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Universal Coverage Not Universally Supported

By Lydia Gensheimer, CQ Staff

October 26, 2007 -- As universal health plans gain traction—through plans offered by Democratic presidential candidates and state-led initiatives—a panel on Friday examined the correlation between health care access and the quality of health care provided through universal coverage.

The forum, which was sponsored by The Alliance for Health Reform, focused on state coverage initiatives to examine the effects of a trend towards universal coverage.

Sara Collins, assistant vice president for the Program on the Future of Health Insurance at The Commonwealth Fund, cited a recent report produced by The Commonwealth Fund which highlights the positive correlation between high rates of insurance and high quality of care.

"Health insurance coverage is the most important determinant of access to health care," Collins said.

The Commonwealth Fund supports a mixed private and public approach to universal care.

However, Tom Miller, a resident fellow at the American Enterprise Institute, criticized the view that universal coverage would result in better access and quality of health care. He cautioned the audience to "curb your enthusiasm" for universal coverage.

Miller presented a chart which compared states' rankings on health care access to their rankings on the number of residents with "healthy lives." Miller concluded that there is no correlation between access to health care and the general health of residents. Miller said, then, that states need different tools—besides money—to implement changes in health care.

Miller's fellow panelists, meanwhile, briefed the audience on the progress of state health initiatives that support universal coverage.

Sarah Iselin, commissioner of the Division of Health Care Finance and Policy for Massachusetts, praised the progress that has been made in Massachusetts since the state committed to a universal coverage plan a year and a half ago. Iselin said the state has 56,000 new Medicaid enrollees and 127,000 residents newly enrolled in Commonwealth Care.

Massachusetts, Iselin said, was able to implement a successful plan in part because the state began with a broad Medicaid program, a highly regulated insurance market, and a relatively small number of uninsured—only six to seven percent of its population was uninsured before the state adopted its plan for universal care. By contrast, over 20 percent of California's population does not have health insurance.

Miller compared Massachusetts' situation to when "you start on third base and hit a triple," and he cautioned that the costs of Massachusetts' plan may undermine its effectiveness.

"Where is the containment, where is the sustainability?" Miller said.

Iselin said polls have indicated that the "public is on board" in Massachusetts, and the state is still working on getting the word out about the relatively new plan.

Ann Torregrossa, deputy director and director of policy for the Pennsylvania's Government's Office of Health Care Reform, described Pennsylvania's plan for universal coverage, Prescription for Pennsylvania. The plan is based on an integrated approach based on quality, accessibility, cost, and affordability. Torresgrossa said Pennsylvania started with an approach to cover all children in the state, and is now working to cover all Pennsylvanians.

Democratic Governor Edward G. Rendell has been criss-crossing the state to promote the plan.

"The governor has finally realized that we can't wait for Washington," Torregrossa said.

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