Paving the Difficult Road to Universal Insurance Coverage: Spotlight on U.S. Innovators

Published by: Decision Resources

Published: Sep. 28, 2007 - 44 Pages

Table of Contents

Executive Summary

Strategic Considerations

Stakeholder Implications

An Old Debate Takes on New Urgency

Massachusetts Provides a Model

Commonwealth Health Insurance Connector

Defining Minimal Creditable Coverage

Defining Affordability

Commonwealth Care Health Insurance Program

Medicaid Expansions and Restorations

Commonwealth Choice Health Insurance Program

Mandating Coverage for All

Employer Responsibilities

Learning from the Massachusetts Experience: Implications for Other Reform Efforts

Future Challenges

Communication

Affordability

Primary Care Provider Shortage

Employer Challenges

Sustainability and Cost-Containment

Maine and Vermont: Other Innovators at the Forefront

Maine

DirigoChoice

Cost-Containment Reforms

Maine Quality Forum

Learning from the Maine Experience: Implications for Other Reform Efforts

Future Challenges for Maine

Vermont

Catamount Health Insurance Plan

Employer Responsibilities

Chronic Care Initiatives

Learning from the Vermont Experience: Implications for Other Reform Efforts

Future Challenges for Vermont

In Search of a National Solution: Universal Coverage Proposals at the Federal Level

Bush Administration Tax Reform Proposal

Details of the Bush Proposal

Problems with the Bush Proposal

Starting a National Discussion

Universal Coverage Bills in Congress

Medicare for All

Healthy Americans Act

State/Federal Partnerships

Future Perspectives

Importance of Federal/State Partnerships

Potential Pitfalls for State Initiatives

A Key Issue: Addressing Costs

Controlling Current Costs and Spending Growth

Targeting Drug Prices

Increasing Patient Cost-Sharing

A Long Road Ahead

Tables

1. Health Insurance Coverage of the U.S. Population, 2002-2006

2. State Universal Coverage Bills, 2007

3. Key Elements of Massachusetts’ Health Care Reform

4. Affordability Scale for Massachusetts Health Insurance Premiums Based on Income
Level, 2007

5. Coverage Options Offered by Commonwealth Choice Plans

6. Maine’s DirigoChoice Coverage Plan

7. Vermont’s Catamount Coverage Plan

8. Comparison of Key Elements of Universal Coverage Proposals at the Federal Level,
2007

9. Key Elements of the Health Partnership Act and Health Partnership Through Creative
Federalism Act

Figures

1 Health Insurance Coverage: United States

2. U.S. National Health Expenditures per Capita and Corresponding Share of Gross
Domestic Product, 1960-2007

3. Status of State Initiatives for Health Care Reform

4 Health Insurance Coverage: Massachusetts

5 Health Insurance Coverage: Maine

6 Health Insurance Coverage: Vermont

7. Key State and Federal Health Insurance Expansion Activities, 2004-2006

8. U.S. National Health Expenditures, by Type of Service, 2005

Sidebars

Ingredients for Health Care Reform: Key Opinion Leader Insights

Universal Coverage Mandates: Key Opinion Leader Insights

Factors Affecting the National Movement: Key Opinion Leader Insights

All Eyes on California as Governor Schwarzenegger Pitches Universal Coverage Plan

Abstract

The controversial issue of establishing universal health insurance has recently reclaimed the spotlight in the United States. Various states, members of Congress, President George W. Bush, and 2008 presidential hopefuls are proposing plans to make health insurance more accessible to the approximately 47 million U.S. residents who do not have coverage.

Get the Answers You Need to Shape Your Strategy

• Massachusetts, Maine, and Vermont are leading the way in expanding universal health care coverage. How have these states achieved consensus on such a hot button issue? What are the key elements of these state health care plans? What are the implications for other reform efforts?
• Other states have expressed considerable interest in Massachusetts’ groundbreaking universal coverage plan. Which states have viable programs on the horizon? What have they learned from the Massachusetts planning and implementation process that will help them develop their own successful new universal coverage plans?
• As this fl urry of state health reform activity continues, proposals at the federal level aim to complement state efforts or to set in motion sweeping national reform. Which initiatives have gained national support? Which of the universal coverage bills in Congress target drug pricing?
• Universal coverage proposals may threaten to take greater control over drug prices. Would new initiatives give states the power to negotiate drug prices with manufacturers? Are proposals requiring drug-price negotiation likely to garner much support in the near future?

Scope

• Massachusetts: leading the way. Details on passage and implementation of the plan, the mandate for individual coverage, employer responsibilities, implications for other reform efforts, and future challenges.
• Maine: at the forefront of universal coverage. DirigoChoice plan details, cost-containment reforms, Maine Quality Forum, implications for other reform efforts, and future challenges.
• Vermont: implementation looming. Catamount Health plan details, employer responsibilities, chronic care initiatives, implications for other reform efforts, and future challenges.
• National solutions: universal coverage at the federal level. The Bush administration proposal, Medicare for All, Healthy Americans Act, and state/federal partnerships.
• Future perspectives: promise and problems. Value of compromise and cooperation, potential pitfalls for state initiatives, cost-control issues, and drug pricing.

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