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Volume 27, Issue 464 |
April 3, 2006 |
“COVERTENNESSEE” WOULD PROVIDE PORTABLE POLICIES
At a hotly anticipated special session of the Tennessee Legislature March 20th, Gov. Phil Bredesen proposed “CoverTennessee” – an insurance program for limited-income small business employees and the self-employed. Coming less than one year after highly publicized cuts to the state Medicaid program TennCare, this move promises to reignite the controversy surrounding the state’s long struggle with health-care costs. With 600,000 uninsured in Tennessee, however, any effort may be welcome. “He [Gov. Bredesen] didn’t present it…as the best that we can do, the best that we’re going to do, but it’s a beginning,” commented Rep. John DeBerry.
Under CoverTN, private-sector insurers would bid to provide policies that meet rules set by the state. An individual policy would cost an average $150 a month, with the state paying one-third, the enrollee one-third, and the enrollee’s employer one-third. Participation would be voluntary, and should an employer choose not to participate, the employee could enroll by paying two-thirds of the premium.
Premiums would be adjusted for age, health status and health behaviors such as smoking or obesity, thereby “rewarding people with healthy lifestyles,” said Rep. Bo Watson. In order to avoid having people drop private plans in favor of CoverTN, the program would available at least initially only to people who have not been insured for a set period of time. There would be no large deductible; enrollees would pay co-pays of $25 for doctor visits, $10 for generic drugs, and hospitalization and emergency care coverage would be limited.
Coverage, once purchased, would belong to the individual, and could follow him or her from job to job. “This proposal represents a fundamental rethinking of the way health insurance works,” Bredesen said. “Health insurance should follow the individual.” So, if an individual who worked for a small business that offers CoverTN is laid off, that individual could maintain the policy by paying $100 instead of $50. “If you join another company that offers CoverTN, it is a seamless transfer,” Bredesen said. “The policy hasn’t changed, just who is writing the check. If you join a company that doesn’t offer CoverTN or any other health insurance, you can still keep the insurance going by paying the very affordable premium yourself.”
If the state kicks in $50 per month per individual policy, it will have to pay $60 million a year for each 100,000 people who join up. The state would draw on existing TennCare reserves to pay for the program for the first three years. “These reserves are state tax dollars that had been set aside to cover claims against the program and which we have freed up either through successful negotiation or legal victories,” Bredesen said. If additional revenues are needed after the first three years, he suggested that the state consider modestly increasing the tobacco tax.
Many details haven’t been decided. Little is known, for instance, about what benefit levels will look like, commented Watson. “If you have health insurance, you wonder, what kind of program can be constructed at a cost of $150?” And, as a voluntary program, CoverTN will likely face selection bias problems. Continued Watson, “I will be interested to see how many people who currently have chosen not to buy insurance…step out and start purchasing a policy.”
Other parts of the initiative announced on Monday include CoverKids, which would provide insurance to children in households with incomes below $50,000, and AccessTN, aimed at covering high-risk individuals who can’t find otherwise find insurance.
“The big issue is going to be selling it,” said DeBerry. “[Tennesseans are] concerned about seeing doctors, they’re concerned about getting medicine, they’re concerned about their children’s health. What remains a challenge for both the governor and the Legislature is to take this program home.”
By Paul DeYoung, an intern with NCSL’s Health Policy Leadership Forum
STATES ADVANCE ON ADVANCE DIRECTIVES
By Anna C. Spencer
In the wake of the Terri Schiavo case, state legislatures have been debating – and some have been passing bills – that deal with end-of-life issues. Schiavo was the Florida woman who suffered severe brain damage after collapsing from heart failure 16 years ago. The fierce legal battles between her parents and her husband over whether to withdraw her feeding tube propelled the issue of end-of-life care to the forefront of the nation’s consciousness.
In mid-March, the New Hampshire House of Representatives overwhelmingly passed a bill (HB656) that seeks to ensure individuals will have their end-of-life care wishes met by simplifying the language of and making it easier to adopt living wills, medical power of attorney documents and do-not-resuscitate (DNR) orders. The state has had laws covering advance directives for end-of-life care on the books since 1991, but often those directives were written in legal language that people found “incredibly confusing,” said bill sponsor Rep. Hilda Sokol. The new law puts the directives in “terms that ordinary people can understand and makes them much more user-friendly.”
A living will outlines the procedures a person wants to receive when they’re near death or permanently unconscious. A durable power of attorney legally designates someone to make medical decisions when a patient cannot. Current New Hampshire law requires two witnesses and a notary or justice of the peace to sign the documents. Under the bill, the forms become official with just two witnesses.
The law also allows patients to include DNRs in their advance directives. DNR orders bar medical personnel from using cardio-pulmonary resuscitation or other techniques if a patient has a heart attack or stops breathing. While most long-term care facilities and nursing homes keep information on their residents’ end-of-life care wishes, patients often move, which can result in confusion about whether they are DNR. The bill creates a standard form that would be binding regardless of where the person receives treatment.
Part of the impetus for the legislation was to “increase awareness of the importance of having these documents in place and to give the issue a little publicity,” said Sokol. The bill includes templates for the living will, durable power of attorney and DNR orders in an effort to help individuals “fully understand their options for end-of-life care and make informed decisions.” The Senate is currently reviewing the bill, where Sokol says it also has broad support.
Montana also has taken steps to ensure that residents will have their end-of-life care wishes met. On March 16, the state launched an online database for living wills that will be accessible to doctors and hospitals 24 hours a day through the Web site or by telephone.
Created by the Legislature in 2005, the Montana End of Life Registry Service electronically stores advance directives and gives registered health-care providers and consumers access to them. The Attorney General oversees registry filings, security and operations.
To participate, Montanans must fill out and print out either the directive available online or another form that meets the requirements set forth in the statute. The form must be signed by two witnesses and then mailed to the Office of Consumer Protection, which ensures its authenticity. The office mails participants a wallet card and four labels – two to place on the back of a driver's license or insurance card, plus two extra. The card also contains an access code for participants to check their advance directives through the online registry.
In 2006, Washington passed and signed into law similar legislation (HB 2342). The law directs the state Department of Health to set up a Web-based system to compile living wills and medical power of attorney documents for Washington residents. “It is the legislature’s intent that the registry would be consulted by health-care providers in every instance where there may be a question about the patient’s wishes for period of incapacity,” the legislation states.
Some states are dealing specifically with the issue, which loomed large in the Schiavo case, of artificially administered nutrition and hydration. The Minnesota Legislature is contemplating the Starvation and Deyhration of Persons with Disabilities Prevention Act. The bill (House File 3255, with companion bill Senate File 2861) states that, with certain exceptions, “It shall be presumed that every person legally incapable of making health-care decisions has directed the person’s health-care providers to provide the person with nutrition and hydration to a degree that is sufficient to sustain life.”
The bill also directs the commissioner of health to carry out a statewide public education campaign on the importance of completing health-care directives that clarify their wishes regarding nutrition, hydration and life-preserving medical treatment.
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