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Access Two years in the making, a coalition of 16 health care organizations unveiled a two-phase proposal to cover half of uninsured Americans by boosting enrollment in public programs and providing tax credits, the group announced Jan. 18. The Health Coverage Coalition for the Uninsured proposal involves two "phases" for providing health care coverage to low-income Americans, the first for children and the second for adults. If fully enacted, the proposal would cover up to one half of the 47 million uninsured individuals in the country. Coalition members include AARP, American Hospital Association, American Medical Association, America's Health Insurance Plans, Families USA, Pfizer Inc., Johnson & Johnson, U.S. Chamber of Commerce, and the United Health Foundation, the organization that convened the effort. "Despite their divergent political and ideological views, the groups today committed to immediately and jointly press lawmakers to act on their historic, two-phased consensus proposal," the coalition said in a statement. 'Kids First Initiative.' The first phase of the proposal is a "Kids First Initiative," which calls on the federal government to boost state funding to allow for greater enrollment in the State Children's Health Insurance Program (SCHIP) and Medicaid, to help reach the 6 million currently eligible yet uninsured children. The proposal calls for "one-stop" shopping, whereby low-income families could enroll their children in SCHIP or Medicaid at the same time they apply for other public programs, such as reduced-cost school lunches, food stamps, or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The proposal also calls for federal funding for a new family tax credit to help families cover "a significant percentage of" the cost of buying "meaningful" health insurance coverage for their children, with the percentage depending on the family's income, according to the proposal. Families with earnings up to three times the federal poverty level ($60,000 per year for a family of four) would be eligible for the tax credit. For those with access to employer-sponsored coverage, the tax credits could be used to buy coverage through an employee health benefits program. The first phase of the program will cost about $40 billion to $50 billion over a five-year period, Mary Grealy, president of the Healthcare Leadership Council, an association of health care industry chief executive officers, told BNA. The coalition does not have a cost estimate for the second phase of the proposal, which focuses on adults, she said, nor did it delve into suggesting corresponding federal revenue boosters or possible spending cuts to finance either phase. "We feel this is an investment that's going to have a real return," Grealy said. "There will be a short-term revenue cost, but we know at the end of the day that having more people covered lowers private health insurance premiums and lowers costs for emergency care." Grealy said the anticipated congressional effort in 2007 to reauthorize the SCHIP program "gives us a wonderful platform for talking about this" and will help drive the coalition's proposal forward. State Grant Initiatives The coalition also proposes a competitive grant program to enable states to experiment with new, innovative approaches to expand health coverage. States winning the grant would receive new money, over and above federal funds now given to the state for Medicaid and SCHIP, according to the proposal. The second phase of the proposal would give states the option to expand Medicaid eligibility to cover all adults with incomes below the federal poverty level, and provide federal funding for this. It would allow states to eliminate family status as an eligibility requirement and base coverage decisions exclusively on financial need, and would give states more effective means of enrolling Medicaid-eligible adults. Also under the proposal, adults with incomes between 100 percent and 300 percent of poverty level would receive a tax credit to help them cover the cost of buying insurance, either through an employer-sponsored or state-sponsored insurance system. The proposal also would provide federal grants to states to cover high-risk populations. "There are effective solutions to the crisis of the uninsured if we can find the political will to implement them," Katie Mahoney, director of health care policy at the Chamber of Commerce, said in a statement. "This diverse coalition has the muscle to break the political logjam on health care and help those most vulnerable in our society, beginning with uninsured kids." "After more than 60 years of debate on how to achieve universal access, this group of diverse stakeholders has come together on a common solution," AHIP President and Chief Executive Officer Karen Ignagni said in a statement. "Now is the time to move forward and make these goals a reality." The coalition also said it believes that strategies need to be developed to increase price and quality transparency, boost use of health information technology, manage chronic care, reform medical liability, improve patient safety, use evidence-based medicine, and boost efficiency of health delivery. The coalition's proposal is available on the Web. By Linda Micco Richmond
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