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Tucson, Arizona Sunday, 10 March 2002
Health care for all
Everyone may get access to coverage
Team aiming plan at 1 million who go without protection
By Jane Erikson
ARIZONA DAILY STAR
Every Arizonan would have access to health insurance within the next three to five years under a proposal being drafted by a statewide team of lawmakers, hospital officials and other health-care experts.
The multi-tiered proposal, in the planning stages for the past two years and now moving toward final planning and action, takes aim at one of the state's most serious social and financial problems: the one in five Arizonans - about 1 million people - who have no health insurance and no reliable source of adequate medical care.
That affects all Arizonans. The state's approximately 100 hospitals provided about $525 million in uncompensated care to people without health insurance last year, up from $331 million in 1995, according to the Arizona Hospital and Healthcare Association. That level of financial chaos threatens hospitals' ability to provide quality care to anyone. And it means higher bills for patients with private insurance.
Members of the Statewide Health Care Insurance Plan Task Force still need to complete the details of a health-care reform plan that would leave the private insurance industry intact and build on existing state programs by allowing people with higher incomes to buy into programs now reserved for the very poor.
A price tag has not been set, but payment likely would come from state funds and patient premiums. The reforms would need the approval of state lawmakers and the governor.
"We want to improve on what we have and make it better," said Sen. Ed Cirillo, R-Sun City West, one of the task force's co-chairmen. "There's a whole lot of arrows in the quiver that we can use to fix the problem."
Most of Arizona's uninsured are working folk who earn too much to qualify under the income limits of the state indigent health-care plan, the Arizona Health Care Cost Containment System, or AHCCCS.
Others are people with medical problems who are flat-out rejected by health plans not willing to assume the costs of their care, or whose policies exclude coverage for "pre-existing conditions."
Still others live in rural areas not served by all the health plans available to people in Tucson and Phoenix.
Barbara Roth, a Tucson mother of 4-year-old twin boys, can't find health insurance for Taran, who suffers from severe hearing loss and asthma.
Her income is too high for the state's KidsCare insurance program, but she is looking for other programs to help with Taran's medical bills. She's been searching for months.
"I feel like I'm tapping in the dark," Roth said.
Another of the uninsured is Richard Southall, 57, of Dolan Springs, about 35 miles north of Kingman. He was laid off from his job at Boeing in Long Beach, Calif., two years ago. The company allowed him to continue his health insurance for 18 months, but now he can't find affordable coverage.
Nearly five years ago Southall had a heart attack. The cheapest policy he can find would cost him $459 a month - nearly half his monthly income.
"I'm treading water," Southall said, "and just hoping the water don't get any deeper."
The task force wants to enact several strategies, which could include:
* Allowing people to buy membership in AHCCCS when their incomes are too high for them to qualify for free.
* Expanding the state's experimental Premium Sharing plan, now limited to four counties, and raising the income limit so more people could buy into it.
* Preserving Healthcare Group, the state-run insurance plan for small businesses and the self-employed, with a state subsidy for at least one more year - a proposal introduced this session. In the future, people with higher incomes would pay higher premiums to stabilize the program and allow it to operate without a state subsidy.
* Starting a health insurance high-risk pool that would sell coverage to the thousands of Arizonans whose pre-existing health problems disqualify them for other insurance. The pool would need to be subsidized, possibly through existing tax revenues or private policy-holder premiums.
* Educating those who choose not to have health insurance that their decision can be financially devastating - not only to themselves, but to all Arizonans.
Reforms vital, DuVal says
There is no question the state needs to support such reforms, said Merlin K. DuVal, the founding dean of the University of Arizona College of Medicine and a former assistant secretary of health under President Richard M. Nixon.
"I'm not personally strong on big government, but there are programs and services that have to be supported, and we've cut too much," said DuVal, who attended each of the task force's eight meetings. "I also have a very strong conviction that when it comes to social problems, the single most important one is health care."
Arizonans can be optimistic the plans will come to fruition, said task force member Sen. Virginia Yrun, D-Tucson.
"People need to know that there are legislators who are genuinely interested in making sure health insurance is available and accessible to all Arizonans," said Yrun, who was appointed to the Senate last April after the unexpected death of Sen. Andy Nichols, D-Tucson, who fought for years for statewide health insurance.
Nichols spearheaded the Healthy Arizona initiatives that voters overwhelmingly approved in 1996 and again in 2000. Finally implemented last year, Healthy Arizona raised the income eligibility limit for AHCCCS from 34 percent to 100 percent of the federal poverty level. The initiative has helped bring 180,000 more adults into AHCCCS over the last year.
Two years ago, Nichols obtained a $1.2 million grant from the federal Health Resources and Services Administration to finance the task force's fact-finding efforts. It was one of 17 such grants awarded nationally.
The task force hired outside experts, including William M. Mercer Inc., a Scottsdale consulting firm, to define the state's uninsured population.
Mercer reported that 74 percent of the state's uninsured live in families with annual incomes below 200 percent of the federal poverty level - $35,300 a year for a family of four. Mercer also found that while Hispanics make up 25 percent of the state's population, they represent 52 percent of the uninsured.
Mercer also found that 97 percent of Arizona's employers have fewer than 100 workers, making it more difficult for them to negotiate affordable health insurance rates; the national average is 41 percent.
The University of Arizona Rural Health Office, which Nichols, a medical doctor, served as director, compiled its own report on the uninsured, stating their number at about 800,000. Others consider that estimate low. All agree that Arizona's uninsured will increase as a result of last year's economic slowdown and layoffs.
The nine-member task force - three senators, three representatives and three community members appointed by Gov. Jane Hull - was aided by a 14-member technical advisory committee of hospital, state agency and insurance company representatives. After completing the first phase of its planning work in December, it should be ready to tackle the second phase by fall, Cirillo said.
The plans would be enacted by the Legislature, with changes to AHCCCS requiring additional federal approval.
Insurance industry skeptical
The private insurance industry has voiced skepticism that the reforms will work.
Sandra Gibson, vice president and chief actuary of Blue Cross Blue Shield of Arizona and a member of the task force's technical advisory committee, said the need for any added state dollars may prove insurmountable.
In addition, Gibson said, state programs pay deeply discounted fees to hospitals and other providers. A report from the St. Luke's Health Initiative in Phoenix said AHCCCS patients account for 35 percent of trauma cases statewide, but AHCCCS pays only about 60 percent of hospitals' costs of caring for those trauma patients, Gibson said.
"An expansion of state programs that don't pay their full cost . . . hurts providers, so they have to make up for that shortfall by passing on higher costs to those with private insurance," she said.
Gibson agrees that Arizonans need to be aware of the true cost of the care they receive.
"Medical technology does so much to improve the quality of their lives," she said, "yet they resist paying even as much to see a doctor as they would pay to go to a movie."
Dr. Joseph Carver, a senior administrator with the University of Pennsylvania Cancer Center, has helped states through a process similar to that of the Statewide Health Care Insurance Plan Task Force. Carver has helped New Jersey and Michigan develop agreements among legislators, insurers, doctors and others to guarantee cancer patients have access to clinical trials of new therapies.
To bring about change in health care, consensus agreements work better than legislating mandates, Carver said. "The real downside of legislation is, it sets a precedent for people who are not health-care professionals, and who are elected officials, dictating how health care is provided," he said.
"What Arizona is trying to do sounds like a very unique and very needed solution," Carver said.
"We've got to make this happen," said Yrun. "I don't think we have any alternative."
* Contact Star Jane Erikson at 573-4118 or at jerikson@azstarnet.com
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