There are some tantalizing bits of anecdotal evidence out there suggesting that a single-payer plan would represent a financial windfall for Pennsylvania. A recent study by the Pew Charitable Trust reveals that the City of Philadelphia will spend $374 million for employee health insurance in 2008, a number that represents 26% of payroll and that they anticipate will increase by 23% by the year 2013. The city will spend an additional $43.5 million in 2008 for health insurance for its retirees which brings the total Philadelphia spends for health insurance up to $417.5 million this year alone. If a single-payer system were currently in place in Pennsylvania where employers healthcare obligations are limited to a 10% payroll tax, Philadelphia’s healthcare tab in 2008 would be $146 million dollars – a savings of nearly $272 million this year alone. That does not include savings in administrative costs as well as reduced Workers Compensation taxes, among other things. According to numbers supplied this writer by the Finance Department for the city of Pittsburgh, that city also would realize substantial savings under a single payer system. Pittsburgh currently spends 24% of payroll on employee health insurance, a number that is projected to increase to 27% by 2010. $136 million is currently budgeted for Pittsburgh employee health insurance over the next three years, a figure that would be reduced to less than $82 million under a single-payer system, for a savings of $54 million dollars.
The Pennsylvania single-payer advocates have one advantage other states with similar initiatives lack. Governor Rendell has pledged to sign it if it reaches his desk. At an April 4, 2007 healthcare forum at Franklin & Marshall College in Lancaster, Pa., broadcast around the State by the Pennsylvania Cable Network, Governor Rendell, while minimizing the prospects of a single-payer bill making it through the State Legislature, said “A single-payer system would serve America well. Would I like to see a single-payer system? Would I sign a single-payer bill if it got through the Legislature? Absolutely.” Expressing perhaps a bit more candor than he intended, the Governor later in the same forum observed “Lobbyists are… very, very, very influential… Legislators will stand up to the lobbyists if they believe the public is angry enough. But you have to let them know that this is important, and that you’re angry enough.”
Despite these remarks, the Governor has consistently refused to engage the single-payer advocates and has denied them a seat at the table on any and all discussions regarding Legislative healthcare reform. At least one co-sponsor of HB 1660 privately admits to having been pressured by the Democratic Leadership not to support the single-payer bill.
DAYS OF DECISION APPROACH
Barring its revival at some future date, Governor Rendell’s “Cover All Pennsylvanians” initiative is dead, but the plain facts are that despite the Governor’s inferences to the contrary, and despite his use of banner props at rallies containing the words “Healthcare for all” ( a slogan he borrowed from the single-payer advocates), The Governor never aspired to cover more than a small fraction of Pennsylvania’s uninsured population, nor to outstretch a helping hand to its millions of underinsured. His plan did nothing to loosen the grip of health insurance companies whose outrages and monopolistic practices are well-documented in Michael Moore’s documentary, “SiCKO,” or to force Pharmaceutical companies to divert some of their immense profits and outrageous CEO compensation packages into lowering the cost of prescription drugs.
The new Rendell initiative, PABC, is even worse. It will, over a five year period, provide low-cost, subsidized insurance to a maximum of 137,000 uninsured Pennsylvanians whose family income is below 200% of the Federal poverty level (up to $20,800 per year for an individual and $42,400 for a family of four). It claims to aspire to insure an additional 65,000 Pennsylvanians who are below 300% of the Federal Poverty level (up to $31,200 for an individual and $63,600 for a family of four), though at an unsubsidized year one cost of $311 per person per month, a cost one finds difficult to imagine too many people in that wage bracket will find affordable. These are the Governor’s own numbers, and they are maximums that assume that that the Legislature will allow the Governor to divert $246, million (in year one) from the fund set up by the State of Pennsylvania to protect doctors from runaway malpractice rates (HCRPA), and that the General Assembly will allocate an additional $120 million (again in year one) to cover the cost of the plan. The anticipated cost of PABC is $579.2 million in year one, and $1.1 billion in year five. If the bill passes but is under-funded, enrollment will be frozen when the available money has been spent. Under “Cover All Pennsylvanians,” families and individuals earning between 200% and 300% of the Federal Poverty level were eligible for subsidized coverage at a cost to them of $80 per person per month. Under PABC it will cost them $311 in year one and perhaps considerably more in subsequent years. Persons earning more than 300% of the Federal poverty Line will not be permitted to buy into this plan except under extremely limited circumstances, and even then, only at the unsubsidized year one rate of $311 per month. Health insurance companies will continue to manage patient care under PABC, insuring continued cost inefficiencies and continued interference with doctors and their judgment regarding required remedies for their patients. It is unfortunate that the forces rallying around PABC continue to grossly exaggerate its objectives, touting it as “a huge step forward… in the fight to bring quality, affordable healthcare to every Pennsylvanian. It is also worth noting that even if PABC succeeds in adding 202,000 Pennsylvania uninsured to the insurance roles in the next five years, it is likely that at least that number will lose their insurance during that time, and perhaps many more. In other words, even if PABC is fully funded and delivers on all of its promises, there will likely be more uninsured Pennsylvanians in 2013 than there are in 2008.
For the very poor and uninsured in Pennsylvania, PABC actually represents a step backwards for many. PABC will replace and absorb Adult Basic, a program enacted in June 2001 under then-Governor Tom Ridge, that invested the proceeds of the State’s $11 billion Tobacco settlement (over 25 years). It was designed to provide subsidized basic medical coverage to uninsured Pennsylvanians between the ages of 19 and 64 earning up to 200% of the Federal poverty level, and again was contracted out to four “for profit” insurance companies. As of December 2007 51,056 people were enrolled in Adult Basic while 95,649 Pennsylvanians were on the wait list (up 28% from 74,456 in January 2007). From the inception of Adult Basic it has been plagued by long wait lists of at least a year. On the positive side, many of those who have endured a long wait to enroll in Adult Basic will be able to enroll sooner in PABC, but there is a tradeoff. The monthly cost of enrollment will increase by 19-20% for those at 150-200% of the Federal poverty line, and any one losing their insurance will now have to wait 180 days before qualifying to apply for coverage under PABC – double the 90-day wait period for Adult Basic.
The ball is now in the court of the Pennsylvania Legislature, and in the hands of Pennsylvania voters who now have an opportunity to press their Legislators to enact true healthcare reform by supporting and co-sponsoring HB 1660 and SB300. Attend hearings on the single-payer bill, due to begin in Harrisburg this coming Wednesday, March 19th. Send money. This effort is woefully under-funded and needs your financial support.
Pennsylvania has an opportunity to become a shining beacon for progressive healthcare reform in this country, and it will reap the benefits of a newly energized economy if it does. If Pennsylvania enacts single-payer universal healthcare other states will follow, and it will not be long before pressure to enact it nationally becomes overwhelming. Only then will we join the rest of the industrialized world in providing truly civilized healthcare for all. Can we, in good conscience, do any less?
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
1
1
1
