The World Around You

I strongly encourage gubernatorial candidates to come out with detailed policy proposals, something we can really sink our teeth into and something that gives a real window into how the candidate thinks about the issues we face.  So I was excited to take a look at what Tim James proposed today in Huntsville for healthcare.  From the campaign press release we get the following policy proposals:

• Health Care Savings Accounts – Introduce health care savings accounts to state workers and teachers as an option to current plans now offered. This will provide people incentives to utilize health services more strategically, putting the decision-making with patients, not insurance companies.
• Incentives for Healthy Living – Offer smoking cessation treatment, exercise classes, nutrition instruction to those enrolled in state-funded health care plans.
• Greater Flexibility in Medicaid Plans – Shift Medicaid from a one-size-fits-all plan of 40 years ago to different levels of care to fit the needs of the 700,000 Alabamians served by the federal-state health care program for low income families.
• Limit Medicaid Prescriptions – Move from unlimited prescriptions for Medicaid patients to five per month, saving the State of Alabama millions in taxpayer dollars.
• Emergency Rooms for Emergencies Only – Restrict emergency rooms for medical emergencies for those enrolled in state-funded health care programs, saving taxpayers millions and taking an unnecessary burden off of hospital ERs. Clinics can accommodate the non-emergent care patients, and at a much lower cost.
• Statewide Health Awareness – Bring Get Healthy Alabama’s message to schools, communities and families statewide in a comprehensive communications program utilizing all media, including the Internet.

Let’s take these one at a time.  First, we have Health Savings Accounts…which must be paired with high-deductible health insurance programs (HIDPs), sound great in concept, and can work well for young healthy people.  But they can also exacerbate many issues we are already experiencing with our healthcare system.  As Dr. Sara Collins of the Commonwealth Fund testified before Congress in 2006,

• The EBRI/Commonwealth Fund Consumerism in Health Care Survey found in 2005 that people enrolled in HSA-eligible HDHPs were much less satisfied with many aspects of their health care than adults in more comprehensive plans.
• People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes.
• Adults in HDHPs are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.
• Few Americans in any health plan have the information they need to make decisions. Just 12 to 16 percent of insured adults have information from their health plan about the quality or cost of care provided by their doctors and hospitals.

I’m interested to know what Mr. James is looking at or who he is listening to that is refuting this information.  The last bullet is particularly concerning, one of the key assumptions about HSA’s is that people will be able to make “informed decisions”, but that is not how they have worked in reality.

Next, we have Incentives for Healthy Living…no problems I can see with the vague statements offered here.  Though I’m not sure what Mr. James is proposing that is different from the existing State Employee’s Insurance Program Wellness Initiative.

Third, he proposes Greater Flexibility in Medicaid Plans…this one is extremely vague and I’m really not sure what this will entail.  We already have a number of different Medicaid waiver programs that offer differing services…so what is he proposing to change?  I would be very interested in if there is another state he is looking to model our program after or if this is something completely different than any of the other 49 states are doing.

Limiting Medicaid Prescriptions…the five prescription limit was put on the table by the current Alabama Medicaid commissioner in December and there is a bill currently bouncing around the legislature that would enact a similar restriction.  Here is a link to an FAQ on the current Medicaid prescription limits.  Before we take this kind of action, it’s extremely important to gather information on those that are currently over the five prescription limit that is being proposed.  Are we saying that if someone needs six prescription drugs to function effectively, we’re going to say, “No, you can only have five.  You have to chose.”  I understand we have to set limits, but it’s impossible for anyone to know whether the limit proposed is reasonable unless we know the types of clients we are talking about who get more than five prescriptions now.

Emergency Rooms for Emergencies Only…this one may simply be illegal.  The Emergency Medical Treatment and Active Labor Act clearly states that any hospital that accepts Medicare must provide services to anyone, regardless of ability to pay.  So, while the state may be able to deny payment for services rendered in an emergency room that are not deemed to be “emergency” through Medicaid or SCHIP (though I question whether we can even do that), the patients who are seeking the services cannot be told they can’t receive the services.  So, we’re left with an unenforceable regulation that will leave hospitals potentially providing even more services for which they will not receive payment.

And finally statewide health awareness…Mr. James has his own catchy slogan.  I’m just not sure his program will be leaps and bounds more successful than any of the myriad initiatives that the Alabama Department of Public Health is already responsible for…like “Scale Back Alabama”.

I’m interested in what other readers thought of these proposals and what I may have missed.