass

EQUAL Health Reform that

Meets Our Needs

The House bills offer more secure coverage, more affordable health care and medicines, better quality of care, improved preventive care and public health protections. Employers will have to contribute to the costs of insurance. Insurance company regulations will be tightened so that people cannot be denied coverage due to pre-existing conditions, and companies can’t rescind payments for your treatments mid-stream.

Here’s how we can do better!

§    A strong public plan option

·        Starts right away

·        Anyone can join

§        More Affordable: Eliminate age rating

§        Insurance company care share (loss ratio) 90%

§        Expand Medicaid, at federal expense (not state)

§        Women’s health: Assure women have access to reproductive services. Respect women’s decisions.

§        Legal immigrants: Eligible for benefits immediately

Keep what works:

§        Pass Dennis Kucinich’s state single payer amendment as part of the health reform bill

§        Strong public plan

o       Include all Medicare providers as a base

o       Reimbursement rates tied to Medicare

o       Nationally administered

§        Premium subsidies up to 400% FPL, to 11% of income

§        Public health: Shifts resources to wellness, prevention

EQUAL Health ® Equitable Quality Universal Affordable

EQUAL CRITERIA FOR A PUBLIC INSURANCE PLAN

A public insurance plan must be open to everyone as a voluntary choice, and must begin immediately. It must be large enough to have the clout to control costs, and to improve coverage, affordability, quality and choice. Minimum features include:

1. Eligibility.

The public insurance plan must have sufficient enrollment of healthy people to be financially viable, and must be open to everyone to be fair
Anyone can enroll, unless in Medicare. The public plan is the default option for newly insured or uninsured. Currently insured people can switch to the public insurance plan.
Can continue coverage for life

2. Comprehensive Benefits.

Add to Medicare benefits: clinical preventive services, reproductive health services, maternal and child health, mental health and substance abuse, alternative and complementary medicine, home and community based care, long term care, rehabilitation, hospice services dental, vision and drug. Private plans must meet or exceed this standard
No out of pocket payments for services recommended by U.S. Preventive Services Task Force

3. Affordable coverage…

Total individual health expenditures limited to 10% of income; lower limits for individuals and families at lower income levels, adjusted by geographic area
Subsidies for low-moderate income.

with fair and stable financing…

Finance through public sector fund
Maintain employer and employee contributions

that controls costs.

Implement careful levers to control health system costs, as the Finance Committee recommends for Medicare, such as reimbursement incentives for team approaches that provide appropriate, high quality care.
Use Medicare reimbursement schedules. Explore other joint functions with the Center for Medicaid and Medicare Services (CMS) regarding reimbursement policies, monitoring and reporting utilization.
Purchase or negotiate for pharmaceuticals on the same terms as other government programs including Medicaid and the Veterans Administration.
Establish systems to monitor for and report on cost shifting among programs and regions. In the event an uneven distribution of risk, adjust risk-related payment annually, and report on other actions to control cost-shifting.

4. Publicly accountable administration.

Administered by the Center for Medicaid and Medicare Services (CMS).
Include an Inspector General.
Explore joint functions with CMS regarding public review bodies.

5. Quality of care.

Collect and report data on regional variations in medical practices, and on outcomes associated with delivery system reforms.
Promote access to clinical preventive services, primary care, integration of health care services, care coordination, team-based care.
Monitor and assure culturally and linguistically appropriate services

6. Improve population health. Coordinate with public health departments to assure delivery systems in underserved areas

Early detection of and response to epidemics
Cooperate with policy development based on health impact assessments

Center for Policy Analysis w Phone: 415-922-6204 w ershaffer@gmail.com w www.centerforpolicyanalysis.org

Rekindling Reform w www.rekindlingreform.org

Joint statement on the Public Plan by Rekindling Reform and the Center for Policy Analysis: The Public Plan in a Nutshell

Opinion polls in the United States show overwhelming support for access to health care that is accessible, affordable and responsive to people's needs, that is sure to be there when they need it and gives them peace of mind. The existing U.S. system falls sadly short.

Government could guarantee such a human right to all through universal national, social, health insurance – a single payer system. However, it is clear that Congress is not pusuing that course. That leaves one effective course open to Congress: to develop a new social insurance option through the public plan. This paper details the features a public plan must have.