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The Role of Academic Health Centers
in Health Care Reform

2006 Annual Meeting
San Antonio, Texas

 

The States Grow Impatient: Leading Reform or a Crazy Quilt?

James J. Mongan, MD, President and Chief Executive Office Partners HealthCare
Massachusetts; David Carvalho, JD, Deputy Director for Policy, Illinois Department of Health;Frank B. Cerra, MD, Senior Vice President for Health Sciences, University of Minnesota; Douglas Barrett, MD, Senior Vice President for Health Affairs, University of Florida; Marcia J. Nielsen, PhD, MPH, Interim Executive Director, Kansas Health Policy Authority

Should the federal government lead in health reform? If the federal government should not or cannot will states be able to create sustainable reform? Health reform plans from five states were examined. The plans in various stages of development highlight the need for academic health center leaders to engage state policymakers to take account of the risks and benefits of grass roots reform now.

Massachusetts
Massachusetts is uniquely positioned for health reform, according to Mongan. The state has only 10% uninsured compared to 15% national average, has broader employer coverage compared to the rest of the nation, and has a strong Medicaid program. Most importantly, Massachusetts has a pre-existing Uncompensated Care Pool that covers hospital costs for the uninsured.

The Uncompensated Care Pool will provide financing for the proposed reforms by:

All players (Advocacy Groups/Business Groups/Insurers/ Providers) came to the table and agreed to work together on the new reform plan.

The most important elements of the plan: Coverage for 95% of uninsured through a number of elements:

The Massachusetts plan will be expanded over the next 3 years depending on:

For the plan to succeed, a balance between funding sources and cooperation between government, employers, and individuals will be needed.

Illinois
In 2004, the Illinois Health Care Justice Act created the Adequate Health Care Task Force, charged with developing a comprehensive health care access plan for the state. The Illinois Department of Public Health, the lead state agency, is working with representatives from the Departments of Aging, Medicaid, and Human Services.

The 29-member Task Force developed criteria for the reform plan, which include access to a full range of preventive, acute, and long-term health care services; improved quality of health care services; portability of coverage; core benefits for all Illinois residents; regional and local consumer participation; cost-containment measures; multiple approaches to preventive medicinebased on new technologies; and affordable coverage options for the small business market.

The Task Force said that for a plan to be recommended for the state it must include:

The Illinois Department of Public Health reviewed the plans submitted for consideration. The Consultant's Hybrid Plan was the most attractive because the plan incorporated an individual mandate, Medicaid expansion, state subsidies for residents under 400% of poverty, and insurance reform elements. The Illinois Department of Public Health will submit a final report for the consideration of the legislature to be approved at the January 9, 2007, task force meeting.

Minnesota
Minnesota has one of the most widely consolidated healthcare markets in the nation. Only 5% of the state's population is uninsured—one of the lowest rates in the U.S. Several years ago, Minnesota enacted a provider tax to be used to pay for care. This tax generates about $650 million annually; one third is deposited directly into a general fund. Out-of-pocket costs to consumers (between 25-30%) are one of the major driving forces for the state's reform initiative. Given the historical roots of Minnesota's population, many are looking to the Scandinavian model for ideas. The state has a government sponsored Health Reform Task Force. The University of Minnesota represents the educational sector on the Health Reform Task Force.

The Health Reform Task Force is currently reviewing a Physicians Plan for a Healthy Minnesota.

The Physicians Plan for a Healthy Minnesota will be submitted to the state legislature in January 2007.

Florida
The Florida Legislature did not believe the state's Medicaid system was sustainable, and created a reform plan centered on cost containment. Currently, $2.2 million of the state budget is spent on Medicaid (24%). Budget analyses from the last few years have shown a consistent 8.8% growth in the number of Medicaid recipients. According to this model, Florida can expect Medicaid expenditures to be upwards of 30% of the state budget by 2010. Currently, 7% of Florida residents—about 1.2 million people—are uninsured. Florida has a very strong anti-tax constituency, limiting the political options for policymakers. To control costs, the state is trying to manage the amount and scope of care that Medicaid recipients receive.

The state's plan is to take the financial burden from the state and move it to the private sector.

The state will have to determine ways to assess the adequacy of premiumsand decide on appropriate profit margins for providers. It is not clear where all the money will come from.

Florida is currently implementing a 5-year pilot program in Jacksonville and Broward Counties involving 350,000 people (16% of Florida's Medicaid population). In this pilot, people have 30 days to choose a plan before one is assigned. Three university-based think tanks will be evaluating the plans and assessing the success of the pilot.

Kansas
The Kansas Health Policy Authority (KHPA) was created in 2005 by the state legislature based on Governor Sebelius' " Reorganization Order." A nine-member board to govern health policy was established. The mission of the Kansas Health Policy Authority is to develop and maintain a coordinated health policy agenda that combines effective purchasing and administration of health care with health promotion-oriented public health strategies which are driven by health data.

In 2006, all Medicare/Medicaid and CHIP programs were transferred to the authority of KHPA. KHPA is trying to find a policy solution that:

To engage state leaders in reform initiatives academic health center leaders should:

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