A special commission in Delaware has recommended expanding access to health insurance for its 95,000 uninsured residents by building on the existing employment-based system.
The panel also proposed using a managed-care program for Medicaid recipients to control costs and expand coverage.
The 10-member Delaware Health Care Commission issued its preliminary recommendations for reform in a report to Gov. Thomas Carper and the state General Assembly in late January.
Recognizing the uncertainty surrounding passage of federal reform legislation and current limitations on the ability of states to enact their own reforms, the commission made recommendations under three different scenarios. One set of recommendations assumes that major healthcare reform is passed at the national level. A second set of options could be pursued if the federal government allows states to implement their own reform plans. If neither of these two scenarios comes to pass, the commission offered some incremental steps the state could take under current federal law.
Executives of the Association of Delaware Hospitals couldn't be reached for comment on the report.
The report gave no estimates of the cost of implementing the proposed reforms. Additional recommendations will be made in the late spring on financing as well as health alliance structure, benefit packages and other issues.
The commission said it favors a market-based approach to reform because it would be "least disruptive" to those who already have insurance through their employers. But if a federal mandate for employer-based coverage isn't forthcoming, the state "must consider enacting its own requirement," the commission said.
However, the state should consider whether similar mandates are enacted in neighboring states before enacting its own employer mandate. Such a mandate could place Delaware's businesses at a competitive disadvantage with firms in states that don't have such a requirement, the commission said.
Whatever reforms are adopted, the panel recommended creating a single, statewide purchasing alliance for state employees, the unemployed, the uninsured and employers with 100 or fewer employees. Larger employers also could participate.