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Senate bill based on ACP's plans to expand access

The legislation mirrors the College's call for all Americans to have health coverage by the end of the decade

From the May ACP Observer, copyright 2003 by the American College of Physicians.

By Robert B. Doherty

Three years ago, ACP began the long process of developing a comprehensive proposal to make health care coverage available to all Americans.

The task before us was daunting: Develop a plan that would reflect the core values of our members, effectively expand coverage and avoid the political pitfalls that have plagued past efforts to reform the health care system.

Those efforts, however, are now bearing fruit. Legislation has been introduced in the Senate that will translate the College's vision for health care reform into measures that stand a real chance of being enacted.

ACP's distinctive approach

The College has taken a truly distinctive approach to tackle one of the nation's most difficult challenges.

We started by defining our own core principles for health care reform and evaluating the pros and cons of various policy options. We next crafted a comprehensive proposal to expand health insurance coverage that combined these core principles with expert analysis on the feasibility and political viability of the options. Finally, we worked with an influential lawmaker to translate our positions into legislation.

The College's core principles, which the Board of Regents approved in October 2000, presented a vision of what a reformed health care system should look like. (The principles are online.) In those principles, ACP clearly stated that any proposal to expand health insurance coverage should focus on giving all Americans adequate health insurance by the end of the decade.

The College published several policy monographs that used ACP's core principles as a framework to review the effectiveness and feasibility of various policy options to expand coverage.

Finally, based on the monographs and supporting literature, ACP's Health and Public Policy Committee developed a position paper calling for a series of steps to expand health insurance coverage to all Americans over the next seven years. This paper called on the federal government to expand enrollment in public programs (Medicaid and S-CHIP), provide premium subsidies to some Americans and set up purchasing arrangements modeled after the successful Federal Employees Health Benefit Program. The paper also called for the government to give states a new option to develop their own programs for universal coverage.

ACP's Governors, Regents, councils and other interested parties reviewed the draft paper. It was then revised and submitted to the Board of Regents for final approval. The final version of the paper, which the Board of Regents approved in April 2002, is online.

Turning ACP positions into legislation

The true impact of the College's distinctive approach, however, couldn't be known until our recommendations were tested in the harsh realities of the political process. Position papers aren't worth their weight in paper if lawmakers ignore them.

The good news is that Sen. Jeff Bingaman (D-N.M.), who represents the state with the highest proportion of uninsured residents in the nation, has decided to introduce a bill based directly on the College's seven-year plan. Because he serves on both the Senate Finance and the Health, Education, Labor and Pensions committees—the two committees with jurisdiction over health-related legislation—Sen. Bingaman is in a very good position to move the legislation forward.

The bill, called the Health Coverage, Affordability, Responsibility, and Equity (HealthCARE) Act of 2003, incorporates the College's proposals to expand coverage in stages over the next seven years to cover all Americans by the end of the decade. (A summary of the bill can be found online.) Just like the College's position paper, the bill calls for the following actions:

  • Give states new options to cover the uninsured. Currently, federal law actually prohibits states from offering Medicaid coverage to low-income adults without children. The HealthCARE Act eliminates this prohibition and gives states a powerful financial incentive to expand coverage to all Americans with incomes up to 100% of the federal poverty level.

    States that participate would have any increased costs of Medicaid enrollment wholly funded by the federal government—a welcome change for cash-strapped states accustomed to unfunded federal mandates. States would also receive a financial incentive to guarantee coverage to all eligible children under the S-CHIP program.

  • Give eligible Americans with incomes up to 200% of the federal poverty level a tax credit to help them buy coverage from group-purchasing arrangements modeled after the Federal Employees Health Benefits Program. Recipients would receive the same dollar subsidy and range of health plan choices that the federal government provides to federal employees and their families. They could also opt to use the credit to buy individual (nongroup) coverage.

  • Give small employers the option of buying coverage through the same purchasing arrangement as tax-credit recipients. Businesses could offer employees the same kinds of health plan choices that the federal government gives its own employees.

  • Allow states to design and implement their own programs to achieve equal or better outcomes, through public or private programs that would guarantee coverage to all residents within their state. States that opt to roll out their own programs would be eligible for federal funding equal to the amount that the federal government would have otherwise spent covering the state's residents through Medicaid and other federally funded programs.

  • Create an expert advisory commission to recommend the essential benefits that health plans would be encouraged to offer, as well as ways to provide affordable coverage to individuals earning more than 200% of the federal poverty level. The bill would force Congress to vote on the commission's recommendations in time to enact legislation to cover all Americans by the end of the decade.

Our chances of success

The beauty of the Bingaman-ACP legislation is that it incorporates lessons learned from the failure of the Clinton health plan.

Rather than mandating a "one-size-fits-all" untested scheme, the HealthCARE Act offers states, businesses and individuals a wide choice of coverage options, based on programs that we know can work.

Instead of using heavy-handed regulations to control insurers, businesses and states, the bill offers financial and market incentives and other types of assistance to encourage stakeholders to expand coverage.

This is not to say that enacting the bill will be easy. Budget deficits, competing priorities and partisan differences will continue to hinder reform. It will take months—even years—of sustained advocacy to overcome the obstacles.

But ACP has already accomplished what few organizations have been able to do: See our ideas for solving the problem of the uninsured accepted as the basis for a major legislative initiative in the U.S. Senate.

We must now build upon our initial success by persuading the remaining 434 members of Congress to join Sen. Bingaman in enacting the bill into law.

Robert B. Doherty is ACP's Senior Vice President for Governmental Affairs and Public Policy.

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