Vol. 2, No. 2, Mar/Apr 1994 |
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FINANCING ASSISTIVE TECHNOLOGY: Health Care Reform - Getting Involved
Ron Sibert, Funding Specialist, DATI
Our last issue discussed disability-related issues under President Clinton's Health Security Act (HSA). It described some of the Act's strengths and weaknesses from a disability perspective, and how average citizens can help make the plan more effective.
HSA is being hailed by the national disability-related organizations as the most promising of all of the proposed health care reform packages floating about Capitol Hill today. Why? Because despite its shortcomings, it is still the only plan that guarantees health care benefit coverage regardless of health status or disability. Additional consumer input is still needed to fine-tune the HSA, but there is now another more basic concern. The Clinton plan is not the only one on the table, and the others are much less sensitive to the needs of people with disabilities. Opponents of the HSA's single payer plan in the Senate and House are busily gathering support for less costly, but much less comprehensive plans.
As the cost and coverage battles rage in Congress, many different proposals are being developed. Each proposal has unique features, but to some extent, they all involve one (or some combination) of three basic approaches: Single Payer, Managed Competition, and Insurance Reform. Differences in these three approaches center around the level of government control, who pays for benefits, and the quality of coverage. The following "quick and dirty" overview is based on the findings of health policy researchers in the Washington office of United Cerebral Palsy Associations Inc. (UCPA).
- The Single Payer option is a federally-financed, state administered, health care system that would be delivered by private insurers. It would provide comprehensive health care benefits for everyone regardless of income, health status, employment, or age. Costs would be controlled by federal budget-setting, and prices would be determined by negotiations with hospitals and other state health care providers. The package would include long-term care and mental health services as well as preventative treatments and rehabilitation. It would be financed through corporate and personal taxes placed in an exclusive health care trust fund. The Health Security Act was modeled primarily after this single payer approach but again, it still needs some fine-tuning.
- Managed Competition would restructure the marketplace by changing the way insurance carriers do business. Instead of the existing free enterprise approach, this model places state administered health insurance purchasing cooperatives (HPICs) between insurance buyers and sellers. The HPIC, also called a Health Alliance, would collect money from consumers and employers, and distribute that money to health plans based on the number of people who choose to enroll in a particular plan. It would screen plans to assure that each one meets minimum federal requirements for health care, and provide consumers with a report card each year to help them make informed carrier choices. Insurers would compete for business on the basis of price, quality, and the extent of their offerings beyond the minimum package. Cost containment would be achieved through government-imposed price controls, by taxing any premiums that cost more than the lowest price plan, and through increased use of managed care plans (such as HMOs). People with disabilities report difficulty obtaining specialist referrals in managed care settings and their restrictive limits on covered services have also been problematic.
- Insurance Reform encourages purchase of private insurance and seeks to make that insurance more "affordable" by various means. One way is to relax state mandates requiring private insurance policies to cover certain services or types of providers. Policies could then cover less and cost less. Another way is to provide tax subsidies to small employers or to low income employees to enable them to pay health insurance premiums. Managed care is considered an option under this model as well. Some insurance reform bills only seek to regulate insurance policies of small groups (2-100 employees) by limiting pre-existing condition exclusions and annual premium increases. Generally, insurance reform has limited scope, does not address the issue of rising health care costs, and many of the benefits packages will not cover certain services such as prescription drugs, rehabilitation therapies, and home care.
The DATI, along with several State agency representatives, recently participated in a two-part national teleconference on Health Care Reform. Urgent concerns were raised about limited access to health care by people with disabilities under certain proposed plans. One such plan, the Cooper bill, was sponsored by one of the 18 senators who voted against the Americans with Disabilities Act (ADA). People with disabilities were asked to write to their senators and congresspersons because true health care reform requires consumer input.
The DATI has joined with the Delaware Health Care Commission to convene a Health Care Reform Summit near the end of February. Representatives of several disability-oriented consumer organizations throughout the State will receive updates on disability-related health care reform issues from both local and federal viewpoints. The organizations are likely to soon begin consumer outreach and advocacy training activities to share information and instruction about how to make a difference. There is still time left to act before any final decisions are made in Washington. Every person will experience disability at some point in their lives; this is not just someone else's concern. Do yourself a favor...take the opportunity be heard ....get involved.
FINANCING ASSISTIVE TECHNOLOGY