With new leadership on Capitol Hill and a national election on the horizon, presidential hopefuls, healthcare coalitions and special-interest groups have been virtually tripping over one another to have their say on how best to whittle down the ranks of the nations 46.6 million uninsured.
The latest group to join that cacophony was the Federation of American Hospitals, which last week unveiled a proposal, called Health Coverage Passport, designed to achieve universal coverage by building on the nations existing system of public and employer-based insurance. Its new planwhich uses the slogan Everyones responsible. Everyones covered.would require all individuals to buy health insurance or face tax penalties.
The federation, which represents investor-owned hospitals, said it felt a social obligation to address the publics call for a coverage solutiona call that has crescendoed in recent months to a pitch not heard since President Clintons sweeping reform plan collapsed in 1994. According to a survey of 1,200 registered voters released by the FAH last week, 86% said they demanded the government take action on the uninsured issue before the next election.
This is possibly the biggest domestic issue that policymakers will face over the next two years, and we wanted to be a part of that conversation and contribute to it, said FAH President Chip Kahn.
No one better understands the crisis of the uninsured than the hospitals they turn to for care, added FAH Chairman Victor Campbell, who is also a senior vice president of HCA.
By and large, industry observers welcomed the federations effort, contending that any discussion of expanding access was better than none.
Still, some questioned whether the plan would prove more than a symbolic gesture and whether it added much beyond the stack of coverage proposals already being offered. Is this something theyre really going to work for? said Susan Sherry, deputy director for Community Catalyst, a healthcare advocacy group. How much political capital are they going to spend to see this proposal through? Thats going to be the true gauge of their commitment.
A few dismissed the plan outright, pegging it as little more than an effort by profit-driven hospitals to protect their own interests at a time when Congress is looking to overhaul the healthcare system. The biggest players in the for-profit healthcare world, or those that have the most to lose from significant reforms, are simply attempting to write themselves into the solution, said Jerry Flanagan, a healthcare advocate with the Foundation for Taxpayer and Consumer Rights, a consumer group. Theyre seeing the writing on the wall and theyre trying to get in front on the issue by saying: Eureka! We have the answer.
Indeed, with healthcare access shaping up to be a pivotal political issue in the 2008 presidential election and beyond, key interest groups have been quick to weigh in on which direction those changes should take. Americas Health Insurance Plans rolled out a universal-coverage proposal in November. Since then, WellPoint and Blue Shield of California have floated their own plans, as has Wal-Mart in an unusual collaboration with the Service Employees International Union (Feb. 12, p. 12). The American Hospital Association also is devising a coverage plan, which it hopes to unveil in July.
Their motivation, industry observers say, is simple: Expanding coverage is a costly proposition, and Democrats, in control of Congress for the first time since 1994, have pledged not to pass major spending proposals unless other programs are cut to avoid increasing the federal deficit.
Everyone is guarding their piece of the pie, Flanagan said.
The stakes are especially high for hospitals, many of which have become saddled with debt problems as a result of treating more uninsured patients, experts say (See story, at right). Hospitals are also fending off more than $100 billion in proposed Medicare and Medicaid cuts outlined in the White Houses fiscal 2008 budget (Feb. 12, p. 6), as well as President Bushs pitch to redirect disproportion-share funds to pay for state experiments on access (Jan. 29, p. 6).