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Whereas, the USA has a
fragmented and inadequate health system which fails to
assure basic care, including primary care and proven
preventive services for all residents, and
Whereas, health care
services in the USA have the highest costs in the world,
costs that are disproportionately borne by American
industry, and
Whereas, more than 40
million Americans lack health insurance in 2001, with
current economic conditions portending a large increase in
the number of uninsured, and
Whereas, it has been
clearly demonstrated by multiple studies that the uninsured
have much higher mortality and morbidity rates, especially
from chronic diseases, and
Whereas, a major cause of
this increased mortality and morbidity in the uninsured
(and, now, also likely with the underinsured) is the delay
in seeking timely care because of financial barriers, and
Whereas, a major preventive
measure to decrease the increased mortality and morbidity
– as well as to minimize racial and economic class
disparities in these outcomes – would be to minimize the
current degree of delayed or omitted care, and
Whereas, compared to other
countries the USA has poor health outcomes for our
population despite having by far the largest expenditure for
health services, and
Whereas, the high cost of
health care and the disproportionate share of these costs
paid by American industry have helped make our products and
services less competitive in world markets, and
Whereas, our current health
care system, while providing incentives to exclude people
with chronic diseases, wastes an excess of resources on
administrative costs and duplicated and unnecessary services
– resources that could be used instead for effective
patient care and prevention, and
Whereas, a more cohesive
and unified system for financing and delivering health care
– a system that included every person in America – would
help decrease health status disparities in America, make
health care more affordable for both individuals and the
nation, and make our nation healthier, and
Whereas, the ACPM has
signed on (1999) with many other health care organizations
as an endorser of "the Joint Statement" in favor
of universal coverage, therefore
Be it resolved,
That: The ACPM develop a
complete proposal to present to Congress for the purpose of
enacting universal coverage, a proposal which could be
called Health Insurance for All (HIFA).
That: This proposal would:
- Guarantee health
insurance for all US residents.
- End the responsibility
of US industry to provide health insurance benefits.
- Create a tax-based (like
Medicare) health insurance program funded by the federal
government and/or the states.
- Build on the current
strengths of American health care professionals and
institutions to deliver quality, scientific based care
and prevention.
- Utilize the strengths of
American health insurers to administrate the system.
- Minimize the economic
incentives or disincentives to either over-utilize
marginally effective services or underutilize proven
beneficial services.
- Allow flexibility at the
state level – except for mandating universal coverage.
That: Some of the
agreed-upon principles (by the authors of this resolution)
of this proposal would include – subject to modification
and/or development in more detail by an ACPM committee:
- Federally funded
health insurance coverage for all residents of the USA
with a single risk-pool that enrolls every resident
automatically (details of enrollment to be worked out)
in an Essential Health Insurance (?Care) Package (EHIP)
in the state where the individual resides.
- The proposal could
cover all residents initially, or phase in some
already covered groups step-wise, such as Medicare,
the VA, and military populations.
- The EHIP would have no
premiums; would include primary care, essential
specialist care, hospitalizations, and
pharmaceuticals; proven preventive care; mental health
with parity; basic dental care.
- There would be no
deductibles and minimal co-payments for essential
services, with a mechanism to waive co-payments as
deemed necessary. [ACPM policy in 1993 stated that
basic preventive services should be delivered
"free of any co-payment."]
- Discretionary
specialty services would have higher co-payments.
- Creation of a national
board for oversight, regulation, and design of the
benefit package.
- EHIP financed through
a progressive payroll tax (or self-employment tax) on
all income, collected similar to social security and
Medicare taxes.
- Supplemental
insurance, for services or co-payments not covered in
the EHIP, would be sold on the private market.
Employers could opt to buy supplemental insurance for
non-covered services.
- Current employer
contributions for health insurance should be converted
to increased wages for employees.
- Provision for capture
of the tax-exemption (currently amounts to about $125
Billion a year) in the financing of this plan.
- Enrollment process to
be developed. Could provide role for current insurers
in enrollment as well as administration.
- Rates and
reimbursements negotiated between the EHIP
administrators and health care
professionals/institutions. Could be fee-for-service
or capitation, or other negotiated payment mechanism.
- Enrollees have full
choice of provider participating with chosen insurer.
- Long term care to be
integrated into package when feasible with current
Medicare and Medicaid long term care programs retained
until altered.
- States responsible to
monitor and regulate insurers in each state and
allowed flexibility to add needed benefits, e.g., as
with current Medicaid recipients.
- Assume continued
federal/state support for delivery systems for special
populations (e.g., Migrant/Community Health Centers,
Health Care for the Homeless, Public Health Clinics).
- Funding for prevention
and public health, as well as educational programs, to
be included within this financing system – but not
excluding other funding as well.
- Federal government to
monitor and regulate state performance in assuring
access and quality of care to residents of the states.
That: The ACPM work with
other professional (?and community) organizations to form a
broad base of lobbying support for this Health Insurance for
All plan.
That: The ACPM form a
committee to develop this proposal in detail to present it
to our membership for approval.
Health Care for All 101
10/1/01
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