Pharmacy & Therapeutics - September 2008 - (Page 545)

COMMENTARY: Universal Health Care The plan’s Silver option also uses a limited network of providers, or a subset of those providers that participate in HNE’s standard provider network, to maximize efficiency and increase cost-effectiveness. Along with the other six carriers approved to offer their products through the Connector, HNE has been faced with the challenge of meeting the state’s price target for premium increases. This means being asked to do some difficult things and making some hard choices, said Dr. Ebert. “We are trying to balance a law designed to provide individual health insurance through the Connector with the rest of insurance that is employer-based.” ent plan does not achieve its goal of universal coverage.13 If the Massachusetts plan is indeed an outline upon which the Obama health proposal is at least partly based, it may give a glimpse into what to expect in terms of a health care system overhaul should he take office in 2009. Not surprisingly, any similarities to the Massachusetts plan end with the Democratic health care proposal. Senator John McCain, the Republican Party’s nominee, is opposed to universal health insurance coverage, particularly mandated coverage. The key to health care reform, he believes, is a free market system in which competition in the marketplace will help reduce costs and improve the quality of health insurance. He proposes that incentives such as tax credits and tax-advantaged health savings accounts be offered to make it easier for employers to offer coverage and easier for individuals to afford it.14 Critics of this approach say that it would not make insurance more affordable or more available and might prevent individuals with pre-existing conditions from getting any coverage at all.15 The outcome of the 2008 elections will no doubt have a significant impact on what type of health care changes are made, if any. According to polls, a majority of Americans are in favor of expanding health care coverage and they support universal care,16 but it remains to be seen how much the issue will count in their choice for the next president. And, of course, if they do elect Senator Obama, there is the question of whether he will be able to learn from the successes and failures of plans like the Massachusetts reform law and work effectively with Congress to adopt a universal health care system that succeeds. One thing is certain, however: as the general election campaign enters its most intense phase, health care reform is sure to surface as a major policy matter and it is likely to make for some lively debates this fall. Insurers, employers, consumers, and other stakeholders will be watching closely. A BLUEPRINT FOR NATIONAL HEALTH REFORM? As Massachusetts continues to consider alternative benefit designs that make insurance affordable for all of its residents, its new health care system shows early signs of effectiveness, providing critical support for the idea of a national plan. Since the implementation of the Massachusetts law almost two years ago, the state has enrolled more than 340,000 newly insured residents—more than 5% of its population and more than half of its uninsured. The number includes 110,000 enrolled in private plans.5 But while the Commonwealth may have made great strides in covering the uninsured, it is also feeling the financial pain that comes with such an ambitious undertaking. The number of needy Massachusettans, or those who are getting free or heavily subsidized coverage (about 175,000 residents), is reportedly more than the state had originally anticipated, and the health plan is now expected to exceed state budget estimates by $400 million in 2009, or about 85% more than projected.11 With its hefty price tag and other hurdles, does universal health care still remain a viable option for the rest of the country? Indeed, a handful of other states, including California, Missouri, and Wisconsin, have tried to pass similar health care laws but without success. Now, more than two years since its implementation and with the presidential election around the corner, all eyes remain on Massachusetts for a possible answer to this question. Senator Barack Obama, the Democratic Party nominee, has no doubt been looking to Massachusetts as he touts his own universal care plan. Of course, there is one large difference between the Massachusetts plan and the Obama plan: Obama’s does not include an individual mandate—only a requirement that parents obtain coverage for their children up to age 18— a distinction that became a bitter point of contention between him and Senator Hillary Clinton during the primary campaign. Beyond that, a quick comparison of the two plans reveals several notable similarities as well, including income-related federal subsidies and mandatory employer contributions. The Obama plan also includes the creation of a National Health Insurance Exchange to provide businesses and individuals with access to public or private coverage, similar to Massachusetts’s Connector.12 And although the Senator has rejected an individual mandate, explaining that his plan is designed not to penalize people with modest incomes, a health advisor to the Obama campaign has suggested that the candidate might well consider a mandate at a later stage if his pres- REFERENCES 1. Kaiser Family Foundation. HealthPoll Report, December 2004. Available at: www.kff.org/HealthPollReport/dec_2004/Care. Accessed July 7, 2008. 2. Wall Street Journal Online/Harris Interactive Poll. Available at: http://online.wsj.com/public/resources/documents/wsj070912_ sept07-poll.pdf. Accessed July 7, 2008. 3. Kaiser Family Foundation. Health08.org. Kaiser Health Tracking Poll: Election 2008, March 2008. Available at: www.kff.org/ kaiserpolls/h08_pomr030708pkg.cfm. Accessed July 6, 2008. 4. Commonwealth of Massachusetts. Health Care Access and Affordability Conference Committee Report. Available at: www. mass.gov/legis/summary.pdf. Accessed May 7, 2008. 5. The Commonwealth Connector. Available at www.mahealth connector.org/portal/site/connector. Accessed May 5, 2008. 6. Appleby J. Everyone watching as Massachusetts sets costs for required health insurance. USA Today, March 9, 2007. Available at: www.usatoday.com/money/industries/health/2007-03-09mass-plan-usat_N.htm?csp=34. Accessed July 6, 2008. 7. Dembner A. 200,000 may need to get more insurance: State healthcare law sets higher minimums. The Boston Globe, January 30, 2007. Available at: www.boston.com/news/local/articles/ 2007/01/30/200000_ may_need_to_get_more_insurance. Accessed May 7, 2008. 8. Dembner A. Basic drug coverage OK’d in universal health plan: Board votes to delay stringent new rules. The Boston Globe, March 21, 2007. Available at: www.boston.com/news/local/articles/ 2007/03/21/basic_drug_coverage_okd_in_universal_health_ plan. Accessed May 5, 2008. continued on page 554 Vol. 33 No. 9 • September 2008 • P&T® 545 http://www.kff.org/HealthPollReport/dec_2004/Care http://online.wsj.com/public/resources/documents/wsj070912_sept07-poll.pdf http://online.wsj.com/public/resources/documents/wsj070912_sept07-poll.pdf http://www.Health08.org http://www.kff.org/kaiserpolls/h08_pomr030708pkg.cfm http://www.kff.org/kaiserpolls/h08_pomr030708pkg.cfm http://www.mass.gov/legis/summary.pdf http://www.mass.gov/legis/summary.pdf http://www.mahealthconnector.org/portal/site/connector http://www.mahealthconnector.org/portal/site/connector http://www.usatoday.com/money/industries/health/2007-03-09-mass-plan-usat_N.htm?csp=34 http://www.usatoday.com/money/industries/health/2007-03-09-mass-plan-usat_N.htm?csp=34 http://www.boston.com/news/local/articles/2007/01/30/200000_may_need_to_get_more_insurance http://www.boston.com/news/local/articles/2007/01/30/200000_may_need_to_get_more_insurance http://www.boston.com/news/local/articles/2007/03/21/basic_drug_coverage_okd_in_universal_health_plan http://www.boston.com/news/local/articles/2007/03/21/basic_drug_coverage_okd_in_universal_health_plan http://www.boston.com/news/local/articles/2007/03/21/basic_drug_coverage_okd_in_universal_health_plan

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - September 2008

Pharmacy & Therapeutics - September 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Effect of Prescription Copays on Adherence and Treatment Failure with Oral Antidiabetic Medications Vaccine Declinations Present New Challenges for Public Health Universal Health Care in America Digestive Disease Week and American Diabetes Association Pharmaceutical Approval Update

Pharmacy & Therapeutics - September 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.