Articles

States' Widening of Health Care Hits Roadblocks

December 25, 2007

By Kevin Sack

SACRAMENTO — A year that began with great ambition for major expansions of health insurance here and in other state capitals is ending with considerable uncertainty, as a second wave of change runs headlong into a darkening economy and political divisions over how to apportion the cost.

Though the governors of three big states — California, Illinois and Pennsylvania — proposed sweeping plans to restructure health care this year, none will finish 2007 with bills passed and signed. In each state, the initiatives confronted entrenched opposition from insurance and other business lobbies that made it far more difficult to build a consensus for change than in the smaller New England states that acted in recent years.

Yet it also was a year of intriguing achievement, here above all, where the Republican governor, Arnold Schwarzenegger, and the Democratic Assembly speaker, Fabian Núñez, drew up a bipartisan blueprint for bringing near-universal coverage to the country’s most populous state.

Mr. Schwarzenegger and Mr. Núñez have yet to close the deal by gaining the support of the State Senate. But they demonstrated in their yearlong negotiations that a consensus on basic principles could be reached, perhaps setting a template for other states and for Washington.

“It’s significant that what they’ve been talking about in California is similar to what many of the leading Democratic presidential candidates are talking about as well,” said Larry Levitt, vice president of the Kaiser Family Foundation, which researches health care issues. “There seems to be some convergence at least on the part of those supporting universal health care on how to get there.”

In addition to being the most populous state, California has among the country’s highest proportions of uninsured residents, about 20 percent. Indeed, there are more uninsured in California than there are total residents of Massachusetts, Maine or Vermont, the states that have set the pace for overhauling health care. Success here, therefore, would send a signal that such plans could be enacted in states with the heaviest burdens.

The Schwarzenegger-Núñez plan, which passed the Democratic-controlled Assembly last week, expands on the universal coverage law that Massachusetts passed in 2006. That state now requires insurance companies to offer coverage regardless of an applicant’s health status and mandates that most residents have insurance by Dec. 31, or face a tax penalty of $219.

State officials project that more than 300,000 previously uninsured people will sign up in time, a third of them in a surge over the last month. That has put Massachusetts more than halfway to its goal of insuring everyone.

The downside, and one noted by states with widening budget gaps, is that the program is expected to exceed its first-year budget by at least $150 million. And state officials are struggling to prevent double-digit premium increases next year.

Whether the momentum that began with State of the State addresses last January will continue into 2008 is not clear. It had been widely felt by health reform advocates that this nonelection year provided the best political climate for change.

Now the focus may shift to the presidential campaign, where the leading candidates for the Democratic nomination have each proposed major overhauls. Some state leaders may be tempted to wait out the year to gauge whether the next president will push for a national health plan that might subsume state efforts.

The essential problem, meanwhile, continues to worsen. The Census Bureau reported that the number of uninsured grew to 47 million in 2006, a one-year increase of 2.2 million. The share of United States residents who had employer-based coverage dropped to 60 percent from 64 percent in 2000, according to the Economic Policy Institute, a liberal research group. And though the rate of growth has slowed, the cost of employer-sponsored premiums still rose by 6.1 percent in 2007, more than double the inflation rate, according to the Kaiser Family Foundation.

Because of its national influence, California will continue to command attention as Mr. Schwarzenegger and Mr. Núñez try to bring along the Senate president pro tem, Don Perata, a Democrat. While supportive of universal coverage, Mr. Perata has said he is concerned about the plan’s $14.4 billion price tag when the state faces a budget gap of commensurate size.

As in Massachusetts, the California plan would mandate coverage for most individuals. It would raise money to subsidize policies for low-income residents through what Mr. Schwarzenegger calls shared responsibility — a tax on hospital revenues, a hefty increase in tobacco taxes and assessments on employers who do not contribute to their workers’ health care.

In a California innovation, the assessment rates would be graduated according to the size of the company. If the Senate passes the measure, voters will be asked to approve the revenue measures in a November referendum that would become the truest test of public support for change.

California, of course, is an idiosyncratic state, and at no time more than now, with its movie star governor and his mantra of “postpartisanship.” But even in a state as comparatively progressive as this one, the coalition that has formed around overhauling health care is notable.

At a postvote news conference beneath the Capitol rotunda last week, Mr. Schwarzenegger and Mr. Núñez stood with the chairman of Safeway grocery stores and the president of the San Diego Chamber of Commerce, as well as leaders of unions representing service workers, government employees and carpenters.

Andrew L. Stern, president of the Service Employees International Union, seemed to speak for many of those in attendance when he said in an interview that successful health reform would depend on “not letting the perfect be the enemy of the good.”

Against that backdrop, the bipartisan partnership between Mr. Schwarzenegger and Mr. Núñez seemed almost unremarkable. The two men need each other — Mr. Schwarzenegger to play on the big stage he enjoys, Mr. Núñez to leave a legacy before term limits may force him from office — and they praise each other lavishly in public.

That is not to say support for their plan is universal; it won not a single Republican vote in the Assembly. Some unions oppose it because they fear that mandatory insurance policies would not be affordable, even with government subsidies. The California Nurses Association opposes the plan because it would preserve private insurance rather than replacing it with universal government coverage.

Other governors, in more centrist states, made less headway this year in overcoming opposition generated by efforts to contain health costs and to raise the revenues needed to subsidize premiums.

Illinois’ Democratic governor, Rod R. Blagojevich, got nowhere with his proposals to pay for universal access to insurance by taxing gross business receipts and assessing employers who do not offer coverage to their employees. He then instigated a fight with his legislature and provoked a lawsuit by using his executive authority to widen eligibility for state-subsidized insurance programs.

In Pennsylvania, Gov. Edward G. Rendell, also a Democrat, failed to persuade his politically divided legislature to cover the state’s 900,000 uninsured through an employer assessment. Like the California leaders, Mr. Rendell has now proposed increasing cigarette taxes, as well as raiding the surplus in a state fund designed to help doctors pay for malpractice insurance.

In both New York and Connecticut, governors expect to receive plans for universal health coverage from advisory groups in 2008 and then to begin their own legislative battles.

“It remains incredibly difficult for states by themselves to get all the uninsured covered,” said Robert Blendon, a Harvard professor of health policy and political analysis. “There just is not a consensus on who should pay.”

While only a few states considered universal coverage plans, it was an active year for more incremental measures, said Laura Tobler, a health policy analyst for the National Conference of State Legislatures.

Maryland and Texas joined the 15 states that have created programs to subsidize insurance for small businesses and individuals, she said. Four states effectively guaranteed that all children could be insured through expanded eligibility for Medicaid and the State Children’s Health Insurance Program, known as S-chip. An additional 13 states passed more modest expansions for children.

Any continuation of that trend in 2008 would likely depend on Congress and President Bush settling their considerable differences over financing for S-chip.

Mr. Bush this year twice vetoed large increases approved by the Democratic-controlled Congress, and his administration used regulatory powers to restrict the ability of states to extend the program beyond its original target: the children of the working poor.

December 5, 2007

John Baer | Another stab at health care going up in smoke?

GOV. RENDELL is back on the attack with yet another way to fund fixes in health care, this time shifting money from doctors to provide coverage for the uninsured.

Like all things having to do with health care - a complex, mind-numbing issue - there are multiple parts to the proposal.

And, like all things having to do with health care, it reminds me how criminally inept Congress and the Legislature are in dealing with the problem.

Reforms needed, insurance chief says

By David Wenner

The state's acting insurance commissioner says he agrees with Republicans that more competition among health insurers is better. Joel Ario, who was appointed by Gov. Ed Rendell, a Democrat, also said he likes some Republican-backed cost-control strategies, such as increasing the personal stake of consumers in their health care spending. Still, he believes new regulations on health insurers are needed to make coverage affordable for small businesses.

Ario spoke Tuesday to the Republican-led state Senate Banking and Insurance Committee, which is gathering information about the proposed merger of Pennsylvania's two biggest health insurers, Highmark Inc. and Independence Blue Cross. In discussing the state's overall health insurance market, Ario said the most needed reform would limit "medical underwriting," where insurers consider factors such as age and medical history when calculating premiums.

Critics of medical underwriting say it leads to "cherry picking," where insurers strive to cover only healthier people and avoid medical risks.This prevents health care costs from being spread over large groups of both sick and healthy people, which many believe is the only way to keep insurance affordable for those with illnesses. But others argue that medical underwriting enables insurers to offer more affordable premiums to people who are younger and healthier, or who have healthier lifestyles. Without medical underwriting, these people are inclined to go without expensive insurance rather than pay for coverage they might not need.

"It's a balancing act," said Ario, who noted that few states allow as much medical underwriting as Pennsylvania. Many Republicans favor fewer regulations on health insurers. They believe more insurers will enter the market and create better and more affordable plans with less regulation. Divisions over the basic goal of health insurance were apparent at the hearing.

Committee Chairman Don White, R-Indiana County, said 30 years ago, when health insurance was more affordable, it was used primarily for catastrophic care. It now resembles an "entitlement" program, with people expecting everything to be covered, he said. Ario said that's true, but he believes health insurance should pay for some non-catastrophic items, such as preventive care. Regarding the proposed Highmark-Independence merger, White said the combined insurer would have a market share of more than 50 percent. He said he can't see how that would be good for consumers.

Pennsylvania has four Blue Cross-Blue Shield plans now. White predicted that will shrink to one within a decade if Highmark and Independence are allowed to merge. Supporters of Blues plans argue that they are nonprofit and must spend a portion of their revenues on things that have a community benefit, such as helping pay for health care for the poor. The Blues plans are barred from medical underwriting. But they can create for-profit subsidiaries that are allowed to use such underwriting methods, and they have been shifting business into such subsidiaries. Ario contends that trend will continue unless the state limits medical underwriting.

