Healthcare Policy A Case Study
Author: Annette Cannon, PhD, MA, RN, MSN
This story begins when Eva Henry, a single mom, and her children, Maurice and Danielle were without health insurance, although Eva was working here in Colorado. She worked in financial services, but was unable to afford the health insurance benefits offered by her employer. She was facing the decision of whether to feed her children and pay the rent or pay for health care benefits on her wages of $15,000 a year. What happened next in Eva’s life, was driven by what happened to her children while being uninsured. She recall’s her son having severe burns on his hands and not being able to afford to take him to the emergency room, thus hearing him cry many nights from the pain. Her daughter, from the age of 6 months was plagued with chronic ear infections. Because she was unable to afford tubes to be placed in her ears, she continued to give her child antibiotics. By age ten, her daughter had lost her hearing in the left ear. Eva’s dilemma was that she was not eligible for Medicaid, but at the same time, she could not afford private insurance. Eva and her children fell through the cracks!
Quality health care that once seemed reliable is quickly being priced out of reach for millions of hardworking, taxpaying Americans. The health care crisis affects us all regardless of age, race or employment. (Colorado for Health Care, 2008) Eva states that the “focus should not be so much on having health insurance, but what is the coverage of that health insurance”. “What good does it do to have insurance if it doesn’t cover what you need or you can’t afford the deductibles?” she said. In Colorado, 772,000 are uninsured, with 37% of that number being hispanic, 13% whites, and 19% women (CHC, 2008). These numbers of uninsured raise the health care premiums for private employer coverage. However, Eva says that underneath all of this, she believes the main political issue is the underinsured population.
Eva became a ‘health care voter’ with Colorado for Health Care. She said that she doesn’t want another family to ever go through what she and her family did and be faced with the difficult decisions that she once had to make. She had already worked many years in financial, helping families who needed consumer loans, so she began to get involved with several groups that focused on matters that were important to the working family. Her interest was to take on projects that examined health care reform and education. With Eva’s passion for her community, she then became involved with volunteering for schools, being a campaign manager for Colorado State Representative Judy Solano and became a community leader by serving on the City council.
Eva became a supporter of HB 1389. This bill was introduced by two Democrats, Representative Morgan Carroll and Senator Paula Sandoval and is supported by many. The bill summary is as follows:
“Requires each insurance carrier to file with the commissioner of insurance a detailed description of its rating and renewal practices for health and automobile insurance. Requires such information to be public when filed. Requires each insurance carrier to file annually with the commissioner the number of lives insured in the previous year. Requires requested rate filing increases for health and automobile insurance to be submitted to the commissioner at least 60 days prior to the proposed implementation date. Allows the rates to be implemented if the commissioner does not approve the rates within the 60-day period. Allows the commissioner to disapprove the rates upon later review. Requires the commissioner to disapprove the rates for health and automobile insurance if certain conditions apply. Requires insurance carriers to report to the division of insurance (division) if specific reasons apply to an increase in rates for health and automobile insurance. Requires the division to track such information and make it public. Prohibits persons from willfully withholding information that will affect rates or premiums charged or from giving false or misleading information. Creates penalties for a violation. Requires that use of credit information for underwriting purposes be open to the public” (Second Regular Session, 2008).
Eva tells me that Colorado has the seventh highest insurance premium among the states, rising at a 98% rate, stating that the money is going for profits to the insurance companies and not into the healthcare of individuals. She states that we are higher than average when it comes to the number of uninsured (800,000 in Colorado) and that over 80% of those numbers come from working families. This bill will effect our insurance rates in the future, by decreasing the discrimanatory acts of insurance companies, decrease profits into their pockets and will assist with getting our claims paid in a timely manner, which will assist in protecting individuals credit from being harmed. It will take away the control power of insurance companies.
Eva’s commitment to her community has led her to a position on the Thornton City Council, Ward Two in Adams County, here in Colorado, which now provides a Democratic majority for the council. She is out there ‘walking for votes’, holding demonstrations, having her voice heard, and fighting for health care reform. Eva believes that “if you want to do something to make sure that everyone gets comprehensive, quality, affordable healthcare, then there are ways to make that happen.” She says to first “become a health care voter, make sure you are informed, become active by spreading the word, talking to candidates and making your voice heard”. Eva said that becoming a volunteer on local and state levels with healthcare campaigns is another way to be involved and make a difference.
