Pennsylvania's Proposed Health Insurance Reforms

ennsylvania's Governor Ed Rendell just introduced his program to reform the state's health insurance. This proposed program is entitled Prescription for Pennsylvania. While it still needs to be approved by the legislature, it would definitely bring significant changes to health care in the state. Rendell's overall goal is to provide health care to everyone, including about 767,000 PA residents who do not have any coverage. Below are some of the ways in which Rendell's proposed plan will benefit residents of Pennsylvania.

1. Affordable Insurance For All

A new program which is part of this "Prescription" is called CAP, which means "Covering All Pennsylvanians." By this, the Governor intends to be able to bring affordable health insurance to everyone in the State, especially to those who make less than the State's average income of $39,000. Two target areas that this program is looking to provide insurance for, are:

Employed individuals who do not have health insurance
Small businesses owners who do not have health insurance

2. Employed Individuals Who Do Not Have Health Insurance

Governor Rendell's own goal for those who are employed but have no insurance, but limited to those who make at least 300% of the poverty level of income, is to be able to provide health care coverage for around $280 per month. Apparently this is the actual cost of providing this policy that his counsel has determined. There are presently several insurance carriers offering health insurance for this amount or less in Pennsylvania.

3. Individual Health Insurance

Governor Rendell's goal for those who are employed but do not have insurance is limited to those who make at least 300% of the poverty level of income. The cost to provide health care coverage would be around $280 per month as this is the actual cost of providing a policy that his counsel determined. There are presently several insurance carriers offering health insurance for this amount or less in Pennsylvania.

4. Program Will Reduce Medical Costs To Make It More Affordable

Several areas in the new Pennsylvania health insurance program are targeted in an effort to curb overgrown and unnecessary medical costs. These targeted areas will help reduce the billions of dollars spent each year and help to reduce the overall cost and make it affordable for nearly all. Here are some of the features that have been specifically mentioned in order to make it happen.

A. Examination of Services Performed - Certain areas are being examined to potentially reduce current medical care costs such as reducing the length of hospital stays in order to prevent things like hospital infections. Another targeted problem will be those hospital stays that could have been prevented by better personal self-care or better physician services in the first place, such as treatment among people who have diabetes, asthma, and other various medical conditions. This also includes scaling back on certain procedures and tests that may be unnecessary.
B. Reduce Medical Costs By Enlarging Services. The annual cost of providing health care is billions of dollars. The Governor is looking to reduce this figure by cutting out unnecessary expenditures in order to lower costs of health insurance in Pennsylvania. By expanding medical facilities hours of operations to include evening hours and weekends, he believes there will be less of a need to use emergency rooms for everyday medical needs. Furthermore, Rendell hopes that by bringing everyone into the health insurance program, the overall costs of healthcare in Pennsylvania will decline.
C. Other Changes That Will Benefit Many - Other additional changes in the health insurance in PA program include:

· Allowing Nurses To Perform More Services:

Governor Rendell is proposing the use of medical attendants like nurses and possibly dental technicians in a wider capacity as they are trained to do more than they are generally permitted to do. For example, in a nurse-controlled medical facility, nurses may not be permitted to do things like stitching wounds, treating infected toenails, or removing moles, if these nurses were in a doctor-controlled facility, they would regularly perform these tasks. Costs will be reduced by allowing nurses to perform these medical treatments on a statewide basis, allowing doctors to perform functions that are targeted to their specialized training.

Another example is the distribution of prescriptions during the birthing process. Many mid-wives and nurse practitioners already deliver as many as 10% of the babies in PA, and it seems like it should merely be the natural progression of their services into this arena, as well.

Nurse care in such fields as has been mentioned here, and others, would reduce health insurance costs as nurses do not charge much as doctors do for their services.

Reducing Costs Through Rebates:

For those insurers that provide plans to small businesses, there may be a need to provide rebates. If an employer's medical costs for their group plan uses less than 75% of the collected premiums, the insurer will need to provide a rebate to each of the employees. This will help keep costs down for employers - at least for those years where expenses are lower than expected.

The question here is how do the insurers fund the claims for the groups whose claims exceed 200% or even 500% of their premiums?...if this is done on an overall loss ratio basis, it would be of great benefit to employers.

With so many changes that will soon be effecting the health insurance in Pennsylvania in a positive way, it appears that many people will certainly be able to enjoy better healthcare. The Prescription for Pennsylvania may indeed be a real good thing, and only time will tell.



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