The August 10, 2006 Minutes of the Select Joint Commission on Medicaid Oversight describes an interesting presentation by Rep. Orentlicher on expanding access to health care for uninsured and underinsured individuals. He described the Tennessee approach and the Oregon approach, both of which had initial success but both states had returned to their initial rate of uninsured citizens by 2005. (Could be the systems didn’t work very well or it could be that they were just sufficient to stem the tide of uninsureds between inception and the present.) Rep. Orentlicher described the Veterans Health Administration as a model for reengineering health care delivery. The budget’s plan remained flat between 1995 and 2000 while patients increased by 40%. (Seems like the Oregon and Tennessee plans had problems between 2000 and 2005 — I wonder what the VA data looks like for that period.)
The VA approach has resulted in a shift from hospital based care to out patient care; an 11% decrease in staffing; a significant reduction in forms; and savings in the pharmacy management program. Rep. Orentlicher suggests a pilot program based on the VA model for Medicaid recipients in Marion County to receive services at Wishard Hospital along with a buy-in program for small businesses. As part of the presentation, Lee Livin, CFO of Wishard Hospital gave testimony. He stated that at Wishard, only 10% of their patients are commercially insured, and approximately 36% are uninsured by any source. He suggested that a viable insurance product can be marketed to small businesses at a minimum average monthly premium of $150 to $175 per individual. (So, for a family of 4, this means at least a $600/month premium — $7,200 per year. The federal poverty guidelines put 2006 poverty level for a family of 4 at $20,000 per year income. A family at 200% of the poverty level would be spending 18% of their pre-tax income on health insurance premiums.)
Rep. Tim Brown commended Rep. Orentlicher on his efforts but also pointed out that VA healthcare and Medicaid weren’t exactly comparable because of the differing populations that they serve.