Unlike the Blues plans, for-profit insurers, such as HealthAmerica and Aetna, are free from rate review by the state Insurance Department and can freely use medical underwriting.

October 11, 2007

Universal push for insurance

In Pennsylvania and across the country, states are looking at ways to broaden health coverage.

By Josh Goldstein

Inquirer Staff Writer

States from coast to coast are seriously contemplating some form of universal health insurance, not just for children but for adults as well.

Gov. Rendell, stumping across Pennsylvania this week to promote his plan for affordable insurance, is a prime example. Expanded coverage for the uninsured is high on the agenda in more than a dozen state capitals and is being considered in at least a dozen more. Four already have it.

The trend can be seen across the country:

Gov. Arnold Schwarzenegger, a Republican, is negotiating with Democratic legislative leaders in hopes of passing bill to expand coverage to California's 6.8 million uninsured residents.

A Colorado commission established last year is due to issue recommendations on how to expand health insurance to the uninsured by January.

Massachusetts is implementing a 2006 law that requires every resident to have health insurance and providing subsidies based on a sliding scale of income.

"There is clearly broad interest across the country and in many states in developing broad strategies to address the problem of the uninsured," said Jennifer Tolbert, a policy analyst with the Kaiser Commission on Medicaid and the Uninsured in Washington.

Sid Smith says he is a good example of the need for change. Before his first heart attack in 1995, Smith, who lives in West Philadelphia, trained disabled people to work as janitors.

But the damage to his heart left him unable to work; that, in turn, ended his health insurance. Now 58 and the survivor of two more heart attacks, Smith has been found to have heart failure, prostate cancer, diabetes, and high blood pressure.

Social Security disability income barely covers his rent, utilities and food, he said, and he depends on a city health center to manage his diseases and provide the 15 drugs he takes. "The care I get from the health center, I know it's not the best in the world, but they do their damnedest," Smith said.

Traveling across Pennsylvania, Rendell says he has met many Sid Smiths this week. He is midway through a five-day "tour to insure" - State College and Johnstown today, Scranton and Wilkes-Barre tomorrow - seeking citizen support for his plan. He talks on his bus with small groups of uninsured residents at each stop.

In Warren County yesterday, a middle-aged man told the governor that he had built an addition to his house and given up his job - and his employer-provided health insurance - to care for his twin brother.

A short time later, Rendell reflected over lunch on that man's situation. "As I listen to some of the stories of the uninsured," he told his staff, "it's just heartbreaking to know that there are so many people who are hurting, and it reinforces the need to act."

Rendell's proposal, introduced in the General Assembly last week, would make individuals eligible to buy state-sponsored health insurance from private insurers for about $280 a month. Premiums would be subsidized for people with low incomes.

Businesses with 50 or fewer employees could enroll their workers in the plan as well. The employers would pay $130 a month; employees would cover the remainder, with state subsidies for those with low incomes.

Rendell would pay for the subsidies with a new tax on smokeless tobacco and cigars, an increase in the cigarette tax, a 3 percent payroll assessment on most businesses that do not offer health benefits to workers, and federal matching funds.

While many states are moving to make health insurance affordable to more of their residents, Rendell's plan is just one part of his broader initiative to increase access to care, control costs and improve quality. His "Prescription for Pennsylvania," announced in January, put the commonwealth at the forefront of states that are advancing changes in health care.

For governments, health insurance for children - provided for the last decade through a jointly funded state-federal effort known as the State Children's Health Insurance Program (SCHIP) - is a very different issue. Like coverage for adults, however, proposals to expand insurance for children are working their way through state capitals nationwide.

More than 30 states were considering additions to the program within their borders when President Bush last week vetoed federal legislation to reauthorize and fund an expanded SCHIP for $60 billion over five years. Congressional leaders are now counting votes to determine whether to attempt an override or come back with a bill more palatable to the White House.

Legislators in states that have passed or are considering laws to expand coverage for adults are closely following the Washington debate over health insurance for children.

"Those broader based reforms in many cases seek to build on existing public programs such as SCHIP," Kaiser's Tolbert said.

Rendell, for example, modeled his cover-all-Pennsylvanians proposal to offer affordable health coverage to the state's estimated 767,000 uninsured adults on an already approved effort to expand the children's health program to all 133,000 uninsured children.

Gov. Corzine was thinking along similar lines when he announced preliminary plans for universal health insurance in New Jersey in January. That proposal, like some other Garden State initiatives, still awaits a politically palatable source of money - and has not been introduced in the Legislature.

Corzine has acted aggressively, however, in pursuing health insurance for children. Two days before Bush vetoed the national expansion of SCHIP, New Jersey sued the federal government over regulatory restrictions that were put in place in August. Seven states said they would join him.

At issue is how generous states can be in providing insurance to children above the poverty level. Although the program was originally intended only for the poor, most states have received federal approval to insure children of families earning 200 percent of the poverty level.

Pennsylvania covers 300 percent. New Jersey's cost of living is particularly high, as is its threshold for coverage: 350 percent of poverty level.

Depending on what happens with SCHIP in Washington, Pennsylvania and other states may have to modify their plans for expanded children's health insurance.

Meanwhile, citizen task forces and legislative committees in dozens of states churn ahead with proposals for universal health coverage for all ages.

"This activity is genuinely local, not national," Richard Cauchi, the health program director for the National Conference of State Legislatures, said yesterday. "Each state is calculating its own needs and resources and checking finance realities. With 2008 sessions just 12 weeks away, it should be an interesting year."

October 4, 2007

As I see it By Jonathan M. Stein

Health plan will expand coverage, cut costs

Angry, ashamed or alarmed about the current health insurance crisis? You are not alone. Today many Pennsyl vanians who share your feelings are doing something about it.

They've come to Harrisburg from across the state to cheer on Gov. Ed Rendell's "Prescription for Pennsylvania." Not only will Rendell's plan cover the uninsured and improve the quality of care, but it also will reduce needless costs in the current, broken health care system. These demonstrators are:

Angry because health insurance premiums have shot up 76 percent between 2000 and 2006, while inflation increased only 17 percent and median wages just 13 percent.
Ashamed because in the richest country claiming to be the leader of the Western world, we have 47 million uninsured. Close to 800,000 of those are in Pennsylvania.
Alarmed because too many state politicians are not facing up to this health insurance crisis and have yet to come on board to the Rendell initiative.

Rendell's prescription reminds us that government can work for people and for business, tackling this number one domestic problem which a heads-in-the-sand approach has only worsened.

The heart of the plan is that uninsured adults making less than $29,400, or less than $60,000 for a family of four, would pay between $10 and $60 a month for full health insurance coverage including prescriptions. Families over 300 percent of poverty would pay the full cost or $280 a month per adult.

Small employers who don't offer coverage now would be offered subsidized insurance at $130 a month per employee for their workers, who would also pay between $10 and $70 a month for their insurance. Children currently can get health insurance under the CHIP program, the re-authorization of which President Bush vetoed Wednesday.

Parents tune in. Coverage also includes covering all college students and requiring insurance companies to allow families to purchase family coverage for their children up to age 30. And that nasty insurance practice of disqualifying those with pre-existing conditions would be history.

If you have insurance now you might ask, "What's in it for me?" The governor wants to rein in insurance companies who keep charging more and doing less. And you are already paying for the uninsured via your insurance premium and through taxes that too often pay for inefficient and costly health care through emergency room care. Pennsylvanians rate among the highest in the country on using emergency rooms, with half of all ER visits in 2007 for conditions that don't need immediate treatment. Affordable health insurance can redirect ER visits to more appropriate sites as save as much as $232 million a year.

Financing would not only come from the subsidized rates paid by workers and small employers, but also by folding in other existing federal and state funds, and providing for a fair share assessment on employers refuse to provide health insurance. This is also fair to all those businesses currently meeting their responsibilities to their workers who are forced to compete with less responsible competitors not offering health insurance.

The Rendell plan wisely attacks the costly, waste side of our broken system by seeking to save billions in health care dollars that now pay for avoidable hospital-acquired infections and medical errors, and avoidable hospitalizations resulting from inadequate care for those with chronic illnesses like diabetes, asthma and heart disease. By requiring that 85 percent of health care premiums actually go to provide health care, the plan improves on the current imperfect system of private health insurance. THE "PRESCRIPTION for Pennsylvania" is a courageous and much-needed initiative, but will need compromises from all. Those of us who are single-payer advocates must recognize that this is the best practical vehicle for our state at this time. Hospitals, enjoying their "uncompensated care" subsidies, must see this as a more rational ordering of health care dollars that will help them in the long run. Businesses must see the value of a healthy work-force and the equity in all businesses carrying their fair share. Insurance companies must accept some additional regulation, but should be happy they're still in this game.

Some 18,000 people die nationally each year because they can't qualify or afford health insurance. As one writer has commented, that's three times the 9/11 loss of life, and it occurs not once but yearly. Whether you're angry, ashamed or alarmed, you should act now and make your voice heard.

JONATHAN M. STEIN is general counsel at Community Legal Services Inc., Philadelphia. TOMORROW: Nathan A. Benefield of the Commonwealth Foundation offers a different health insurance solution.

October 3, 2007

Rendell renews push for health care plan

BY DAVID WENNER

Of The Patriot-News

Gov. Ed Rendell on Tuesday began his second push for a tax on businesses to help fund state-subsidized health insurance coverage for the uninsured.

The proposed 3 percent payroll tax, which would apply to businesses that don't provide employee health benefits, has already met opposition from business groups.

Those groups have argued that putting so much of the burden for addressing health care problems on employers is unfair, and a 3 percent payroll tax would eat into profits at struggling businesses.

Rendell said business owners who oppose his plan either don't understand it, or prefer to shift their workers' health care costs to other businesses.

