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Tuesday, March 28, 2006My proposal is not rooted in a 1960s entitlement program; it is a modern, fiscally cautious, down-to-earth approach. It’s a starting point; we begin cautiously and grow step by step as we are able. We don’t throw the barn doors wide open at the beginning. We use partnerships. We don’t mandate. We put a priority on Tennesseans who work for modest wages, for small businesses, for themselves. This is a health insurance plan dressed up, not in 60s bell bottoms and beads, but in the clothes of today’s working men and women. I call this effort Cover Tennessee. Let’s talk specifics. The heart of our plan is a partnership between the state, individuals and small business. Frankly, it’s high time that we provided individuals and small business with the same economies of scale enjoyed by large businesses and their employees. At the outset, we’ll limit participation to those small businesses with substantial numbers of lower- and middle-income workers — this insurance right now is for retail shops and restaurants, not small consulting or professional firms. The idea is simple: Small business is the heartbeat of our economy, and it can be the heartbeat of our solution to health care as well. Now, remember these two words: Affordability. Portability. These will be the core principles behind our approach. My definition of affordable is no more than a hundred dollars a month for an individual. We plan a benefit package that has a total cost on average of about $150 a month. Of that, the state will pay $50. Where an employer is willing to contribute, a $50 contribution on their part will leave the employee to pay $50. If an employer won’t or can’t participate, and the individual has to pay it all, it will still be no more than a hundred dollars. The prices I’ve used are the average; we’ll adjust the premiums for age — older people simply have higher health care costs. We’ll also adjust for whether a person is a smoker, and for whether a person is substantially overweight. People who take care of themselves should not have to pay extra for those who don’t. It’s time to move past political correctness and instead to reward personal responsibility. In order to achieve these prices, we obviously can't do everything and some benefits will be limited. For example, we may have to exclude coverage for certain pre-existing conditions for a limited period of time - say six months. However, this is practical insurance that would provide a generic drug benefit for $10, routine doctor visits for $25, and emergency room and hospital care with limits. And no one would be turned away for medical reasons. The core components: A voluntary basic health insurance plan for employees of small business and the self-employed with limited incomes — no mandates. A total cost of about $150 a month, shared 1/3 the state, and ideally 1/3 or more the employer, 1/3 or less the employee. The cost to the individual and employer varies with age, with whether the person smokes, and with whether the person is substantially overweight. For this you’d get $25 doctor visits, $10 generic prescriptions, and hospitalization, outpatient and emergency room coverage with limits. There’s no large deductible for routine coverage; we encourage prevention and early detection. You are guaranteed to be able to buy it at the posted rate; you may have some exclusions in coverage during the first months. You own it and can carry it with you. He estimates that such a program will cost the state $60 million per year per 100,000 people enrolled. (Because the state pays $50 into the program each month for each enrollee.) But, consider this: To keep everything in perspective: If this were highly successful and five years from now we had 150,000 people signed up, the cost to the state would be about 3% of what we spend on TennCare. Sounds like he might be on to something. Tennessee will be the place to watch in the coming years. posted by Sydney on 3/28/2006 01:15:00 PM 2 comments 2 Comments:There will have to be some incentives for doctors to accept this insurance. The fee schedule has to be realistic. The administrative hassles have to be minimal. The rules have to be clear-cut. Reimbursements have to be prompt. There needs to be an administrative staff and medical directors who return phone calls. In other words, an affordable plan for patients must be matched with a responsible relationship with physicians and other providers. If this turns out to be another Medicaid program, it will fail.
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My concern is that this will be an expensive card that people carry in their wallets, but that there will be few benefits that will be covered. Because it is not Medicaid, there is no accountability to the Federal government. Because it is not provided through your employer or through any group that you belong, you have no advocate who will hold the insurance company accountable to deliver what you thought you were buying. Because Tennessee does not have a strong insurance oversight, one cannot count on the state to hold the insurance company's feet to the fire.
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