Several states moved a little further last week toward health-
care reform and universal coverage in varying degrees.
The advances in Washington, Connecticut and Hawaii and illustrate the snowballing effect that the healthcare access issue is having in statehouses around the country.
These reflect a growing concern among the population about rising healthcare costs and the rising number of uninsured people, said Sara Collins, assistant vice president at the not-for-profit Commonwealth Fund. Its on the publics mind and is being made part of the public policy agenda.
In Washington, Gov. Christine Gregoire signed into law a broad measure that aims to provide high-quality, affordable healthcare to state residents.
The bill, which includes more than 20 initiatives, many of which were recommended by a blue-ribbon commission on healthcare, perhaps most significantly addresses cost and quality issues as well as access to healthcare, Collins noted. It is not just putting more (uninsured) into the system, they are also trying to address the quality issue, too, which is very important and should be part of insurance proposals overall, she said.
Among other things, the bill establishes a means to assist small businesses with insurance, creates health record banks to connect providers and patients with their health information on demand, and changes how the state reimburses for healthcare to pay for quality care and prevention. The measure also expands health insurance coverage to dependents up to age 25, a feature that many states have been implementing in the past couple of years in an attempt to reduce the number of uninsured young adults, according to Collins.
Consumer groups also applauded the Washington measure for being the first of its kind to endorse shared decisionmaking, a process that promotes communication between patients and practitioners. Studies indicate that patient well-being improves significantly when decision aids such as brochures or online tools are available to patients and they have an opportunity to participate in medical decisionmaking with their physician, according to proponents.
The bill should give needed momentum to the practice, which was tested in a pilot project at Seattle-based Group Health Cooperative, a two-hospital integrated healthcare and financing system, said Karen Merrikin, the systems executive director of public policy.
The new bill both encourages the state healthcare authority to work with providers to try out shared decisionmaking practices, and it supports the use of high-quality decision aids by changing the law on informed consent to give providers a little bit extra legal protection from liability, Merrikin said. Its not the most revolutionary change in the world but it is signaling something important about moving toward greater emphasis toward evidence-based care and getting the right information about treatment into the hands of patients.
In Connecticut, a coalition of business, healthcare and health insurance representatives released consensus principles for effective healthcare reform to the state Legislature. The principles come in the wake of three major proposals on the table in the Legislature, said Stephen Frayne, senior vice president of health policy for the Connecticut Hospital Association. The most sweeping proposal offers single-payer, universal coverage while the other two aim to expand coverage, albeit in different ways, he said.
The coalition digested all that, stepped back and evaluated them, offering the principles for healthcare reform. Key to any proposal would be adequate reimbursement to providers under the Medicaid and general assistance programs, or GAPs. Otherwise, providers are forced to cost-shift, burdening the employer community and creating a vicious cycle, he said. In total, the state pays hospitals $250 million less than what it costs them to treat patients on Medicaid and GAPs, according to Frayne.
The coalition is now working on legislation around the principles. Frayne could give no timeline on when a proposal might be ready, but he said that the current legislative session ends in June.