AAFP, Others Announce Proposal To Help Reduce Ranks of Uninsured

A groundbreaking alliance of health care stakeholders, including the AAFP, on Jan. 18 announced a proposal that would extend health care coverage to America's nearly 47 million residents without health insurance. The group, the Health Coverage Coalition for the Uninsured, or HCCU, advocates a mix of public programs and tax credits to achieve the coverage. HCCU estimates that the proposal, if fully implemented, would cover more than half of the uninsured population.

In addition to the Academy, which is the only medical specialty association in the group, HCCU members include the AMA, Families USA, America's Health Insurance Plans, American Hospital Association, U.S. Chamber of Commerce and United Health Foundation, as well as nine other organizations (see box below). Coalition members have been meeting for more than two years to hammer out the consensus plan.

Reed Tuckson, M.D., senior vice president of the United Health Foundation, moderated a news conference held at Union Station to announce the plan. The event drew a capacity crowd of reporters. "Today, 16 powerful, influential, politically diverse and highly principled organizations, many of whom often do not come together on issues here in Washington, are gathered on this stage to announce a set of consensus recommendations -- and to pledge our full and continuing support for the implementation of those recommendations," Tuckson told reporters.

Why now? "Day after day after day, there is debate, there is discussion," Tuckson said. "And day after day, people die.

"We are sick and tired of the debate. We are focusing on what is achievable and what is possible. People have to learn to get past their only one solution and their 18-point theology plan and move to something that can make a difference for people tonight."

HCCU's proposal first focuses on expanding coverage to the nation's 9 million uninsured children -- and that could happen this year, say coalition members. Under the proposal, states would be given the flexibility to deem uninsured children from low-income families eligible for and enroll them in Medicaid or the State Children's Health Insurance Program, or SCHIP, when they qualify for other means-tested programs such as food stamps.

"Surveys have shown over and over that Americans want children covered because they see the health and well-being of children as being the health and well-being of our future," AAFP President Rick Kellerman, M.D., of Wichita, Kan., told reporters.

Speaking as a physician, Kellerman said getting kids insured "gives us an opportunity to discover developmental delays earlier, find medical problems when we can intervene and treat, take care of acute problems before they can become complications, and provide immunizations. So this proposal is not only cost-effective but also good medical care."

According to the HCCU plan, the federal government should provide additional SCHIP funds to cover costs associated with enrolling additional low-income children. It's a good time to advance this idea, because SCHIP is up for reauthorization in 2007, said Ron Pollack, executive director of Families USA.

The HCCU proposal also calls for a tax credit to help families with more income pay for private health insurance for their children. Families earning as much as three times the federal poverty level would be eligible. The credit would cover a significant percentage of the premium, with the percentage graduated on a sliding scale based on family income.

In addition, the proposal's first phase would establish a grant program to enable states to experiment with innovative approaches to expand coverage.

The HCCU proposal's second phase focuses on uninsured adults. It would give states the flexibility and funds to expand Medicaid eligibility to cover all adults with incomes below the federal poverty level. Those with incomes between one and three times the federal poverty level would get a tax credit to help them pay for private insurance.

Too often, uninsured people don't get the primary and preventive care they need; instead, they "depend on the local emergency department as their family doctor," said Kevin Lofton, chair of the American Hospital Association Board of Trustees. "Delaying action on the uninsured will only increase the human suffering, the moral urgency, and the financial costs to our society and to our health system. According to the Institute of Medicine, an estimated 18,000 people die each year because they do not have health insurance."

Not surprisingly, reporters at the news conference raised questions about cost.

"We've already started having meetings on Capitol Hill, and we're hearing a number of ideas about how this might be paid for," Pollack said, though he offered no specifics. "I'm very encouraged that there are some real ways to get this paid for (that are) practical and could get bipartisan support."

The reporters laughed when Pollack noted that two conflict management organizations had helped the coalition's ideologically and politically diverse members achieve consensus.

"Not surprisingly, when we initiated our deliberations, each organization entered the process with its own top-priority proposal," Pollack said. "Its 'principles,' if you will. What made this process unique is, we decided to rise above our individual principles to achieve a much higher collective principle. Namely, we decided to compromise, to find virtue in a second-favorite proposal, so we could do something politically practical to cover America's uninsured."