She adds that she has taken many lessons from those in the area and has also taught her children to become strong community leaders through giving back. Her son, Maurice, is in his tenth year of serving in the US Army and her daughter, Danielle, graduated with a Political Science degree, is involved with the SEIU and fighting for workers rights regarding health care.
In return, where is this policy today? The Colorado House Bill 1389 (The Fair and Accountable Insurance Act) has been approved by the House Business Affairs and Labor Committee. It will now be going to the House Appropriations Committee. According to the Colorado for Health Care group,
“The efforts of health care voters paid off as HB 1389 passed the Labor and Business Affairs committee and now heads to the House Appropriations Committee on Thursday, April 17th. Health care voters testified and lobbied in support of this bill which prevents excessive, unnecessary insurance rate increases by allowing our division of insurance the same power that 38 other states have - the power to review the reasons for a proposed increase and approve or deny the hike. If we are going to effectively tackle spiraling health care costs in Colorado, we need to know where the money is going and have the power to tame the excesses. As a prior approval state, we can lay the foundation for future health care reform that will lower costs and increase access” (CHC, 2008).
Eva adds that she is looking forward to continuing to fight for future health care interests in regards to our federal funding issues. Eva is concerned about the recent Medicaid funding cuts and how that would impair our Colorado hospitals. The cuts would reduce payments to Denver Health, the city's safety-net hospital, and cut funds for medical education, reducing low-income patients' access to teaching hospital clinics (CHC, 2008) Denver Health and other hospitals generally get more of a reimbursement than some because they treat Colorado’s uninsured and poor. By cutting the funds, it will cost individual states into the billions of dollars, which will certainly shake their financial stability.
Colorado is in no position to make up the difference in funding levels as we are wrestling with our own budget problems. Again, the people on Medicaid are primarily children, the disabled, and elderly; they will not find an alternative health care plan. They will become uninsured, but the need will not disappear. Increasing the number of uninsured leads to more uncompensated care for hospitals and providers, which leads to higher premium cost for the insured (Colorado Consumer Health Initiative, 2008). It will also leave it up to the state to figure out how to treat those people who are part of the budget cuts.
Eva is out campaigning this week against these cuts and the Republican proposal that would force those with existing health insurance through an employer, out in the cold to fend for themselves, leaving millions of people in loss of benefits. This also leaves those with chronic diseases out of insurance too, due to being denied insurance due to pre-existings. “When people don't have health insurance, we all pay the price. Uninsured people put off care until they have to go to the emergency room, but if they can't pay the cost, it gets passed along to those of us who do have insurance” (CHC, 2008).
The sub-system theory in regards to Sabatier’s model seems to have the greatest relevance to this case study. “The greatest advantage of sub-system throry is that like the alliance it models, it cuts across innumerable dimensions of policy makding” (Lee & Estes, 2003) All of the non-governing entities, such as Eva’s involvement in consumer groups and political advocacy groups have shown how their interactions with each other and with larger governing bodies can communicate and interact. She continues to debate the healthcare reform issue and lack of financing with policymakers to come to a workable policy solution.
Colorado Consumer Health Initiative. Medicaid cuts at the Federal level would hurt Colorado. Retrieved April 11, 2008 from http://www.cclponline.org/pubs/medicaidcuts4-06-05.pdf
Colorado for Health Care. Claims DENIED: McCain’s Proposal Would Cost More and Cover Less. Retreived April 20, 2008 from http://www.coloradoforhealthcare.org/
Colorado for Health Care. Medicaid Funding Cuts Would Impair Colorado Hospitals. Retrieved on April 17, 2008 from http://www.coloradoforhealthcare.org
Colorado for Health Care. Project of Service Employees International Union, CtW, CLC. Retreived April 17, 2008 from http://www.coloradoforhealthcare.org/facts/
Lee, P. R. & Estes, C. L. (Eds.). (2003). The nation’s health (7th ed.). Sudbury, MA: Jones & Bartlett
Second Regular Session. Sixty-sixth General Assembly. State of Colorado Premended. A Bill for an Act 101 Concerning Increased Oversight of Health Insurance Rates. http://www.leg.state.co.us/clics/clics2008a/csl.nsf/billcontainers/A9D0C892B8408F21872573680059F8CC/$FILE/1389BA_01.pdf