In Senate Testimony, Commonwealth Fund Expert Makes Case for Health Insurance Redesign
<p>In her <a href="/Content/Publications/Testimonies/2009/Feb/Testimony-Insurance-Design-Matters-Underinsured-Trends-Health-and-Financial-Risks.aspx">invited testimony</a> today at a U.S. Senate hearing on health reform focused on the underinsured, Cathy Schoen, a Commonwealth Fund senior vice president and noted expert on the underinsured, made the case for redesigning health insurance so that it "provides affordable coverage for all in a manner that ensures access to health care and financial protection" as well as "a more secure foundation for payment and system reforms." <br /><br />"In addition to steady increases in the number of people uninsured during the year, we are seeing a surge in the number of adults and families who are underinsured--those who are poorly protected in the event of illness although they are insured all year long," Schoen told the U.S. Senate Health, Education, Labor and Pensions Committee. "In the midst of a severe recession, current trends are saddling individuals with medical debt that can last for years." <br /><br />Schoen discussed findings from Commonwealth Fund and other studies that highlight the consequences of inadequate insurance and gaps in coverage. From 2003 to 2007, the number of adults who were insured all year but were underinsured increased by 60 percent, she noted. Moreover, the erosion in benefits has been "moving up the income scale": the proportion of underinsured nearly tripled among adults with annual incomes in the middle-income range. <br /><br />Schoen says that our "fractured insurance makes it difficult to develop coherent payment policies that could align incentives with better outcomes and prudent use of resources." She outlined a number of insurance reforms for the committee, among them: </p>
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<li>setting a minimum floor and standard for health insurance, with benefits designed to support access to effective care and protection when sick or injured </li>
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<div>providing income-related premiums to ensure coverage is affordable </div>
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<div>establishing lower cost-sharing and ceilings on out-of-pocket expenses for low-income families </div>
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<div>limiting the range of variation to facilitate choice and discourage risk segmentation </div>
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<div>ensuring insurance access and renewal and prohibiting premium variations based on health risks </div>
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<div>structuring insurance choices through a national insurance exchange to help individuals and families choose coverage and stay continually insured. </div>
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<p>Without a comprehensive approach for improving the quality and cost performance of the U.S. health system, Schoen said, any coverage expansions will be difficult to sustain. <br /></p>