Pennsylvania Gov. Announces Health Care Proposal

Pennsylvania Gov. Ed Rendell (D) on Wednesday announced a health care reform proposal that he said would expand access to health care services and reduce costs to the state, the Philadelphia Inquirer reports (Worden/Goldstein, Philadelphia Inquirer, 1/18).

Rendell did not release cost estimates for the program, but state officials said it would be funded using:

• Contributions from workers and employers;
  
• Federal grants;
  
• State funds currently allocated to other health programs;
  
• Increased state cigarette tax; and
  
• A state tax on smokeless tobacco and cigars (Fahy, Pittsburgh Post-Gazette, 1/18).
  

The governor's proposal gradually would require state residents whose annual incomes exceed 300% of the federal poverty level to obtain health insurance. Residents with lower incomes would have the option of buying coverage at reduced rates but would not be required to obtain health insurance.

The plan would create financial penalties for businesses that do not offer health insurance coverage to employees.

The proposal would expand an existing state program that helps provide insurance for children to help uninsured adults and small businesses obtain coverage through private insurers. Contributions would be on a sliding scale based on income (Pittsburgh Post-Gazette, 1/18).

Four-year colleges and universities would be required to guarantee that students were insured or had access to a health clinic (Philadelphia Inquirer, 1/18).

Rendell's proposal also would permit nurse practitioners, midwives, dental hygienists and other licensed health care professionals to practice within the full scope of their training, as part of an effort to expand access to health care services (Pittsburgh Post-Gazette, 1/18).

The state also would offer incentives to health care providers that offer evening or weekend hours.

Hospitals would be required to provide an alternative to EDs to provide primary care services to patients who do not need urgent care (Philadelphia Inquirer, 1/18).

Rendell's proposal would expand the state Department of Insurance's authority to review rate increases. Insurers would have to provide policies that allow parents to cover children up to age 30 and would be restricted from considering factors other than age, location and family size to determine premiums for small-business group plans (Philadelphia Inquirer, 1/18).

The Post-Gazette reports that insurers would be required to spend 85% of premiums for small group plans on medical services (Pittsburgh Post-Gazette, 1/18).

Insurers would have to offer rebates to groups if medical spending was less than 75% of premiums, according to the Inquirer (Philadelphia Inquirer, 1/18).

Under Rendell's proposal, the state at some point would stop reimbursing hospitals for unnecessary care in a hospital ED or for services to treat conditions resulting from hospital-acquired infections. The policy would apply to beneficiaries of Medicaid or other programs the state administers.

Rendell also plans to meet with other large purchasers of health care to develop a pay-for-performance program that would link payments for health care services to the quality of care (Pittsburgh Post-Gazette, 1/18).

The proposal would call for hospitals to invest in health IT applications, such as electronic prescribing systems, to help reduce medical errors (Pittsburgh Post-Gazette, 1/18). Hospitals would be asked to install electronic systems to track hospital infections to ensure accurate reporting of the problem (Philadelphia Inquirer, 1/18).

In addition, the governor's plan calls for a new review process for some regions to evaluate the need for new medical technology or other investments under consideration by hospitals (Pittsburgh Post-Gazette, 1/18).