A state Universal Health Care Work Group formed last year is working on recommendations to the state legislature regarding a universal, or single-payer, health care system. After an initial report in November revealed division over the concept of a single-payer system, group members are now exploring whether to implement it through the state or through health care providers.
A March survey sent out to work group members with a 60-percent response rate found a high priority placed on health care affordability, access, and equity, yet mixed opinions on who should pay for it, and how. A report released last year found that a single-payer system would require $28 billion in new taxes to implement.
The work group is now looking at several implementation models that range from a for-all benefit package delivered through a state-run system with no health insurance carriers, to a system-only program for those without federal or employer health coverage and carriers who meet state requirements would contract with .
Another possible scenario would have coverage for all state residents except for people eligible for federal health care coverage where those services are provided through health insurance carriers who contract with providers.
The state legislature last year passed a bill creating a standardized health care plan that would start next year that has set deductibles and medical visits covered by insurance. Though intended to lower the costs for residents seeking medical care, critics in the health insurance industry say it removes incentives for providers because it sets prices for their services.
While some say a single-payer system run by the state could reduce inefficiencies, Optumas Senior Consultant Shane Mofford said at a June 9 presentation for the work group that “while the fragmentation that occurs by having so many payers drives inefficiencies, the presence of competition can have a positive impact. Payers innovate (and) drive costs down to be able to offer competitive premiums for coverage.”
During a June 24 work group meeting Mofford said: “someone might lose their job or not lose their job based on the policy implemented. It’s really important to consider not just how people are getting the insurance, but also the delivery system…because it will have a really big impact on how you try to roll it out and what the impact will be for the individual companies and the overall economy.”
The June 24 meeting discussions underscored some of the practical issues with a single-payer system, such as allowing undocumented immigrants to access the system. Country Doctor Community Health Center Medical Director Dr. Richard Kovar said: “everyone should be included,” a stance also supported by work group member Rep. Nicole Macri (D-43).
Another question raised was whether residents would be able to buy additional private insurance if it should be mandatory to have insurance. One work group member suggested if the penalties for not having insurance are too low, residents will simply not sign up and pay the fee.
Another work group member said: “I can’t envision how it would work if everyone wasn’t a part of it.”
Most of the respondents to the work group survey indicated that all their health care models should assume residents pay monthly premiums for the same coverage based on their household income. That sentiment was also expressed by one work group member at the June 24 meeting who said it would make the state tax system more “progressive. Charging people who have a higher level of income more than people who don’t have that level of income would be appropriate.”
The next work group meeting is Aug. 25. The work group plans to develop recommendations in October.