In painting a picture of his plan, Rendell described a business with 10 employees and a $300,000 payroll. That business would pay $9,000 in additional payroll taxes if it chose to pay the proposed tax rather than provide health benefits, he said.

If the business in Rendell's example wanted to offer health insurance, it could do so with the proposed state-subsidized plan, which he said would cost the business about $15,000 annually.

Rendell also described an identical business that already provided insurance coverage, but needed a more affordable option. It could switch to a private plan, identical to Rendell's state-subsidized plan, that he would require all insurers to offer. That would cost the business about $130 a month per employee -- less than the $450 per employee per month that Rendell says businesses pay now.

According to Rendell, businesses that don't provide employee health benefits are largely responsible for the uninsured. Their employees often get free health care at hospitals. That cost gets shifted to those who pay for health insurance, adding an estimated 6.5 percent to premiums.

Rendell was joined at the rally by representatives of organized labor, the clergy and health care workers, many of whom were bused in from Philadelphia and Pittsburgh.

Speakers said the high cost of health insurance, which averages about $11,000 a year for family coverage, puts most state residents at risk of becoming uninsured.

Rendell criticized politicians who talk about "morals" and "family values," yet refuse to support his plan for covering the uninsured.

If they care about what's right morally, Rendell shouted, they should heed the Bible's advice to "heal the sick" or stop claiming to support such values.

Rendell also wants regulations to prevent health insurers from charging higher premiums to women of child-bearing age or people who have pre-existing medical conditions. He said those practices can result in dramatic spikes in premiums for small businesses.

State Rep. Mike Sturla, D-Lancaster, and state Sen. Jay Costa, D-Allegheny, have introduced bills to create Rendell's state-subsidized health insurance plan, called "Cover All Pennsylvanians."

Rendell, a Democrat, said the biggest obstacle is the Republican-controlled state Senate.

Republicans have tended to side with business groups that oppose the payroll tax and favor using private market forces, as well as greater use of consumer-directed health care, to address the problems.

GOP opponents said Rendell should focus more on lowering the cost of health care, saying that will make private health insurance more affordable and do much to eliminate the working uninsured.

Rendell claimed aspects of his plan that have already been approved, including measures to reduce hospital-acquired infections and expand the role of nurse practitioners, will take a big chunk out of health care costs.

October 2, 2007

Rendell gives insuring all a new push

By Amy Worden
Inquirer Harrisburg Bureau

HARRISBURG - Gov. Rendell and House Democrats are making another run at the most ambitious and controversial component of Rendell's wide-ranging health-care plan: providing health insurance for all Pennsylvanians.

The goal is to cover the state's 767,000 residents with no health insurance, 70 percent of whom are employed.

The latest effort to win passage of the "Cover All Pennsylvanians" legislation begins today with a rally at the Capitol sponsored by labor groups and advocates for the uninsured. A poll also will be released that advocates say shows strong voter support for health-care reform.

As he has for other major policy initiatives, Rendell next week will embark on a cross-state bus tour to drum up support for his health-care plan. The plan was unveiled by Rendell in January but ran into Republican opposition over its cost. The "Cover All Pennsylvanians" legislation is the centerpiece of Rendell's sweeping health-care package. Six other health-related bills that were part of that package have already been passed by the legislature.

Under the medical-coverage plan, businesses with fewer than 50 employees would be eligible for reduced-cost insurance. Employees would pay monthly premiums on a sliding scale, depending on income. Those businesses that do not offer insurance would be required to pay a 3 percent "fair share" payroll assessment.

Health-care burden

Administration officials contend that the health-care burden of uninsured workers is being carried by insured individuals and companies through embedded costs in insurance premiums.

"People argue whether you need to cover the uninsured, but not having people insured has a definite impact on everyone who is insured," said Rosemarie Greco, director of the state Office of Health Care Reform. "Businesses that don't help employees by offering health insurance should be held accountable."

The proposal is estimated to cost $302 million in the first year, covered through contributions from businesses and employees, Pennsylvania's share of the national tobacco-settlement fund, and federal funding.

Rendell hoped to have signed a bill into law by July to accommodate a January start date but has met with opposition from Republican lawmakers, the insurance industry and business groups.

"Raising taxes and creating a government health-care system should be the last resort, not a first option," said Kevin Shivers, state director of the National Federation of Independent Business of Pennsylvania, which represents small businesses. "Businesses and individuals are struggling to make payments as it is. What is the plan doing to reduce costs for the eight million people that have insurance?"

Legality and cost

Senate Majority Leader Dominic Pileggi (R., Delaware) said he was not likely to move the bill in its current form because of concerns about the proposal's legality and cost. "It's not clear that it will reduce costs, and I am concerned of how it will negatively affect business," he said.

But John Dodds, director of the Philadelphia Unemployment Project, called the bill "a major step in the right direction." He said the wait list for the current state-funded health-care plan for lower-income adults, which has no prescription drug coverage, is "years long."

More than 10 states have comprehensive health-care reform bills or proposals under review, and more states are expected to follow, especially as efforts to craft a national health-care program have made little headway in Congress, according to the National Conference of State Legislatures.

So far, only Massachusetts and Vermont have programs in place aimed at providing universal coverage. In Maryland, a federal court overturned legislation that required employers to provide health insurance or face a payroll tax.

Shivers and others say the Pennsylvania proposal also would violate federal labor laws stipulating that large corporations have the right to set up uniform insurance rather than deal with laws state by state.

Rendell administration officials dispute that contention, saying they have consulted lawyers who say the state is within its rights to impose such a mandate.

Before breaking for summer recess, the General Assembly approved six bills that were part of Rendell's multi-pronged health-care proposal, including expanding the scope of practice allowed by medical professionals and requiring hospitals to monitor and report infection rates as a way to reduce costly - and deadly - hospital-acquired infections.

October 1, 2007

Rendell asks public support of affordable insurance plan

By Joe Fahy,
Pittsburgh Post-Gazette

Gov. Ed Rendell is gearing up for a renewed push to generate support for "Cover All Pennsylvanians," his proposal for making affordable health insurance more available to individuals and small businesses.

Consumer groups from around the state plan to rally at the Capitol tomorrow in support of the proposal.

Next week, the governor plans to begin a bus tour, appearing at town meetings in support of Cover All Pennsylvanians and insurance proposals that also are part of "Prescription for Pennsylvania," a wide-ranging health plan that he announced early this year. He plans to be in Pittsburgh Oct. 9, the first day of the tour.

At a meeting last month with top members of his administration, Mr. Rendell concluded that Cover All Pennsylvanians and insurance reform should be part of his fall legislative agenda, said Rosemarie Greco, director of the Office of Health Care Reform.

"Some tried to dissuade the governor from putting it all out there," she said. But Mr. Rendell believed that lawmakers will "want to do the right thing," she said.

Businesses have been critical of a "fair share assessment," one of several sources proposed to pay for Cover All Pennsylvanians. The assessment, consisting of 3 percent of annual payroll, would be collected from employers that did not offer health coverage to their workers.

One bill being prepared by Rep. Mike Sturla, D-Lancaster, will propose the same provisions for Cover All Pennsylvanians that were outlined earlier this year, including the 3 percent assessment, Ms. Greco said.

Another bill being prepared by Sen. Jay Costa, D-Forest Hills, would be similar to Mr. Sturla's but would not include the assessment.

Ms. Greco reiterated the governor's earlier statements that he would consider an alternative revenue source.

Gene Barr, a vice president for the Pennsylvania Chamber of Business and Industry, said his group remains "adamantly opposed to the payroll tax."

Some small employers have said the tax could put them out of business, he said.

Dan Fee, executive director of Pennsylvanians United for Affordable Health Care, said the assessment is a fair approach when more than 70 percent of the state's 900,000 uninsured people are employed.

He said a recent poll of state voters by his group found that 60 percent favored the tax for employers who did not provide insurance for their workers.

Under Mr. Rendell's original proposal, businesses could participate in Cover All Pennsylvanians if they have not offered health care for their employees in the past six months, have fewer than 50 employees and if, on average, those employees earn less than the state average annual wage, about $39,000. Businesses that join the program would pay about $130 per employee a month, and workers would pay from $10 to $70 a month, depending on income.

Other uninsured adults could also get coverage and receive help paying for their premiums if they earn less than 300 percent of the federal poverty level. Those earning more than that would pay about $280 per month for coverage.

Insurance proposals in Prescription for Pennsylvania that Mr. Rendell also plans to push would limit the ability of health insurers to consider certain factors such as health history in setting rates for plans offered to individuals and small businesses. Eighty-five percent of premiums also would have to be spent on health care, and the Insurance Department would have more authority in setting rates.

The department has been holding "listening sessions" around the state inviting businesses to share their problems with providing health coverage to their employees.

Mr. Rendell has urged that reforms are needed in part to curb the spiraling cost of health care.

State lawmakers already have approved portions of Prescription for Pennsylvania that address expansion of practice capabilities for nurse practitioners, midwives, nurse specialists, physician assistants and dental hygienists. They also approved new reporting requirements concerning infections acquired in hospitals and nursing homes, provisions that were modified from the original plan.

Through executive order, the governor also has created a commission aimed at improving care and reducing costs of treating chronic disease.

Proposals aimed at expanding access to health care and making other improvements are being implemented in several states, said Jennifer Tolbert, principal policy analyst for the Kaiser Family Foundation.

A state plan to increase coverage in Massachusetts continues to move forward, for example, and Vermont's Catamount Health plan to extend coverage to the uninsured should become available this month, she said.

But in other states, such as Pennsylvania and California, major proposals are still being debated, Ms. Tolbert said. Still other states have turned over proposals to commissions for more study.

