Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, February 3, 1992 TAG: 9202030173
SECTION: EDITORIAL PAGE: A-11 EDITION: METRO
SOURCE: By F. PETER LIBASSI
DATELINE: LENGTH: Long
LET'S LOOK AT CONNECTICUT
ONE OF the most important social, political and economic issues of the 1990s is access to health care. More than 30 million Americans lack health insurance, while millions of others worry that they may lose their coverage. Employers see more of their resources diverted to skyrocketing medical expenses.The nation's health-care financing system faces pressure for total overhaul, not unlike the urban-renewal mania of the 1960s when entire neighborhoods were bulldozed in a let's-start-over view of progress. We now regret that these neighborhoods were destroyed; their communities will never be replaced.
Last December, U.S. Senate Democrats, led by Majority Leader George J. Mitchell, D-Maine, held hearings in five cities to advocate radical changes in the health-care financing system. Recently, House Democrats sponsored town meetings in up to 200 House districts promoting the same agenda.
At the risk of being labeled an obstructionist, I urge caution. As history has shown, a "bulldozer" mentality is shortsighted and dangerous. We must consider the long view on access to health care. The vast majority of Americans - more than 85 percent - are covered by a system that works better than any available in any other country. It is not perfect, but much is right. It is to Americans' advantage to build on that system.
Too often, however, the complex problem of access to health care is boiled down into simplistic solutions that work well as media campaigns and political slogans, but translate poorly into practice. A single-payer national system imposed on all states or a mandate imposed on all businesses to provide insurance are two examples.
The health-care crisis is not one issue, but four: cost, access, quality of care and security. These four areas do not lend themselves to one-dimensional proposals. That some policy-makers have come out so strongly in favor of one quick fix or another shows an overall misunderstanding of the problem. In the end, no radical change will prove more effective than the current system. There has been significant progress toward fundamental reform. That momentum can continue.
It is better to experiment at the state level with different solutions than to grasp at a national single-payer or mandate system that does not allow for state-by-state and regional differences.
Two problems high on everyone's list are coverage for employees of small businesses and insurance for long-term care. Connecticut is taking on both with experimental programs that hold great promise. The common denominator is a public-private partnership. Both efforts require significant adjustments by the insurance industry.
The first got off the ground in 1990 with legislation that cleared many of the obstacles that stand in the way of the more than 300,000 state residents who lack health-care coverage. Passage required the cooperation of state government, the insurance industry, health-care providers, employers, consumers and other interest groups. Their cooperation brought significant reforms, including:
Guaranteed health insurance to small employers; guaranteed renewal of that coverage; limits on the waiting periods for coverage when an employee changes jobs; limits on annual rate increases; and reinsurance to cover high-risk individuals and small groups.
Under this law, every carrier serving small business in Connecticut must offer to issue and renew a policy without regard to prior health-claim experience. Since the policies became available less than a year ago, many small employers have obtained coverage for the first time. North Carolina has adopted similar legislation, and other states are considering similar action this year.
The second experiment is aimed at the long-term care needs of Connecticut's elderly. The program, which grew out of a commission I chaired, ensures that Connecticut residents will not be forced to impoverish themselves before receiving Medicaid assistance for nursing-home costs.
In testimony before the commission in 1986, relatives of the elderly repeatedly told of the heartbreak, despair and loss of dignity their loved ones had to endure when they had to seek welfare assistance to pay their nursing-home costs. One woman said that if her mother knew that she was going to have to go on welfare, "she would die today."
Under the plan, which gained federal approval last August, state residents can buy a state-certified long-term care-insurance plan from a private carrier. The plan protects assets in a formula equal to the amount of insurance benefits received.
For example: A family buys a long-term care policy providing $50,000 in benefits and, in effect, $50,000 in asset protection. When the $50,000 benefit limit of the policy is reached, Medicaid would look at the total financial picture of the individual. If the person has no more than $50,000 in assets, Medicaid immediately would cover chronic-care costs and leave untouched the $50,000 in assets.
If the person has $75,000 in assets, Medicaid would require the individual to spend $25,000 before it would cover expenses. In both instances, the patients could keep significant portions of their savings for their spouse, children or others.
In addition, the agreement establishes strict standards for home-care coverage and protection against inflation. The partnership also will help constrain the growth of the state's Medicaid budget as more private insurance dollars will go to finance long-term care.
Connecticut is breaking new ground with experiments that address the problems of access to health care for employees of small businesses and long-term care for the elderly. The best information was gathered, the best minds in the public and private sectors were put together to create two solid progressive public-private partnerships.
I hope the national discussion will begin to follow the Connecticut method of operation and opt for thoughtful, evolutionary change.
F. Peter Libassi, a vice president at the Travelers Insurance Company in Hartford, Conn., was general counsel to the U.S. Department of Health, Education and Welfare from 1977 to 1979. The Hartford Courant