Pennsylvania universal care plan gets wary welcome

Washington -- Like many new prescriptions, Gov. Ed Rendell's Prescription For Pennsylvania universal health care plan has people optimistic about healing but worried about costs.

The Pennsylvania Medical Society praised Rendell for developing comprehensive health system reform that could offer health insurance to virtually all of the state's 767,000 uninsured. However, the society voiced concern about the governor's claim that "Cover All Pennsylvanians," a new state-driven health insurance proposal aimed at the uninsured, would only require $300 million in combined state and private funding.

There was also uncertainty that the plan could reduce health care spending by $7.6 billion through savings including reductions in medical errors and hospital-acquired infections, and increases in preventive care.

Pennsylvania Medical Society President Mark Piasio, MD, MBA, voiced skepticism shared by many stakeholders. "Are these overestimates?" asked Piasio, an orthopedic surgeon.

Rendell unveiled the fundamentals of his proposal during his Feb. 6 budget presentation. The plan, expected to be introduced as legislation soon, includes a health insurance purchasing mandate for higher- income residents and full-time college students, potentially more freedom for allied health professionals, and a state-subsidized, privately run health insurance plan targeted to employees of small businesses and the uninsured.

Some of the private costs -- such as electronic medical records and translation services at hospitals -- have not been estimated, despite the plan's potentially requiring them, said Amy Kelchner, spokeswoman for the governor's Office of Health Care Reform.

Prescription For Pennsylvania doesn't have the universal insurance purchasing mandate of Massachusetts. However, the plan addresses myriad issues, including the lack of physicians in rural areas, pay-for-performance and substandard palliative care. And that's only a partial list.

The ideas have Dr. Piasio interested but also a little wary. He hopes partisan politics don't derail the plan when the Pennsylvania General Assembly begins debating the legislation in the spring.

The proposal is an honest effort to address the problems facing health care in the state, Dr. Piasio said. "I don't think you can ask for anything much more fair than that."

The president of the Pennsylvania Academy of Family Physicians, Russell Breish, MD, agreed. "The plan looks promising for expanding access, and we look forward to hearing more of the details and working with the governor."

Talk of new rules for allied health professionals has Dr. Piasio's attention. He said he doesn't want to see midwives and others practicing independently.

But physician assistants and nurse practitioners could help expand access to care if the collaborative agreements between them and physicians allowed doctors to supervise more than two allied health professionals, said Dr. Piasio. He employs a nurse practitioner who helps with sprained ankles and other minor injuries.

The state needs to align its allied health professional reimbursement laws to match those of Medicare, he added. "It really is kind of a hodgepodge of reimbursement schemes."

The immediate past president of the medical society is more welcoming of the overall plan than he is of an expanded role for allied health professionals.

"They have not had all the training physicians had and can't possibly know all of the problems that come up," said William W. Lander, MD, a family physician in Bryn Mawr.

The proposal's pay-for-performance component, while yet to be fleshed out, also had Dr. Lander concerned. "That's not for me. I'm a solo practitioner, and it wouldn't help me a bit." Dr. Lander said he doesn't have the resources to set up electronic medical records on his own and doesn't think any pay-for-performance system would increase his income enough to afford it.

He applauded the idea of getting more people enrolled in health insurance and would like to see the Medicaid program revamped, which the governor's plan proposes to do. Dr. Lander hasn't accepted Medicaid in 20 years but still treats beneficiaries -- for free. That's possible because he invests his retirement funds into his practice.

Although Prescription for Pennsylvania includes a mandate for insurance companies to spend at least 85% of their small business premiums on health care, Highmark in Western Pennsylvania and Independence Blue Cross in Eastern Pennsylvania are withholding judgment on that part of the proposal for now.

Like Dr. Piasio, Michael Weinstein, spokesman for Highmark, which operates in 29 counties, is focused on the dollars.

"There are a lot of questions on how [Cover All Pennsylvanians] is going to be financed," Weinstein said.

The Pennsylvania Chamber of Business and Industry said the proposed payroll tax should be abandoned in favor of a statewide funding source. "A payroll tax simply raises the cost of each employee to the business and gives it added incentive to reduce its workforce or otherwise compensate to the detriment of workers," the chamber wrote in response to the proposal.