"What this shows is broad-based reform is hard to do," she said. "The financing issue remains a challenge for states."

Posted on Fri, Sep. 28, 2007

Rendell to take case for expanded health insurance on the road

MARTHA RAFFAELE

The Associated Press

HARRISBURG, Pa. - Gov. Ed Rendell plans to take his case for expanding state-subsidized health coverage for uninsured adults on the road next month in a statewide bus tour designed to drum up support for the proposal.

But Republican leaders in the Legislature remain adamantly opposed to the idea of a payroll tax on certain businesses that do not insure workers.

A coalition of nurses, small business owners and uninsured people is scheduled to rally in support of Rendell's "Cover All Pennsylvanians" proposal at the Capitol on Tuesday. The bus tour is scheduled to begin Oct. 9 and is expected to last about a week.

The tour is intended to call attention to Pennsylvanians who cannot afford health insurance, said Chuck Ardo, spokesman for the Democratic governor. An estimated 800,000 adults are uninsured.

"We need to spur the dialogue," Ardo said. "We need to get it going so that the Legislature begins a serious debate."

Staunch opposition to a payroll tax that would be levied on all but the smallest businesses that do not cover their employees has stalled the nearly $317 million plan unveiled earlier this year. It is the cornerstone of Rendell's broader "Prescription for Pennsylvania" initiative aimed at reducing the cost and improving the quality of health care.

Business lobbyists and Republican legislative leaders have said increasing state spending is the wrong approach and have questioned whether such a payroll tax would be legal. Some critics say Rendell's proposal resembles a now-overturned Maryland law that would have forced Wal-Mart to spend more on employee health care.

The expansion would also be financed with federal Medicaid dollars and money the state currently spends on its adultBasic program for uninsured adults as well as premiums that would be paid by small businesses and health plan enrollees.

"I have not heard of any new response to the questions that have been raised," Senate Majority Leader Dominic Pileggi, R-Delaware, said Friday. "I think it's incumbent on (the administration) to recognize there is not an appetite for new taxes."

Rendell is also pushing for related insurance changes this fall, such as giving the state Insurance Department more authority to regulate rate increases and requiring insurers to spend at least 85 percent of the premiums they collect through small group plans on health care.

August 5, 2007

By David Wenner

Pennsylvania businesses and legislators have raised a wall against taxing businesses that don't provide employee health benefits.

But Gov. Ed Rendell intends to go around it.

The governor will continue pushing the idea that all businesses should pay toward health care -- either by providing coverage or making payments to the state.

"He believes that businesses that do not offer [health benefits] should be held accountable in some way for what everyone else is paying for," said Rosemarie Greco, Rendell's top health care official.

That might involve a flat fee paid by businesses that don't cover employees, she said.

The Rendell administration has said Pennsylvania has about 900,000 uninsured residents.

Others, including the Pennsylvania Medical Society, have said the number of residents without coverage could be as high as 1.5 million.

Rendell has tried to win support for his 3 percent payroll tax proposal by pointing out that the uninsured obtain plenty of health care, usually in hospital emergency rooms. That cost is shifted to businesses that cover employees, adding $681 to the annual cost of every family health plan.

Greco believes many businesses are still bothered by that and would like businesses that don't provide coverage to be forced to pay their fair share.

But groups such as the Pennsylvania Chamber of Business and Industry have argued that the tax would be disastrous to businesses that can't afford health insurance and would surely increase as state health care spending rises.

Business groups and for-profit insurers also argue that the tax would violate federal law and would be struck down in court.

Greco said the administration researched the issue thoroughly and the tax is legal. But she concedes that the plan could be impeded by court challenges.

Rendell won't back down from a "fair-share assessment," Greco said, but he is open to alternatives and suggestions from businesses.

Some form of payment from these businesses is needed to help pay for Rendell's proposed state health insurance program for individuals and businesses that can't afford coverage.

The 3 percent tax, which would have been phased in, was expected to contribute $60 million toward the cost of the $302 million program during its first year. By the fifth year, it would have contributed $317 million toward overall costs of $1.4 billion.

Paula Kostick, owner of Classic Dry Cleaners and Laundromats, said she believes employers providing health is the morally "right thing to do," and that all employers should contribute.

But she has doubts whether the 3 percent tax would do much good. Some employers might decide it's more cost-effective to pay the tax rather than provide coverage, especially those in low-wage industries. People with low incomes would still be unlikely to have employer-sponsored coverage, she said.

In the fall, Rendell also will push for health insurance reforms. Greco predicts these proposals will result in the most heated battles with special interests. She said a state-subsidized insurance program wouldn't do much good without health insurance reform.

Rendell would give the state insurance commissioner power to review all health insurance premiums and prevent insurers from earmarking more than 15 percent of premiums to administrative costs and profits.

Insurers no longer would be able to charge dramatically higher rates to people with medical problems. And they would have to allow adult dependents to stay on family plans until age 29.

Every insurer would have to offer a uniform, basic insurance plan, forcing them to openly compete on cost and quality.

Alan Jeffrey, owner of Signorama, said he supports Rendell's attack on "medical underwriting," where insurers base premiums on medical and health factors, charging significantly more to people who are sick or old. Rendell's goal is to spread costs over larger pools of people.

Jeffrey, 60, says that would be better for him.

"When I was younger, I helped contribute to the pool. Now that I'm older, the rug is being pulled out. ... I'm not seeing anyone else sharing [in my costs], and I'm getting hit. My rates have gone up astronomically."

Kostick also believes it would be better if insurers put people into larger groups, spreading the costs among more people.

Her business, with 65 full-times, offers insurance from HealthAmerica, splitting the cost evenly with employees. Monthly premiums for single people have reached about $400, meaning that person pays about $200.

As premiums have risen, more of her younger workers have opted out of coverage, and now only about 40 percent of her work force is covered, she said.

Overall, Greco said the administration isn't discouraged by reaction to the plan so far.

She maintains that, during the recently ended legislative session, the administration accomplished more than most people expected. The victories included Rendell's biggest cost-control measure -- requiring hospitals to do more to reduce infections that strike patients.

Despite struggles with the hospital industry, the administration won measures that will require hospitals to increase efforts to monitor infections and publicize the results.

One proposal that didn't succeed would have required hospitals to test each incoming patient for an infection called MRSA that takes an especially high toll.

Two other rebuffs include an alternative health care proposal from Republican legislators called "the real prescription for Pennsylvania." This plan centers on so-called consumer-driven measures, such as health savings accounts, and using less regulation and more competition to drive down health care costs.

In addition, the state House, where Democrats hold a slim majority, formed a task force to explore the cost and access to health insurance -- tasks the administration feels it has already accomplished.

Still, Greco contends the "the stars are aligned" for major health care reform in Pennsylvania and nationwide.

"There are more and more people who have health insurance who fear losing it," she said.

July 24, 2007

DR. RENDELL WANTS YOU TO FEEL BETTER

Daily News Editorial

IMPROVING THE HEALTH-CARE SYSTEM IS A START

GOV. RENDELL has made a few notable journeys, but the most remarkable one is his move in recent years from poster boy for cheesesteaks to the poster boy for public health.

In the budget season just mercifully ended in Harrisburg, the governor scored a few solid victories in his vision for improving access to, and the cost of, health care. Still, the cornerstones of his vision for health reform in the state -covering all Pennsylvanians and health-insurance reform - have been put off until the fall.

(And in case you confused Pennsylvania with a modern, enlightened state, the Legislature did fail to approve a statewide smoking ban.)

Two big wins included a bill that would address hospital staph infections and one that would widen the scope of services that can be provided by nurse practitioners.

Both of these are critical to reining in health-care costs in the state. For example, the bill designed to reduce hospital-acquired infections will force hospitals to test for a common bacteria that can cause big problems - even death - in patients. The law will require hospitals to reach certain testing benchmarks, and punish them right in their reimbursements for failure.

Another bill will widen the scope of services that nurse practitioners can perform, a move expected to reduce the costs of some medical services and provide better access to health care for many, important since 30 percent of Americans don't have access to a primary-care physician.

In separate legislation, fuller services were also granted to dental hygienists and midwives. Now, for example, midwives can write prescriptions; Pennsylvania is among the last states to make this change.

In May, Rendell also established a Chronic Care Management Commission to grapple with the staggering costs associated with chronic diseases, including diabetes. He also formed an office of health equity to eliminate disparities in health-care access and quality based on race, general and income.

All of Rendell's initiatives - developed with Rosemary Greco, his director of the office of Health Care Reform - are way overdue.

Pennsylvania now ranks third in the nation in the size of its aging population, and that's a trend that foreshadows huge potential health-care crises.

More importantly, these initiatives confront the inability, or unwillingness, of President Bush and Congress to come to grips with a health-care system that works for far too few Americans.

This unwillingness is playing out this week, in the attempts to reauthorize the Children's Health Insurance Program, which expires in September. Bush wants to keep this program from being expanded; he says it would lead to government-run health care for all Americans.

He might be shocked to hear how many Americans, fed up with a broken system, might actually embrace this notion.

Rendell declares germ warfare at hospitals throughout state

July 21, 2007

By Luis Fabregas

The crackdown on deadly hospital infections is about to heat up in Pennsylvania.

Under a law signed Friday by Gov. Ed Rendell, the state will reward hospitals for reducing the number of infections -- a move intended to curb the more than 2,500 deaths attributed last year to killer germs.

"This is huge for us and for all hospitals across the state," said Dr. Carlene Muto, chief of infection control at the University of Pittsburgh Medical Center, considered among the nation's leaders in eliminating infections.

Although hospitals in Pennsylvania have long been required to report infections, no government agency ever has mandated to cut them back.

Those that show a 10 percent reduction in infections by Jan. 1, 2009, will be eligible to receive a quality-improvement payment. Those that don't risk fines and tougher licensing hurdles from the state Department of Health.

