Issue Brief

Health Care Reform

 

Background

The United States has the most expensive health care system in the world. Medical costs currently consume 16 percent of our national income and are expected to grow to 20 percent by 2015.  This has become a heavy economic burden that adds significantly to the cost of virtually every product and transaction in our economy.  Studies now report that the cost of health insurance for an average family is between $10,500 and $12,000 each year.  Many employers are trying to shed this load by shifting the cost of health insurance to their employees or by abandoning health insurance coverage altogether.  Thus, a growing percentage of people living in the United States are uninsured, and families on tight budgets are increasingly at risk. 

There are nearly one million adult Pennsylvanians, below age 65, that do not have any health insurance and are not eligible for government-funded insurance.  Many of these uninsured adults access health care primarily via emergency rooms, which they utilize when medical problems are acute.  If they suffer from a chronic disease, a medical professional does not manage their treatment.  The uninsured often cannot afford to fill their prescriptions or, if they do, they cannot afford to take prescription drugs in the recommended dosages.  They are usually forced to pay retail prices for both medical treatment and medications which they often cannot afford.  When costs pile up, many choose bankruptcy as the way out.

In addition to Medical Assistance (MA), a government program which provides health insurance to families with very low incomes and people with long term disabilities, Pennsylvania insures 45,000 working age adults through adultBasic, a program created in 2001 by the Ridge Administration.  Since last year, the waiting list for adultBasic has grown from 83,000 to nearly 250,000 people.  Last year, efforts to expand adultBasic to include behavioral health benefits and prescription drug coverage failed to pass the General Assembly.  Without these benefits, the program does not qualify for federal dollars that would allow Pennsylvania to increase enrollment.

This year the General Assembly will once again take up the issue of whether or not to expand adultBasic.  Leaders in both the House and the Senate, a Democrat and a Republican, are very interested in covering at least an additional 50,000 people. However, there are significant differences between their proposals that would need to be worked out.  All representatives and senators need to hear from you that expanding adultBasic to serve more people who are currently on the waiting list is an important priority.

 

Additionally, the General Assembly will also decide whether or not to reform insurance regulations in what is known as the small group market.  Currently, Pennsylvania is one of only two states in the nation that does not provide some form of rate protection for its small businesses (those with fewer than fifty employees), even though small businesses account for 50% of Pennsylvania’s private employment.  This means that the rates currently quoted for group health plans are based on how the insurer assesses the risk of the employees in each small group.  “Rate spikes” occur frequently in the small group market as insurers deliberately attempt to shed small groups that have generated higher medical claims.  These rate spikes are forcing more employers to stop offering health plans to their employees.  This leaves employees with the choice of shopping for coverage in the individual market, where medical underwriting is applied even more harshly, or going without coverage entirely.

 

House Bill 746, authored by Rep. Tony DeLuca, Chair of the House Insurance Committee, would introduce rate protection into the small group market.  For example, the mix of male and female within a work group could no longer be a factor in pricing coverage.  This would end the existing discrimination against women.  Also, use of medical histories to identify preferred and non-preferred risks would be prohibited.  Furthermore, the Insurance Department would be granted the authority to review rates, ensuring that insurance companies are using known best practices to control rising costs.

 

 

ELCA Policy Base  (Caring for Health: Our Shared Endeavor, 2003)

 

“The prophetic voice of Jeremiah cried out to the Israelites, ‘Why then has the health of my poor people not been restored?’  (8:22). 

 

“The Christian Church is called to be an active participant in fashioning a just and effective health care system…  We of the ELCA have an enduring commitment to work for and support health care for all people as a shared endeavor.   Our Commitment comes in grateful response to God’s saving love in Jesus Christ… God continues to call the Church – its institutions and believers – to work in society for individual and collective actions that promote health and ensure care for those who suffer.”

 

“Government is intended to serve God’s purposes by limiting or countering narrow economic interests and promoting the common good… We call for…appropriate government regulatory reform so that governments can monitor private sector practices more effectively and efficiently…”  (Sufficient, Sustainable Livelihood for All, 1999)

 

 

What You Can Do:

 

·         Visit, write, call, or e-mail your state legislators and urge them to expand adultBasic and enact small market insurance reform.

 

·         Join your local Pennsylvania Health Access Network (PHAN) coalition (www.pahealthaccess.org) and participate in the discussion on how best to provide health care for all Pennsylvanians.  If a coalition does not exist in your area, be a leading force in creating one.  You can call the LAMPa office to help get you started.  (717-545-3500)

 

 

 

May 2009