Kahn, Pollack Discuss Plan for the Uninsured

In an interview published in yesterday's Los Angeles Times, Ronald Pollack, executive director of Families USA, and Chip Kahn, president of the Health Insurance Association of America, outlined their joint proposal to reduce the number of uninsured, which has created a "framework for bipartisan cooperation on health reform." The two organizations, which disagreed over the 1993-94 Clinton health plan, have come together, along with the American Hospital Association, to offer their proposal, which aims to increase coverage among the "low-wage working population with incomes below 200% of the federal poverty plan" (Raksin, Los Angeles Times, 1/28). The proposal offers a three-pronged approach -- providing states additional funds to broaden Medicaid eligibility; allowing states to expand CHIP eligibility; and offering tax credits to employers who provide coverage, which could be used to cover "part or all of the cost of premiums that are often too expensive for low-income workers"(California Healthline, 11/21/2000). Some of the issues that Kahn and Pollack addressed in the interview include:

• Cost. While Pollack acknowledged that the proposal is not "cheaper than the status quo," Kahn said that indirect savings to the entire health care industry would arise when the uninsured gained coverage. Hospitals, for example, would have "less cost shifting," thus reducing "whatever health plans are paying for the indigent."
  
• Political viability. Kahn and Pollack said they are more concerned with increasing coverage than with reducing health care costs at this point, because, according to Kahn, "you can't do both at the same time." Pollack noted that if their proposal tried to reduce expenditures by tackling the pharmaceutical industry or managed care, the plan would run into opposition. He added that while "[l]ow-income people don't have the same kind of political clout that higher-income or middle-income people do ... I think we have a better chance of achieving a consensus with respect to a lower-income population than we do in a higher-income population. No single organization is going to be threatened by (our proposal.)"
  
• Enrollment efficiency. Pollack said the proposal would try to "simplify" the current "fragmented" health system, particularly in enrollment procedures for Medicaid and CHIP. He added: "We want to create a seamless web in which you don't have to start talking about what your family status is. Our current system stems from 16th-century Elizabethan poor laws. When Medicaid came along in 1965, it said the pathway to getting health care was being on welfare. One of the things we do is end that (linkage between welfare and health insurance)."
  
• Timing. When asked what was the "best argument for attending first to the low-income uninsured," Kahn said, "If not now, when? ... [W]ith the federal surplus, we have the ability to allocate new funds to help (poor) people." Pollack added, "If we don't do it now, we're going to shift the burden to the states and to communities. ... A proposal like ours will give the states and communities the capacity to expand coverage. And only the federal government can do that"