The amount of the payments has not been determined, said Amy Kelchner of the Governor's Office of Health Care Reform.

The new rules call for hospitals to change the way they collect infection data by using a long-standing federal tool developed by the Centers for Disease Control and Prevention. More than 600 hospitals already use the Internet-based system.

"It will give us consistency as a profession," said Cheryl Herbert, director of infection prevention at Allegheny General Hospital in the North Side. "I'm quite pleased with the agreement to use national definitions that we all feel comfortable with."

The system collects data in real time -- a factor that gives hospitals the ability to identify trends more quickly and compare their numbers to those of other facilities.

Rendell's plan largely was inspired by the work of several hospitals in Western Pennsylvania -- including the VA Pittsburgh Healthcare System -- that have sharply cut back the number of infections among hospitalized patients.

"These are the kinds of common-sense programs that improve and save people's lives and money," Rendell said.

Other key aspects of the plan include a requirement to test high-risk patients for resistant bacteria as soon as they are admitted. Hospitals such as UPMC currently test high-risk patients only when they are transferred to an intensive-care unit. High-risk patients include those who come to the hospital from nursing homes, where infections are believed to be prevalent.

Hospitals have 120 days to comply with the new rules.

Midwives approved to prescribe medication

July 19, 2007

By Sally Kalson, Pittsburgh Post-Gazette

Pennsylvania is the sole remaining state to bar certified nurse-midwives from writing prescriptions for their patients. Now, that barrier is about to fall.

Tomorrow morning, Gov. Ed Rendell is scheduled to sign the first laws to come out of his health care reform package, all aimed at making high-quality, low-cost health care available to as many people as possible.

The package, known as Prescription for Pennsylvania, is designed to ensure that all licensed health care providers are able to practice medicine to the fullest extent of their education and training, including advanced nurse practitioners and certified nurse-midwives. The authority to write prescriptions is part of that. (It does not apply to lay midwives, who are trained mostly through apprenticeship and are not licensed by the state.)

The changes in so-called "scope of practice" issues have been a major focus of groups representing non-physician medical professionals. That includes the Pennsylvania Association of Licensed Midwives -- www.pamidwives.org -- and the Pennsylvania State Nurses Association -- www.panurses.org.

"We've been working on this since 1985, when new regulations were written by the state Board of Medicine," said Vivian Lowenstein, a certified nurse-midwife from suburban Philadelphia and president of the midwives association.

The Board of Medicine is comprised almost entirely of doctors, who long have opposed letting non-physicians write prescriptions. Ms. Lowenstein was the first and only nurse-midwife to hold a seat on the board, which occurred from 1997 to 2002.

"We tried to negotiate for prescriptive authority, but the board wouldn't allow it," she said.

"Without Gov. Rendell, the Office of Health Care Reform and our supporters in the Legislature, this change would not have happened."

Amy Kelchner, spokeswoman for the governor's health care reform office, said "Nurses and doctors have been at odds for 40 years on this issue. Coming up with a plan everyone can agree to is very significant. It's also a sign of the times -- everyone knew the governor was serious about Prescription for Pennsylvania and this is a common-sense change."

Most nurse-midwives practice in hospitals such as Magee-Womens Hospital in Oakland because that's where most women choose to have their babies, said Ms. Lowenstein. But Pennsylvania also has five free-standing birthing centers, one in Pittsburgh.

Christine Haas, executive director of The Midwife Center for Birth & Women's Health in the Strip District, said state regulations have been out of step with the education that certified nurse-midwives receive.

"Advanced pharmacology is a core requirement in every nurse-midwifery educational program accredited by the American College of Nurse-Midwives," said Ms. Haas.

Every other state lets them use that training.

"It's been an issue for us in recruiting nurse-midwives to our practice," she said. "When they've had prescriptive authority in other places and find out they would not have that here, it's a strike against us. This really gets us on par with the rest of the country."

Nurse-midwives contribute to higher health standards by delivering lower cost care to women and children, she said -- something the governor wanted to emphasize in his health care reform package.

"Birth centers consistently have fewer C-sections, epidurals, episiotomies and low birth-weight babes," Ms. Haas said. "We have lower incidences of induced labor and premature birth compared to the national average."

That's partly because birthing center clients must be healthy and low-risk. But it's also because the midwifery model of care emphasizes educating women and their partners, prevention, wellness and the use of medical technology only when necessary, not as routine care for normal, healthy labor and birth.

The governor's overall health care plan was introduced as a single bill but the Legislature broke it up by profession into eight pieces. Six of them have passed, concerning nurses, nurse practitioners, clinical nurse specialists, midwives, dental hygienists and physician assistants. Bills dealing with nurse anesthetists and pharmacists are still pending.

The laws don't go into effect until their regulations are written by the Board of Medicine. That will be a yearlong process, and Ms. Lowenstein said members of the nurse-midwife profession will be involved in crafting the language.

"The question is whether the Board of Medicine will follow the legislative mandate of writing regulations that are not restrictive," said Ms. Lowenstein. "Many of us will be going to Harrisburg to work on this," to make sure they do, she said.

Rendell bills cover midwives, infections

July 11, 2007

By David Wenner

A pregnant woman under the care of a nurse midwife will be able to get prescriptions from the midwife.

People will be able to find out the infection rate at their local hospital and what's being done about it.

And people might get greater protection against secondhand smoke in public places.

Rendell administration officials said yesterday they expected passage of bills to accomplish those things within the next few days following agreements made as part of the budget. They said the bills -- part of his "Prescription for Pennsylvania" -- represent good progress toward his goals of improving access to health care and lowering costs.

The bills include efforts to enable health professionals -- such as nurse midwives, nurse practitioners and physician's assistants-- to practice to the full extent of their training.

For example, nurse midwives would be allowed to prescribe drugs, which previously had to involve a doctor, said Rosemarie Greco, who heads Gov. Ed Rendell's office of health care reform.

The overall goal is to expand availability and lower the costs of some health care services.

Doctors can focus on the most serious problems, and a team approach can be used to better manage chronic diseases, such as diabetes, and address health problems before they require expensive emergency room or hospital care, Greco said.

Another bill involves infections that strike hospital and nursing home patients. Rendell has said such infections account for $3.5 billion in hospital charges annually and cause 2,500 deaths.

Hospitals will be required to screen patients transferred from nursing homes for infections. The department of health also will make recommendations on other high-risk patients that should be screened. The goal is to reduce the spread of the infections.

By 2010, all hospitals will be using electronic methods to track infections and determine whether the infection rate is within an acceptable range, Greco said.

Hospitals, nursing homes and outpatient surgery centers also will have to submit infection data to a Web site where the public can view it.

As of yesterday afternoon, there was still disagreement surrounding the public smoking ban.

One sticking point involved whether Philadelphia will be allowed to continue a stricter ban. Some legislators want a single ban that would apply to all municipalities.

The administration wants municipalities to be able to choose a stricter ban on public smoking.

Another sticking point involved proposed exceptions to the ban that caused Rendell to threaten to veto it, Greco said.

One major Rendell proposal that has not moved is his plan for state-subsidized health insurance for people who can't afford it. The proposal includes a 3 percent payroll tax on businesses that don't provide health insurance for workers.

Many business interests have objected, saying it's unfair to tax small businesses that can't afford health insurance, and arguing that businesses would have an incentive to drop private coverage in favor of the state-subsidized plan.

Rendell has argued that requiring all businesses to provide coverage, and covering all state residents, will lower the cost of health insurance in Pennsylvania.

Rendell plans to resume pushing the plan in the fall, said Susan Anderson, deputy director of Rendell's office of health care reform.

The administration and others also were working out details of a bill, from state Sen. Pat Vance, R-Cumberland, intended to address problems with assisted living in Pennsylvania.

Pennsylvania has no formal definition of assisted living. The term, commonly used in advertising by facilities that provide various levels of living support, generally describes more support than is found in personal care homes, but less than in nursing homes.

One consequence is that residents are unable to obtain Medicaid funding toward assisted living.

Another issue is that there's no guarantee of what people will get from a facility billed as providing assisted living, said Amy Bolze, executive director of the Senate Aging and Youth Committee.

Health care proposal still alive

July 6, 2007

By David Wenner

Gov. Ed Rendell remains confident that important parts of his universal health care proposal will become law within days, according to Rosemarie Greco, his top health care official.

The governor also expects that his full "Prescription for Pennsylvania" plan, including a new health insurance program for low-income people and an attack on poor-quality care and financial waste, will become reality this year, Greco said.

In an interview yesterday, Greco said some business and insurance groups have spread negative, inaccurate information about the plan, slowing its progress.

"I'm disappointed, but frankly not surprised," she said.

Still, recent bipartisan efforts involving affected interest groups have resulted in key bills moving forward, she said. These include bills to expand the roles of health care professionals, including nurse practitioners, physician's assistants and nurse midwives.

The goal is to increase access to basic health care to help prevent or better manage illness and reduce more expensive emergency room and hospital use.

Greco said the Pennsylvania Medical Society and various professional groups were able to overcome differences to come up with House bills that would achieve Rendell's goals. They have written to Senate leaders, saying they support the bills and want them approved without amendments, she said.

She said several other bills are being worked out, and there's no good reason they can't be finalized in the next few days as part of the new state budget. The measures include:

Allowing dependent children to stay on family health plans until age 29.
Changing the way health insurers set premiums for small businesses.
Banning smoking in public places.
Requiring hospitals to use screenings and electronic surveillance to eliminate infections that strike hospital patients.

Rendell announced his plan in January. He said he wanted it approved by the June 30 budget deadline.

More recently, he conceded that it will take more time for measures such as state-subsidized insurance coverage, which would be available to lower-income adults and some small businesses.

