Real Health Care Reform Means State Innovation and a Public Insurance Option

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Tammy BaldwinCommentary on The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey on Health Reform by Tammy Baldwin, Representative from Wisconsin

Health care for all is a part of the American dream that has gone unfulfilled since 1945 when President Harry S. Truman first proposed it. How many people have suffered; how many families have been bankrupted; how many business plans have been deferred; how many futures have been denied because we do not have affordable, accessible, quality health care for all?

For the first time in more than six decades, as we begin to transform our economy and reclaim our stake in the American dream, health care for all is within our grasp.

In a reformed health care system, all individuals must have a wide variety of health insurance options to ensure quality, affordable care. Further, real health care reform demands that health care decisions be made by health care providers and their patients, not by accountants and actuaries.

For too many years, health care professionals have seen their treatment plans thwarted, the medications they recommend restricted, their time with patients limited, and their love for their profession quashed by anonymous bean counters. Enough is enough!

I have the privilege and responsibility of serving on one of the three House committees charged with drafting real health care reform legislation, and we delivered our draft proposal on July 14. As I write this, the bill remains a work in progress, but it promises the reform we need.

Our proposal will prevent insurance companies from denying people coverage because of a pre-existing medical condition. It will ensure that workers can still have health insurance if they lose or change their jobs, or start a new business. And it includes a health insurance exchange that will allow families and small businesses to compare prices and quality so they can choose the health care plan that best suits their needs.

Two aspects of our reform legislation are essential to expanding coverage to all Americans, and both find their roots in my home state of Wisconsin. First, I have worked hard to include flexibility for states to serve as incubators for better health care delivery. Wisconsin and other states have proven that, when given the flexibility they need, they can take bold steps toward improving the quality of care, lowering cost and expanding coverage.

For example, Wisconsin received a waiver to leverage funds that the state received for its disproportionate-share hospitals to create an expansion of its Medicaid program, called BadgerCare Plus. As a result, the state is now able to provide coverage to an additional 50,000 adults without children.

In our national health care reform plan, state innovation of this kind will be encouraged and facilitated. States will be able to operate their own Medicaid medical home pilot programs, operate their own health insurance exchanges, and create new prevention and wellness programs.

The other essential element to expanding affordable access to health care is a public health insurance option.

Including a public option among the many plans offered will make health care affordable by increasing competition, providing more choices, and keeping the insurance companies honest.

We have a highly successful public health insurance in Wisconsin to provide a prescription drug benefit. It's called SeniorCare, and it enjoys broad, bipartisan support. Since 2003, Wisconsin has been offering this public option for seniors in need of prescription drug coverage. After Medicare Part D was enacted, SeniorCare was able to continue through a federal waiver.

For a $30 enrollment fee and minimal copayments, Wisconsin seniors have access to any drug their doctor might prescribe—without the "doughnut hole." While Senior-Care is wildly popular and hugely effective, private prescription drug insurance plans continue to flourish in Wisconsin, with a large number of available plans and fair premium rates.

In 2007, against the wishes of the Bush administration, every member of our state's congressional delegation rallied successfully to keep the waiver that allows our state to offer this public health plan option. That Republicans who openly embraced Senior-Care now react so negatively to a public option in broader healthcare reform makes no sense.

Wisconsinites, and indeed all Americans, deserve high-quality, low-cost healthcare. Lack of coverage is the worry that keeps parents up at night; keeps seniors from taking all the medications they need; keeps young people from getting early, preventive care; and keeps America from the position of world economic leadership we enjoyed for so long. It's the issue I hear more about than any other, the one whose painful personal stories move and motivate me day in and day out.

The loud voices and well-financed campaigns of the naysayers, the cynics, and the keepers of the status quo will not trump the millions of Americans in all parts of the country and every sector of society who know that enough is enough. Real health care reform, transformational reform that includes a public plan option, is within our grasp and we will seize this moment.

The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

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Publication Date:
July 27, 2009