"Moving Beyond Planning"

On July 28–29, the State Coverage Initiatives (SCI) program, a national initiative of The Robert Wood Johnson Foundation, hosted a summer workshop attended by over 100 officials from 41 states. The meeting, which took place in Chicago, focused on the current policy debate on the future of public coverage as well as strategies to advance both public and private coverage beyond the planning stage.

The meeting began with a two-part session entitled, “Medicaid and SCHIP: Past, Present and Future,” facilitated by W. David Helms, Ph.D., President & CEO, AcademyHealth. As the federal government debates the future of public insurance, the session focused on how state policymakers are operating in the current environment. The panel featured several leaders of state Medicaid program and State Children’s Health Insurance Program (SCHIP); Eugene Gessow (IA), Barbara Ladon (CO), and Steve Norton (NH) spoke about their current policy goals, and their present reform efforts. Vernon Smith, Ph.D. from Health Management Associates followed with a presentation on the role of Medicaid within the health care system, cost drivers within Medicaid, the program’s impact on state and federal budgets, and his outlook for the future of the program. Finally, Matt Salo of the National Governor’s Association provided his perspective on possible changes to the Medicaid program at the federal level and the outlook on SCHIP reauthorization.

The next session featured three speakers from diverse backgrounds and perspectives who discussed leveraging new funding sources for coverage expansions. Titled “Finding the Money for Coverage,” the panel began with Steve Scheer from Health Management Associates discussing his efforts at locating financing for three-share programs in Illinois and Michigan. He has primarily worked to leverage Medicaid to match community dollars with federal dollars. Cindy Roberts from the Oklahoma Health Care Authority presented on the Oklahoma Tobacco Tax ballot initiative that passed last fall. The new revenue source provides funding for the Oklahoma Medicaid premium assistance program. Finally, Walter Smith from the DC Appleseed Center for Law and Justice, Inc. told the story about the failed CareFirst Blue Cross Blue Shield conversation in the Washington, D.C. area. He used this particular example to make the argument that not-for-profit carriers have a larger duty to provide funds for charitable care. Mr. Smith discussed not-for-profit carrier reserves and potential methods of accessing those funds for coverage.

The final panel of day focused on cost drivers within the health system and ways to control costs. Enrique Martinez-Vidal from AcademyHealth began with an overview of cost drivers, and showed data on the rising prevalence of treated disease. A large percentage of private premium increases can be attributed to this rising number of individuals diagnosed with certain diseases and chronic conditions. He also reviewed potential strategies to reduce the cost of health care and health insurance premiums. Next, Maria Schiff from the Massachusetts Division of Health Care Finance presented her analysis of the Massachusetts Uncompensated Care Pool high cost users and possible solutions to curb the growth of costs within the Pool. Massachusetts is currently debating the future of the Uncompensated Care Pool to determine whether the program will remain a bill payer, become a purchaser of health services, or become an insurance product. Finally, Kerry Schaefer discussed her efforts as the benefit manager for the King County, Washington public employees system to create benefit design incentives to maximize participation in their wellness assessment process and to improve and maintain healthy behaviors in order to reduce health care costs.

Many states continue to build public/private partnerships to expand coverage. Recognizing no one entity can solve the uninsured problem alone, states have partnered with the private sector in unique ways. A crucial element to a successful partnership is gaining employer participation. Merry Davis from the California HealthCare Foundation discussed their small business insurance website. The website provides small businesses with information the health insurance marketplace with the end goal of increasing employer health insurance offer rates. She reviewed the type of information that small businesses say they need as well as the barriers to obtaining that information. She also outlined potential outreach strategies. Gary Packingham from Community Health Ventures, who works with numerous three-share health coverage initiatives, urged the audience to select the target business population carefully and to think like a business person. He noted that successful outreach requires networking within the community and realizing that the small business population is very heterogeneous. Mr. Packingham discussed various strategies to reach a targeted population, giving the example that the needs of a small non-profit organization are quite different from a local retail store. Ron Walters, State Representative from the West Virginia House of Delegates and an insurance broker, spoke about the new small business insurance product in West Virginia and their outreach strategies. He remarked that it was important to involve brokers early in the design process for any new insurance product. Brokers can become part of a successful outreach campaign because, especially in a rural state, brokers are trusted members of a small community. Small businesses rely on brokers for their insurance needs and West Virginia has successfully enlisted the aid of brokers to sell this new product.

The meeting concluded with a panel on consumer-directed health care (CDHC). Paul Fronstin, from the Employee Benefits Research Institute, noted that increases in private insurance premiums have driven employers to look to CDHC as a means to control costs. Mr. Fronstin said more research was required to determine if CDHC slower premium growth will be one-time savings or if this new insurance product can control costs for the 20-25 diseases and conditions that generate 80 percent of health care spending. Beth Grice, Director of Large Group Actuarial for Humana, Inc, presented on Humana’s in-house pilot CDHC program. Ms. Grice showed slower premium growth for the CDHC plan versus traditional products and evidence of consumer behavior modification including: increased generic drug selection; lower emergency department use; and higher use of physician office visits versus inpatient hospitalization. Scott Leitz, Director, Health Policy Program for the Minnesota Department of Health, concluded the workshop by framing CDHC policy questions for state officials in terms of regulation, market stability, and purchasing health care services.