Some of the plan focuses on the state's uninsured, which Rendell says number about 900,000. The Pennsylvania Medical Society has put the number as high as 1.5 million.

Much of Rendell's plan focuses on financial waste due to infections that strike hospital patients, medical errors, use of emergency rooms for non-emergencies and poor management of chronic diseases. He said $7.5 billion a year could be saved.

Greco said the plan has been the victim of false information spread by some of the groups that would be affected.

For example, she said some have misrepresented the proposed 3 percent payroll tax on businesses that don't provide health coverage for employees. Employers that provide health benefits would qualify for a tax credit and wouldn't pay the payroll tax, Greco said.

But some business groups have told their members that businesses would have to pay up front and then apply for a refund, she said.

"We've said [businesses] are going to be accessed, and we're still waiting to see the exact process by which you will get out of that assessment," Barr said.

Greco also pointed to the Insurance Federation of Pennsylvania, saying the group has told people the 3 percent payroll tax would be struck down in court, and the plan doesn't do enough to address costs.

A court struck down a Maryland proposal to assess Wal-Mart for alleged failure to provide adequate health coverage for employees.

Sam Marshall, president of the federation, said he only expressed the opinion that the Rendell proposal might also be struck down.

"It doesn't make sense to come up with a big program unless you have a stable funding stream," he said.

Marshall said his group is largely supportive of the plan, although he believes obesity, smoking and defensive medicine should be added or moved higher on the list of health care cost drivers to attack.

The federation opposes proposed changes that would prevent health insurers from using age and medical history as a reason to charge dramatically higher health insurance premiums. Marshall said the changes would stifle competition, which he doesn't expect would lead to more affordable health insurance.

The Rendell administration has had other setbacks. The Democrat-controlled state House recently voted to form a task force to study the cost of health insurance and access.

The administration spent more than a year documenting a health insurance crisis in the state and was "stunned" to see the call for a task force and fails to see the need, Greco said.

top of page

Pa. health-care system in ‘crisis mode’

Forum discusses possible reform solutions

June 28, 2007

By Jessica Bruni

Avoidable illnesses and hospital stays are driving up the costs for Pennsylvanians and sending the health care system into crisis-mode, representatives from Gov. Ed Rendell's office say.

On Wednesday, Michael Huff, state deputy heath secretary for health planning and assessment, led a public forum at Dickinson College where he went over Rendell's “Prescription for Pennsylvania” reform plan as part of a state-wide tour.

About 50 people from the area attended.

Joining him was Carlisle Mayor Kirk Wilson, Nathan Staggs, chief executive officer of Carlisle Regional Medical Center, and Bets Clever, executive director of the Carlisle Area Health and Wellness Foundation.

Huff outlined a integrated plan to reform the state health care system, at the core of which, he said, are affordability, accessibility and quality.

Expanding responsibilities

When Huff said the plan would expand access to health care providers by removing restraints on nurses, dental hygienists and other licensed providers, Carol Robinson spoke up.

A family practitioner at Graham Medical Clinic in Newville, Robinson said she was concerned that physicians assistants or nurses wouldn't have the full extent of training to safely treat patients. Doctors, she noted, spend eight years in school before they take on several more years of training in a residency program. PAs, she said, spend a total of six years in school.

“I don't think you can really equate the two,” she said. .

However, Huff said, the plans would not extend health care providers beyond their training.

“We clearly do not want people practicing outside of their scope,” he said.

As people filed out of the meeting, which stretched close to 90 minutes, Huff said he was pleased with the responses received from residents.

“I think it was exciting,” he said. “It was exactly the kind of feedback and discussion we need to have at the local level.”

The prescription plan currently is in the general assembly awaiting vote. If approved, the plan would provide uninsured Pennsylvanians will more affordable health insurance. An estimated 767,000 adults in Pennsylvanian go without health care, Huff said. Of those, he noted, 71 percent are employed.

Pittsburgh Post-Gazette

Group rallies in Harrisburg to back Rendell health plan

Thursday, May 24, 2007

By Tracie Mauriello, Post-Gazette Harrisburg Bureau

About 700 Pennsylvanians crowded into the Capitol rotunda yesterday for a rally promoting health care for low-wage workers.

Participants, including a busload from Pittsburgh, came to support Gov. Ed Rendell's "Prescription for Pennsylvania" plan, which would require most employers to provide health insurance or pay a 3 percent payroll tax.

Employers are reluctant to provide health insurance because of the cost, about $130 per employee per month, said Tracy L. Lawless, Pennsylvania coordinator for the Healthcare for Healthcare Workers Campaign.

In the big picture, though, providing health-care coverage could save companies money, she said, because the employee retention rate would improve and less money would be required for recruitment and training. Clients will be more satisfied, too, because their caretakers will be more experienced, she said.

Members of Service Employees International Union also came out in droves to support the governor's health-care policy.

"I don't know if it's exactly the right thing, but it's a step in the right direction," said Lynnwood Schultz, president of the SEIU chapter at the Polyclinic Medical Center in Harrisburg.

Rally photos

Jesus would back my plan, Rendell says

Thursday, May 24, 2007

BY DAVID WENNER

Of The Patriot-News

What would Jesus do about Pennsylvania's health care crisis?

He'd vote for Gov. Ed Rendell's universal health care plan. So would Moses and Muhammad.

That's what Rendell told a crowd who rallied in Harrisburg yesterday in support of his "Prescription for Pennsylvania." He urged them to flood their legislators with demands to approve the plan.

The governor also directed a message to state legislators, saying they can't claim to support "moral" and "family" values if they don't support his plan.

He singled out Republican legislators, saying not one has come out in favor of his plan. That stance is morally indefensible, given our nation's great wealth and the number of people who can't afford good health care, he said.

State Republicans yesterday objected to Rendell's claim that supporting his plan is the only correct "moral" choice.

"We certainly care that people have access to health care," said state Rep. Kathy Watson, R-Bucks. "How we reach that might be different."

State Rep. Scott Boyd, R-Lancaster, said he and Watson are developing an alternative proposal that might be ready in June. He said the plan focuses on reducing the cost of health insurance and making it affordable through tax incentives.

It also would involve greater transparency in prices for medical care and consumer-driven approaches to make people take greater responsibility for their health care spending and their personal health.

Rendell's plan would raise some taxes while creating new taxes to pay for it. The plan calls for a state-backed health insurance program to help cover the state's 900,000 uninsured residents. It also would attack about $7.5 billion worth of health care waste that Rendell says occurs annually because of hospital-acquired infections, medical errors and poor management of chronic diseases.

Rendell also would impose a 3 percent payroll tax on employers who don't provide health insurance for employees, and prevent health insurers from charging significantly more to people who are ill.

The rally yesterday was sponsored by labor unions, including the Service Employees International Union, the United Food and Commercial Workers and the Pennsylvania State Nurses Association. Busloads of people arrived from areas such as Philadelphia, Scranton and Hamburg.

At the rally, they chanted slogans such as "health care is a right" and carried signs with messages such as "Cover All People" and "Stop Rising Insurance Costs."

Rendell told them that health care and business groups are saying they support his proposals, but they quietly lobby legislators to remove parts they don't want. Bit by bit, the plan becomes emasculated, he said.

The governor urged them to demand that their legislators face the political risk that comes with challenging the existing health care system.

When Rendell announced his health care plan in February, he asked legislators to approve it by the June 30 budget deadline. But legislators have yet to vote on any aspects of the 96-page bill, and the Legislature appears to be focusing on overall budget issues.

Yesterday, Rendell said he still expects some aspects of his plan will be approved before the legislators leave for the summer. But key aspects, including the state-backed insurance plan, probably won't be dealt with until fall, he said.

Rally photos

Rendell: Insurance plan unlikely to be tested before fall

May 24, 2007

HARRISBURG, Pa. (AP) - Gov. Ed Rendell acknowledged Wednesday that his proposal to expand state-subsidized health coverage to roughly 800,000 uninsured adults probably won't be put to a vote in the Legislature before fall.

Rendell's "Cover All Pennsylvanians" plan, which also would enable small businesses to insure low-wage workers at a discount, has encountered strong resistance from Republicans and business lobbyists. They object to a payroll tax that would be levied on certain businesses that do not currently insure workers to help pay for the expansion.

The measure is part of the Democratic governor's broader "Prescription for Pennsylvania" initiative to reduce health care costs and improve the quality of care.

"I think it would be very tough to have that passed before (the Legislature's) summer break, just because of the budget and so many other things," Rendell said after speaking at a Capitol rally organized by a coalition that included organized labor and consumer groups. "It's my hope that a number of the important cost-containment components (of the plan) will pass before the break."

Both houses are working on other elements of the plan, including legislation to eliminate hospital-acquired infections, help hospitals and doctors' offices create computerized patient records, and remove regulatory barriers that prevent health care professionals who are not doctors - such as nurse practitioners and nurse midwives - from providing certain kinds of care.

Several lawmakers also are sponsoring bills to ban smoking in workplaces, restaurants and bars - another part of Rendell's plan.

But the payroll tax proposed in "Cover All Pennsylvanians" - 3 percent for each of the first three years and increasing to 3.5 percent in the fourth year - appears stuck for now. Businesses with fewer than 50 workers would be exempt from paying in the first year.

"It appears not to be getting a lot of traction" in the Legislature, said Eugene Barr, a lobbyist for the Pennsylvania Chamber of Business and Industry.

Business groups are urging lawmakers to examine other ways to reduce health care costs before increasing state spending, said Kevin Shivers, state director of the National Federation of Independent Business.

"Enacting a new payroll tax ought to be a last resort," Shivers said.

In the Senate, neither party seems interested in taking up the payroll tax, said Erik Arneson, spokesman for Senate Republican Leader Dominic Pileggi of Delaware County.

