GOVERNMENT & MEDICINE

Council urges plan to expand health coverage

Bans on new mandates outside of patient protections and expanded outreach to ethnic populations are cited as ways to make coverage more affordable and accessible.

By Geri Aston, AMNews staff. June 14, 1999.
AMNews Annual Meeting '99 coverage - AMA's Annual Meeting site.

Washington -- In light of continuing increases in the number of uninsured Americans, the AMA's Council on Medical Service will recommend at the Annual Meeting this month four additions to Association policy aimed at making health insurance more affordable and accessible.

The council will ask the House of Delegates to:

• Oppose new health benefit mandates unrelated to patient protection.
• Urge the Health Care Financing Administration to require states to use its simplified four-page Medicaid/Children's Health Insurance Program application or a comparable form.
• Prod HCFA to ensure that Medicaid and CHIP outreach efforts are bilingual and culturally sensitive in states or localities with large uninsured ethnic populations.
• Encourage state medical associations and specialty societies to work with state agencies to develop innovative programs, such as expanding CHIP to cover the families of eligible children and to increase insurance coverage.

A problem growing worse

The report recognizes that the problem of the uninsured "has gotten worse at a time when the economy has gotten better," said CMS Chair Kay K. Hanley, MD. More than 43 million Americans are currently uninsured. The AMA has at least 28 policies on insurance choice, access and affordability, Dr. Hanley noted.

The CMS recommendations would "fill in the blanks from previous reports and serve as an action plan," said AMA President Nancy W. Dickey, MD, who has made increasing insurance access a focal point of her presidency. The CMS plan complements the AMA's support for increasing insurance access and choice through individual health insurance tax credits and the establishment of purchasing pools known as voluntary choice cooperatives, she said.

The council's recommendation to oppose benefit mandates reflects concern that they increase premiums.

"There is plenty of evidence that any time you mandate benefits, you increase the cost of insurance," Dr. Hanley said.

Such cost increases reduce choice by pricing some people out of the insurance market and by making coverage more generic, Dr. Dickey said.

"The more you allow mandates, the more everything looks the same," she said. Patients should have the opportunity to choose their health plans, whether they be "platinum-plated or gold-plated," she added.

Although some groups may view patient protections, such as those called for in several bills before Congress, as benefit mandates, the AMA advocates passage of a strong patients' bill of rights package, Dr. Dickey said. "As long as patients have no choice, we have to protect them from the worst [health plan] abuses."

The campaign for parity in mental health benefits also differs from benefit mandates because it simply calls for equality in mental health coverage compared with medical/surgical coverage, Dr. Dickey added. None of the congressional mental health parity bills would require insurers to offer mental health benefits.

The council's recommendations that simplified Medicaid and CHIP enrollment forms be used and that outreach efforts be culturally sensitive reflect concern that eligible individuals are falling between the cracks.

"A couple of the barriers are language and the complexity of the forms," Dr. Hanley said. "You have to go out and look for people. They're not going to come to you."

In its report, the council points out that in 1996, almost two-thirds of uninsured adults had no education beyond high school. "The finding underscores the importance of developing outreach and program application materials that are accessible to individuals with low levels of education," the report concludes.

Some states still use enrollment forms that are 30 pages long or more, the council notes. Those states might be using the form as a barrier to Medicaid access to avoid the cost of insuring eligible people, Dr. Hanley said.

The report notes that with 36% uninsured, Hispanics are more likely to lack coverage than whites (14%) or African-Americans (23%). This statistic helped spur the council's recommendation that outreach efforts be bilingual and culturally accessible.

The recommendation calling for the expansion of CHIP to families would ask state medical groups to advocate for something state governments already have the power to do, Dr. Hanley said.

CHIP lets states provide insurance -- either through a Medicaid expansion or private insurance -- for children from families that earn too much to qualify for traditional Medicaid but too little to buy private coverage.

But the program also allows states to cover families if they demonstrate that the family contains eligible children and that covering the entire family would not cost more than insuring only the family's children, the report notes. The council points to Massachusetts as a state that has expanded CHIP to cover families.

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