A Really Big Band-aid

In today’s news it was announced that America’s Health Insurance Plan (AHIP), an organization of the health insurance industry, had released a new proposal to reform health care in the United Stated. According to their web site, “AHIP is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.” You can find their announcement on their web site here. You can find a news summary, with a variety of links to news stories and comments, here.

According to the AHIP web site,

“The AHIP plan calls for enactment of federal legislation that provides significant financial incentives to states and makes changes to federal tax policy to make health coverage more affordable. Key elements of the AHIP plan include:

* Expanding the State Children’s Health Insurance Program (SCHIP) to make eligible all uninsured children from families with incomes under 200 percent of the Federal Poverty Level (FPL).
* Improving and expanding Medicaid to make eligible all uninsured adults, including single adults, with incomes under 100 percent of the Federal Poverty Line.
* Establishing a Universal Health Account (UHA) to allow all individuals to purchase any type of health care coverage and pay for qualified medical expenses with pre-tax dollars, with federal matching grants for contributions made by working families to the UHA.
* Establishing a health tax credit of up to $500 for low-income families who secure health insurance for their children.
* Establishing a new $50-billion Federal Performance Grant to assist states in expanding access to coverage.”

According to their estimates, this would allow coverage for all children within three years, and for 95% of adults within ten years, at a cost to the federal government of approximately $300 billion.

In an earlier post, I spoke of meeting with senior staff of one of my senators during the Waging Reconciliation Conference in 2003. At that meeting we discussed association health plans, which the senator supported. I felt at the time that association health plans were a band-aid; a big band-aid, a good band-aid, but a band-aid nonetheless. I find myself with something of the same suspicion about this proposal. It may bring welcome and productive changes. But I wouldn’t call it real reform.

First, it continues to assume that most of us will receive health insurance through an employer. This proposal expands significantly who would be included at the edges, but the center would remain unchanged. I can’t really say that this is a surprise. Any real change would significantly affect the way these companies to business.

With that assumption, it doesn’t seem to provide any assistance to or incentive for small businesses to provide the benefit, or to pay well enough for employees to obtain it themselves. After all, most of those now uninsured or under-insured are employed by companies that don’t provide health care. And if it’s true as we’ve been told that small businesses provide most jobs over all and most entry level jobs, there seems little here to assist those small companies in providing the benefit. Why not instead continue to hold wages down and allow more and more entry-level workers and their families into Medicaid and SCHIP plans?

This proposal does not address efforts to control the costs of health care. One way it might have would be to propose standardized paperwork and electronic communications, using a single, standard set of codes and forms. This was the one really useful proposal in the Health Insurance Portability and Accountability Act (the dreaded HIPAA), and apparently the least likely to come to pass. But with almost 1300 member companies, this might be difficult for AHIP to propose.

Finally, in the end this proposal continues to see health care, and the health insurance that pays for it, as commodities. There is no endorsement of the principle that health care, available and accessible and adequately funded quality health care, should be a human right, both for the citizen and for the sojourner that dwells in our land. That, I will note, has been the position of the Episcopal Church meeting in General Convention. It is the first principle of Resolution 1994-A057: “That universal access to quality, cost effective, health care services be considered necessary for everyone in the population.”

Now, the devils and angels are in the details, and there are few details in what has been published so far. This would require a great deal of commitment and statesmanship in Congress and the White House, characteristics that have been sorely lacking, at least in addressing health care needs. Like the experiment in Massachusetts, this is worth watching to see what good it might actually do. But I can’t see it as real reform. It may be a really, really big band-aid; but it remains a band-aid nonetheless.