Three Opinion Pieces Weigh In On Coverage Expansion Issues

Three opinion pieces published in newspapers this weekend discussed coverage of the uninsured. The pieces are summarized below.

System 'Seriously Flawed'
The U.S. health insurance system "is seriously flawed" and "contains a built-in contradiction" by placing routine and catastrophic coverage under "one system," Lawrence Mirel, commissioner of insurance and securities for the District of Columbia, writes in a Washington Post opinion piece. Mirel points out that by "general definition," an "insurable event" -- an event "unlikely to happen" and not an event that "the person who insured ever wants to happen" -- will result "without warning," which "does not apply to routine health maintenance." However, he writes that the "current paradigm for the payment of health care tries to cover both ... catastrophic" events, such as serious injuries and illnesses, and "routine" care, such as doctor visits, "in one system." He proposes a "two-tier" system of health coverage. The first tier would cover "catastrophic illness" and treatment for chronic illnesses and would have a high deductible, he writes. According to Mirel, the plans may cost more for "older purchasers," but they "will always be far less expensive than their full-coverage counterparts." Mirel adds that the second tier would cover routine and maintenance care and would rely on medical savings accounts. He writes that employers could contribute funds "that would otherwise go into the purchase of health insurance," to employees' MSAs, allowing employees to "determine how they spend the money." In addition, Mirel points out that insurers could offer a separate plan for those "who are not employed and cannot afford health maintenance or routine medical costs at all" through public health programs, such as Medicaid HMOs. Mirel concludes that a tiered health insurance system "is the least expensive, most easily administered system" and would prove "sensible" and "cost-effective" (Mirel, Washington Post, 8/26).

Covering Childless Adults?
Although a "good case can be made" for expanding CHIP programs to cover parents of eligible children, a Philadelphia Inquirer editorial states that enrolling childless adults in the programs has "no logic." The editorial praises a decision by officials with FamilyCare, New Jersey's CHIP program, to stop enrolling childless adults in the program, calling the move "the right call." Although health coverage "for all working poor is desirable," the editorial points out that "it shouldn't come out of children's funding." The editorial adds that enrolling childless adults in CHIP programs may leave "hard-to-find, uninsured children" without "affordable" health coverage. However, the editorial touts using funds from the national tobacco settlement to establish a separate program to cover uninsured childless adults as "a fine idea." The editorial adds that although New Jersey's effort to enroll more children in FamilyCare by expanding coverage to parents of eligible children "needs more time before it is judged," the state has enrolled "only 6,000 additional children as a direct result of expanding coverage to parents," 18,000 less than expected. "If the numbers of youngsters added to CHIP continue to lag, if covered parents do not reapply for their children, then state and federal officials ought to reconsider their approach," the editorial states. The editorial concludes, "The notion of getting poor children enrolled by making coverage a family affair is a good one. ... But diluting the funds without getting the desired goal ... is a prescription for failure" (Philadelphia Inquirer, 8/25). For further information on state health policy in New Jersey, visit State Health Facts Online.

Praising PCAP
The Pima Community Access Program, a new "discount health care plan" for low-income adults in Pima County, Ariz., "is cause for celebration in more ways than one," an Arizona Daily Star editorial states. PCAP participants pay a $20 fee every six months to receive access to "an array of deeply discounted health care services." The editorial states that the plan hopes to reduce "logjams" in hospital emergency rooms by allowing individuals to access preventive care. While reducing the number of patients in hospital waiting rooms may represent "a worthy goal," PCAP "more important[ly] ... has the potential to greatly reduce human suffering in Pima County," the editorial states. The editorial concludes, "The community should embrace this plan wholeheartedly, through increased participation by doctors and hospitals or donations to the loan fund for hospital care. Employers who do not provide health coverage could also encourage worker participation by offering to cover the program's modest membership fee" (Arizona Daily Star, 8/26). For further information on state health policy in Arizona, visit State Health Facts Online.