"I continue to see no sign of a pulse for the so-called 'fair share' tax in the Senate, from either side of the aisle," Arneson said.

Rep. Todd Eachus, D-Luzerne, the sponsor of a bill that serves as the framework "Prescription for Pennsylvania," said he plans to organize a "work group" of House and Senate leaders in early June to discuss how to pay for the proposed insurance expansion.

"As an act of creativity, getting together with leaders of different positions on this can many times help to form a compromise, and I'm hopeful that can take place," Eachus said.

At the rally, several hundred people applauded and cheered as Rendell exhorted them to tell their legislators to support his broader plan. Other speakers included James Anderson, a Philadelphia resident who works part-time and cannot afford health insurance.

"God has blessed me, and I haven't had any health problems, but who knows?" Anderson said. "This bill is a godsend, not only just for me, but thousands of people in the same class - the working poor."

Rendell said he was open to a compromise, but noted that payroll tax revenue would cover only about 7 percent of the cost of the insurance expansion. Other sources include federal Medicaid dollars, funds the state currently spends on its adultBasic program for uninsured adults, and premiums paid toward "Cover All Pennsylvanians" by small businesses and health plan enrollees.

The payroll tax is an important part of his proposal, Rendell said, because "it levels the playing field."

"We can't have some businesses providing health care, and other businesses not providing health care and not paying into the system, because it leaves the businesses who do provide health care at a competitive disadvantages," he said.

Rally photos

Rendell sells his insurance plan

May 23, 2007

By John Hilton

Gov. Ed Rendell defended his budget initiatives Tuesday and urged business owners to get on board with his health insurance plan to extend coverage to all Pennsylvanians.

Speaking to the Harrisburg Regional Chamber of Commerce at the Four Points Sheraton in Lower Paxton Township, Rendell said employers either accept his health care plan or face socialized medicine down the road.

Health care costs increased by 75 percent from 2000-06, the governor said, or four times the rate of inflation. If that trend continues over the next seven years, “single-payer (a national health insurance) will pass in Washington,” Rendell insisted.

Advocates of a single-payer system - where the government would collect taxes and cover everyone, similar to programs in Canada and across Europe - have introduced bills in at least 18 state legislatures.

“If you don't want socialized medicine ... you better hop on the Pennsylvania plan,” Rendell told the chamber audience.

The administration is calling for a payroll tax on an estimated 100,000-plus employers that do not currently insure their employees. The tax rate would be 3 percent for each of the first three years and would then increase to 3.5 percent in the fourth year. Businesses with fewer than 50 workers would be exempt from paying in the first year.

Republicans have complained that Rendell's proposal would encourage some employers to drop private insurance coverage if it is cheaper to pay the payroll tax for state-subsidized insurance.

Administration officials have said that is unlikely to happen because employees would have to go without health insurance for six months before they could enroll.

State Sen. Patricia Vance, R-31, was in the audience and questioned the payroll tax plan. It started out as a 2.6 percent tax, she noted, adding that Rendell included good ideas in the plan with no means to pay for them.

“He's a very good saleman,” she said this morning. “But you don't necessarily hear the rest of the story.”

Rendell said his proposal is practical for employers in more ways than one.

“If you offer health care, your turnover is significantly lower than if you don't offer health care,” he said, noting that General Mills and Verizon support his plan. “We think it's a very reasonable package.”

Rendell became mildly annoyed when chamber President David Black began a question about the governor's budget by calling it “the most aggressive budget in history with regards to initiatives and taxes.”

Republicans have assailed Rendell's $27 billion budget plan because it calls for increases in the state sales and cigarette taxes, the new payroll tax for health insurance and new levies on chewing tobacco, cigars and electricity use.

Due to shifting and savings, the governor insisted most Pennsylvanians will actually pay less taxes. For example, Rendell said the payroll tax for health insurance will be offset in part by a 6 percent reduction in health insurance costs once everyone in the state is covered.

Likewise, increasing the state sales tax rate from 6 percent to 7 percent would augment $1 billion a year in property tax reductions that slot-machine gambling is eventually expected to generate.

As for the so-called “sin taxes,” the governor said Pennsylvania is the only state that does not tax smokeless tobacco.

At some point, the debate has to be about what is best for the state, Rendell said.

“It's always great to say we're against taxes,” he added. “Well, does anybody want to continue the state of Pennsylvania's bridges and roads? You business folks - does anybody want their employees not to have access to mass transit to get to work? I don't think so.”

Black questioned the “inequity” of the new taxes and the tax shifting. Employers seem to be the only group that doesn't come away with something.

“If you want to talk about inequities... we should talk about getting everybody to pay their (corporate income) tax,” Rendell shot back.

Many companies - 74 percent according to the governor - get out of paying the corporate income tax rate, which now stands at 9.9 percent, by registering all or part of their operations in Delaware. The neighboring state has long been a tax haven for corporations.

Rally photos

Pittsburgh Post-Gazette

A Healthy Start

Pennsylvania takes the plunge on total coverage

Pittsburgh Post-Gazette editorial

January 21, 2007

In a nation where 46 million people have no health insurance and the federal government has abdicated its role on the problem, it was inevitable that states would begin to act. Now Gov. Ed Rendell wants Pennsylvania to join Massachusetts, California and others in trying to find its own solution.

The wide-ranging proposal he unveiled last week is not the single-payer method that deserves consideration on a national level. But it offers enough change -- through incentives, mandates and controls -- to be an effective state response.

On the surface, Pennsylvania's problem doesn't look so dire. About 767,000 adults are uninsured and, with 92 percent of its residents covered by health insurance, the state ranks seventh in the portion of those with health care. But a closer look shows even those robust numbers are precarious, with employers hit hard by the rising costs of worker health policies, employees having to pay a greater share out of their own pockets and too many Pennsylvanians living too close to the edge of a state of no insurance.

So Gov. Rendell wants to move from Cover All Kids, his initiative passed last year to make affordable insurance available to every child, to Cover All Pennsylvanians, in which nearly 50 pieces of legislation will be required to make changes on a host of fronts. We don't suspect every bill will be passed, or that each one will survive in original form, but the governor has launched a welcome and ambitious drive to confront the problem in a way that may actually work.

His multipronged approach seeks to improve access to health care by making it more affordable. By focusing attention on a variety of special interests, Mr. Rendell might even be improving the plan's political chances of success. For starters, we welcome his call to ban smoking in indoor workplaces, including bars and restaurants; extend the sales tax to smokeless tobacco and cigars; and raise the tax on cigarettes, the source of so many illnesses.

The plan would impose tougher regulations on the insurance industry to spare small businesses and individuals from sudden spikes in premiums. The governor wants to prohibit insurance rate-setting linked to health status, gender and number of claims filed. He wants 85 percent of every insurance dollar to provide health care -- meaning a hard limit on profit and advertising. He wants to give the state insurance commissioner the power to reject rate hikes.

The Rendell proposal would make changes in the health-care industry to bring down costs. The governor wants to exert pressure to reduce costly hospital-acquired infections and avoidable medical errors. He'd require hospitals to have non-emergency treatment centers that care for patients who don't need the high-cost attention of an emergency room. He'd allow health-care professionals like nurses, physician assistants and others to render treatments and services to the fullest extent of their training and skills, thus reducing reliance on higher-priced medical personnel. He wants the state to curb the duplication of expensive, underutilized treatment facilities in the same region.

At the workplace, Cover All Pennsylvanians would help small businesses provide health insurance to lower-wage employees at reduced rates. Companies that refuse would be hit with an assessment to help fund the insurance program. All uninsured Pennsylvanians, regardless of income level, would also be able to buy insurance at affordable rates and, eventually, may be required to carry coverage -- just as all Pennsylvania drivers must have auto insurance.

Although Gov. Rendell said various interests are bound to reject the aspects of the plan that hit them hardest, we are pleasantly surprised that the response, to date, has not been vociferous. There may be a reason for that.

Perhaps everyone -- consumers, business, hospitals and insurers -- finally agrees that something must be done, that 46 million Americans without health insurance leaves too many uncovered and, just as bad, too much cost for the rest of society to absorb.

The governor's plan is not only a healthy way for the state to address the problem, but it also has the makings of a progressive approach to covering all Pennsylvanians.

For more on Governor Rendell's Prescription for Pennsylvania, go to:

http://www.ohcr.state.pa.us/prescription-for-pennsylvania/index.html

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other campaigns | low cost health campaign

Philly News

Posted on Wed, Feb. 07, 2007

Health plan's goals, costs

By Josh Goldstein
Inquirer Staff Writer

Gov. Rendell's "Prescription for Pennsylvania" health-care initiative comes with a hefty $255 million price tag in its first year alone, according to the proposed budget he released yesterday.

He proposed to cover that cost by hitting up Uncle Sam for more money, raising the state's tax on tobacco, and assessing a fee on businesses that don't insure their workers.

Most of the price tag - some $233 million - would be spent to provide the state's 767,000 uninsured adults with access to government-subsidized health coverage.

The administration projects that 153,600 people would enroll in this program, dubbed Cover All Pennsylvanians, in the first year.

Other key elements of Rendell's Prescription for Pennsylvania - such as improving the care of the chronically ill, reducing the number of infections people get while in hospitals, expanding the school breakfast program - would cost a relatively modest $22 million.

And one part of the proposal - banning smoking in workplaces, restaurants and bars - would hardly cost a thing.

The premise of Rendell's health-care plan is that expanding access to primary care, enhancing the quality of chronic care, and reducing medical mistakes would ultimately produce major savings.

For example, the administration estimates that $1.7 billion could be saved by reducing hospital admissions for chronic conditions such as diabetes.

The administration hopes the effort to reduce hospital-acquired infections - and in time, stop paying to treat them - would save billions more each year.

