May 2007 No. 23Table of ContentsHealthcare - Part I |
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IN ties with Kansas for the 14th youngest population in the U.S.A.—36.1 median age (half older, half younger). Utah’s the youngest at 28.5, and Maine is oldest at 41.2. Hard to believe? At the last census, IN had the 20th highest teen pregnancy rate.
So, fertility and longevity are two benchmarks in the health of our people. Second only to the Iraq war, Americans name healthcare as the “top priority for the president and Congress.” The response to Gallup pollsters was the same across age groups. Women mentioned healthcare slightly more often than men, those leaning Democratic (87%) more often than Republican (64%). But it’s been a growing concern—mentioned by 9% a year ago and 27% this late February.
A February UPI/Zogby poll found 91% of Americans believe the U.S. healthcare system is in need of some kind of reform, but respondent were divided between those who want “major reform” (46%) and those who think “small fixes” are required (46%).
What should we do? Congress created a Citizen’s Health Care Working Group—chaired by Indpls St. Vincent Hospital CEO Patricia Maryland—that held 84 community meetings nationwide involving 6,650 Americans and asked them what their priorities were. In September, 2006, the group sent its report to President Bush. Its #1 recommendation was to “establish public policy that all Americans have affordable health care” by 2012. That report is now before Congressional committees. See it and the Group’s detailed findings at www.citizenshealthcare.gov.
In late April, Gallup got the same result. Asked “what is the most important thing that could be done to fix the healthcare system in the U.S. today,” Americans said “have universal coverage/make coverage available to all/assist those who cannot afford it” (32%). That was the highest response for Republicans, Independents, and Democrats alike, regardless of age.
An early 2007 Rasmussen poll, found 33% of Americans favoring a national health insurance program, with 55% favoring the idea of requiring companies to provide health insurance and 57% favoring taxing wealthier Americans to provide coverage for the uninsured. But that proposal is controversial.
Into the middle of melee, states stepped in. Massachusetts passed a complex law that requires everyone to have health insurance in one way or the other. On the other coast, California’s Governor Schwarzenegger proposed another cover-all plan. IN was no “Johnny-come-lately” as it often is. Governor Daniels put his own plan before the IN General Assembly, and something eventually passed over five months later!
Governor Daniel’s Healthy Indiana Plan (HIP) morphed into a bi-partisan Indiana Check-Up Plan (ICU, “intensive care unit”?) passing in the wee hours of the last legislative day, April 29. It both creates a funding stream for healthcare reform and creates ICU. HEA 1678 ups IN’s cigarette tax 44¢ to 99.5¢ a pack starting July 1, 2007, generating estimated state revenue of $187M in FY 08 and $206M in FY09. Of that, 27% goes into the ICU Trust Fund, 54% into the General Fund, and the remainder into assorted other Medicaid and health-related funds. The state funds can leverage another $600M/year in federal funds.
ICU is complex but has these primary features:
The Family & Social Services Agency (FSSA) has already issued an RFP for implementation of ICU. “These things will not happen automatically,” Daniels said. “It’s harder than you think.” FSSA’s Mitch Roob wants to sign up 50,000 in 2008. He plans on community groups helping to get the word out.
Patti O’Callaghan, president of the IN Coalition for Human Services (ICHS), says this task will be as difficult as getting people to sign up for a tax refund using the federal and state Earned Income Tax Credits. Despite her outreach efforts in Lafayette, some 20% of those eligible for the EITC don’t use it.
HEA 1678 also increased eligibility for the Children’s Health Insurance Program (CHIP) to 300% of the federal poverty level. IaUW is on the IN Covering Kids & Families board that promotes enrollment in CHIP.
Among the Hoosier uninsured is an unlikely but needy group—employees of United Ways and other nonprofits with small staff and budgets. In a 2004 survey, IaUW found that among the one-third of IN United Ways raising less than $1M few provided basic healthcare insurance for their staff. None of those raising less than $200,000/year had coverage. Like many small for-profit employers, this was an employee benefit they could not afford, or they hoped staff would be covered under a spouse’s plan. Most of the United Ways raising $1+M paid at least half of the worker-only health insurance premium.
HEA 1678 provides new options for these employers with 2-50 full-time workers. Beside tax credits and incentives to develop employee wellness programs for employers paying business taxes, it also allows certain small nonprofit employers to join together to purchase group health insurance for their workers.
A version of this legislation—which did not pass—allowed employers to include their workers in the health insurance programs offered to state government employees. This would have been a great advantage for small nonprofits, as the state’s benefits are generous and the payments relatively low. This approach got changed as the final bi-partisan package emerged in the waning days of the session.
According to HEA 1678, starting July 1, the Dept. of Insurance and the FSSA secretary’s office “may” implement a program to allow small employers “to join together to purchase health insurance” as described in a new section of the Indiana Code {new IC 17-8-5-16 (8)}. “Small employer” is a “person, firm, corporation, limited liability company, partnership, or association” that goes at least half of the year employing 2-50 workers primarily within the state.
What this means is that IaUW and others will have to work with these two state entities to develop such a healthcare insurance group. The “may” language means they might not; it did not say “shall.”
Let’s get started. The sooner, the better.
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