State Gauges Sentiment on Universal Health Coverage

By LAURENCE DARMIENTO
Staff Reporter

As employers scramble to find ways to cut health care costs by trying new plans offered by insurers, there's a little-known state effort that could lead to far more radical change.

Nine proposals to achieve universal health care coverage, solicited by the California Health and Human Services Agency under a 1999 state law, have been developed and presented at public hearings across the state.

The proposals range from incremental plans calling for expansion of public programs, to business subsidies to schemes that revive the concept of a "single payer" system, in which a single state-administered fund would pay for all health care. There's even a plan to develop a British-style health system in which the state provides nearly all care through the employment of doctors and operation of hospitals.

With the defeat of Proposition 186, the 1994 statewide ballot initiative that would have created a single-payer system, the hearings now being conducted for the Health Care Options Project have generated little public debate. But elements of the plans are being looked at.

There's a proposal calling for a state and privately-funded subsidy that would assist small businesses in purchasing health care coverage through PacAdvantage, a non-profit purchasing pool.

"This is a legitimate incremental step," said John Grgurina, executive of PacAdvantage, which offers health coverage to 150,000 enrollees. "Why can't we help get some of the small employers to put some of their money on the table?"

While PacAdvantage has not shopped around the proposal to legislators, Grgurina said he believes it may be accepted because it doesn't radically change things. He also noted that it's not envisioned as an entitlement program, since the subsidy would vary in response to available financial resources.

Another proposal is based on a stalled but still active bill authored by Assemblyman Keith Richman, R-Granada Hills. It would create the California Health Care Program to administer expanded government coverage available to all persons with an income level under 250 percent of the federal poverty level. The bill stalled last year when the Davis Administration concluded that expanding government health coverage to all working poor would be too costly.

Another proposal takes that concept even further by opening such a program to all legal residents of the state, with a share of the funding paid by employers who do not offer health coverage a tab estimated to be $4.3 billion. State Sen. Jackie Speier, D-San Francisco, recently introduced a bill based on it.

Small-business assistance

Speier's proposal still awaits detailed language. However, the "Stepping Up to Universal Coverage" plan by E. Richard Brown, a UCLA professor, and Richard Kronick, a colleague at the University of California at San Diego, is well fleshed out.

It is based on the premise that if everyone contributed their fair share to the health care system, there would be more than enough to cover the necessary funding. (Employers and employees each would bear a portion of a payroll tax if the employee is not covered under private insurance.)

But existing contributors, such as businesses that already buy health insurance for their employees, would no longer have to subsidize through higher premiums those who don't pay.

"We are going to eliminate the free rider," said Brown, a professor at the UCLA Center for Health Policy Research.

Despite its seemingly onerous mandate that all businesses and even self-employed individuals pay into the system, Brown believes the proposal is politically feasible. It does not prohibit employers from continuing or seeking private insurance, and an analysis has found that firms that currently offer coverage would save $3.7 billion by having the free riders brought into the system.

The hearings process will finish with a symposium on April 12 in Sacramento, when the final versions, as well as estimates of their costs, are presented.

Lucien Wulsin Jr., co-author of a plan calling for increased public spending, employee credits and business tax breaks to improved coverage, said he has been disappointed with the lack of participation in the process by the medical community, insurers and labor.

Even so, he said he is hopeful the final products will generate some movement toward solving the problem of the uninsured. "We will see if there is any momentum to get anything done," he said.

Universal Care

Proposals submitted to the state to achieve universal health coverage:
- The creation of a publicly funded agency that would take over all health care services from the private sector.

- The establishment of a "single payer" system in which a state-managed insurance pool would pay for all coverage.

- A proposal based on Assembly Bill 32 that would extend government health coverage to all working poor.

- Broadening the AB32 concept to expand coverage to all adults, with much of the funding coming from a tax on businesses that do not provide insurance for employees.

- Coverage for all non-elderly adults and their dependents through the creation of a state-sponsored network of medical providers.

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