"Our approach differs from most of the states," Rendell said in the prepared text of his budget message. "We not only address the need for universal access to coverage, we also address the major cost-drivers that are making health insurance less affordable."

State officials predict that after four years, 431,300 people would be covered by the state-subsidized insurance program.

The monthly premium would be $280. But steep discounts would be available to poor and lower-income families.

The subsidy would be funded with increased tobacco taxes, a 3 percent assessment on their total payrolls for businesses that don't offer insurance to workers, existing money such as the state's tobacco settlement fund, and federal matching funds.

Reactions to the health-care pieces of the budget were muted yesterday as interest groups slogged through the nearly 1,000 pages of the $27.3 billion budget plan and prepared for legislative hearings.

The governor's budget, particularly the health elements, comes as hospitals and other providers gird for Medicare and Medicaid cuts in President Bush's federal budget plan.

Carolyn F. Scanlan, president of the Hospital and Healthsystem Association of Pennsylvania, estimated that Bush's budget could reduce payments to the state's hospitals by nearly $500 million.

Rendell's plan could add to those cuts, further damaging the fiscal health of the state's health-care providers, she said.

"The governor holds out the promise of trying to cover the state's uninsured," Scanlan said. "But the peril is, how do you fund that, while maintaining existing programs without hurting hospitals - the safety net for patients."

Philadelphia Daily News

Published January 19, 2007

LET'S FILL PRESCRIPTION FOR PA. - RENDELL'S HEALTH PLAN DESERVES SUPPORT

WE MUST BE coming down with something. We feel little chills of hope. A dizzying sense of possibilities. A disorienting decrease in our skepticism levels.
We've acquired all these symptoms after being exposed to details of Gov. Rendell's comprehensive health-care reform that promises health coverage for all Pennsylvanians and recommends ways to reduce the high costs of such care.

Rendell's Prescription for Pennsylvania is an ambitious plan that the governor will spend the next few weeks stumping for around the state.
We do have a queasy feeling about how Rendell's intriguing ideas would work in the real world of special interests.

And while there's a lot for the insurance industry, hospitals and health-care providers to like, there's something for everyone to dislike, and maybe lobby against. Only some of the funding questions have been answered. Meanwhile, we applaud the governor for a number of things:

For tackling the intractable health-care problem that continues to spiral out of control, and has for too long felt unfixable.
For addressing the shameful truth that basic quality health care is out of reach for more and more people. Too many people are uninsured -nearly 800,000 in Pennsylvania - and too many others pay far too much for a system that fails to provide the best quality care at the best price.
For the level of his optimism that he can get the General Assembly to pass the necessary legislation by June.
For daring to challenge lobbyists, insurers and the health-care industry to fix this system and be more accountable to containing costs. And for acknowledging upfront that much of this depends on regulation, and that regulation is a good thing.
For demanding that the burden of caring for all be more fairly shared, by charging a "fair share' tax on companies who do not offer health care. * For underscoring the failure at a federal level to fix the system, and acknowledging that this is no longer acceptable. And admitting that the best solution would be a federal single-payer health insurance, but not waiting around for that day.
For pledging his commitment to this by promising to lose 25 pounds.

As for that last . . . OK, we're back to feeling skeptical again. *

No safety nets; Haves and have-nots 'Dehumanizing'

People who don't have health insurance tell their stories of fear, shame and frustration

By Helen Colwell Adams
Lancaster Sunday News
April 29, 2007

When the hospital official embarrassed Hung Nguyen by stopping a treatment with the words "Hold it -- he doesn't have insurance," the humiliation was deadly. Almost literally. Nguyen thought about jumping from a Route 30 bridge. Remembering his children, and people who tried to help him through his medical problems, led him back home. He didn't tell anyone about his despair. "But today I have to tell it," he said.

The day was Friday, when Nguyen and 12 other clients at SouthEast Lancaster Health Services gathered to tell their stories of life on the margins of the health care system as part of nationwide Cover the Uninsured Week. It was a litany of frustration, shame and fear.

Margarita Colon lost coverage when her Social Security payments rose $29 a month. Her children had to chip in to pay her medical costs. James Harris needs hernia surgery but can't afford it. Mauricio Pena has diabetes and other serious health conditions, but no insurance. Listening to the tales were Lancaster Mayor Rick Gray and state Reps. Mike Sturla, D-96th District, and Scott Boyd, R-43rd District.

They offered sympathetic ears, but no easy answers. "We as Americans have a problem," Giovanni Escribano warned. "We are killing our country from within. ... We don't take care of our own people."

As Friday's lunch got under way, social worker Meagan Howell asked participants to introduce themselves and to note if they have insurance. Before long the pattern emerged: The people with professional jobs, mainly white, had insurance. The people with other kinds of work, and the ones who had lost their jobs, didn't. Many of them were Latino, African-American or, in the case of Nguyen, Asian. Social worker Helen Jones noticed the pattern.

"Why should that be?" she asked. "Why should I not have to worry about it, and he does, and she does? "... It is just not fair."

Dr. Bill Fife, medical director at SouthEast Lancaster, said 1 in 5 patients at the clinic, which handles about 12,500 people, are uninsured. Lisa Riffanacht, director of Project Access Lancaster County, a new initiative in which local doctors, hospitals and pharmacies are offering free care for some of the uninsured, said an estimated 11 percent of county residents have no health insurance. Five clinics around the county treat patients without insurance, but those can handle a caseload of only about 8,400.

The demand isn't just in the city, she said; "there are pockets of poverty all over the county." Of the uninsured, Riffanacht said, 80 percent are working, often at part-time jobs or positions that don't offer health benefits. Work instability emerged as a common thread in many of the stories.

Ilka Colon Morales, Margarita's daughter, said she ran into trouble paying for medications when her husband lost his job. Ilka also was working. Efrain Rodriguez had insurance when he worked in computer technology, but he is changing careers and studying nursing, so now he has no coverage. His doctor recommended a tonsillectomy for chronic throat infections, but "I can't afford it." George Lopez sometimes goes without medication for his high blood pressure because he can't pay for both the prescription and his rent.

Juana and Giovanni Escribano came to Lancaster three years ago. He worked for county government, while Juana cared for their children. When the county began requiring its employees to contribute to the cost of health insurance, Giovanni decided to go to nursing school so he could find a position with better pay and prospects. "To take $60 to $70 out of your paychecks to pay for health insurance," he said, "when you get not much -- it's a lot."

Cathy Bell's daughter, at 17, can't get coverage for prenatal care or delivery of her baby because of a six-month waiting period to get into the state's insurance program for children. Michele Skipper was a nurse, but she's now unemployed, and her husband, who is on Social Security disability, isn't eligible for Medicaid yet. "I'm extremely blessed to be able to come to get care here," she said.

Nguyen immigrated to the United States from Vietnam more than 30 years ago. He worked until 2005, when Kemps Foods closed its plant and eliminated his job. He has been diagnosed with diabetes and also has kidney failure. But when he was sent to the hospital for an injection to treat his kidney disease, a hospital worker stopped the procedure because she had discovered Nguyen had no insurance and still owed money on a previous bill. "I can feel my tears want to come out," he said.

As Nguyen described the loss of dignity that comes with loss of health insurance, heads nodded around the table. Howell, the social worker, called it "dehumanizing." Giovanni Escribano spoke of having to convince welfare officials to provide short-term Medicaid help for his family while he's in school. "It was not easy for us," he said, "especially because I've always been working."

"It isn't that people want to be on welfare," said Rodriguez. "... People don't want to be dependent on others. What they need is a little help so they don't have to be dependent." Lopez pointed out it would be cheaper to offer preventive care than waiting until health problems become serious before offering financial aid. "It certainly feels like you have committed a crime," Escribano said, "because you have no health insurance."

Project Access Lancaster County may help to care for about 5,000 people, mainly adults, who have jobs but insufficient coverage. Under the program, Riffanacht said, 621 doctors have agreed to treat 10 to 20 uninsured patients each "pro bono," while all four hospitals have pledged to pick up the costs of lab work and other tests.

Pharmacies are working out a system to provide medications for participants at no cost, she said. Rep. Sturla noted that he sponsored legislation to "Cover All Kids" last year and is working with Gov. Ed Rendell on an insurance plan for adults. But that initiative is "getting a bit of resistance" in Harrisburg, Sturla said. He agreed with some clients who wondered why nations like Canada offer universal health care, while the United States does not.

About 45 million Americans are uninsured. In Pennsylvania, about 10.5 percent of the population has no coverage. "We're the only industrialized nation in the world that doesn't have universal health care," Sturla said, "and I think we should be ashamed of that."

"I'm just frustrated with the system," Rodriguez said.

"We have to find a good solution," Nguyen said, "for the future of us."

Daily News

Why I'm supporting the guv's Rx

By LANCE HAVER

I WOULD LIKE to see a single-payer health system in America, one that eliminates the bureaucracy and profits of the insurance companies.
Yet I've added my name to the list of endorsers of the governor's "Prescription for Pennsylvania" (Rx4Pa). I know there are some who will ask: If you support a single-payer plan, why are you supporting Rx4Pa?

The answer is simple. I see supporting the governor's plan as the most humane and progressive step to getting a single-payer system.

Here are the choices: I can either support Rx4Pa, which will cover 155,300 Pennsylvanians in the year to come, or work to defeat it, telling people who don't have health insurance they have to wait for coverage until there is a perfect plan.

I believe if we asked the uninsured what they want - coverage as soon as possible or waiting for the perfect plan to be passed - the overwhelming majority would say coverage as soon as possible.

That's why supporting Rx4Pa is the most humane way to get a single-payer system. I don't want to be someone who argues that the only way we can achieve social progress is by depriving people of what they n