Wellstone and SEIU Unveil Health Security Act for All Americans

by Anne Hill

No problem concerns working Americans more than health coverage for our families and ourselves. With the nation's economy
booming and corporate profits at an all-time high, SEIU (Service Employees International Union) decided it is time to unite behind a practical plan for secure, affordable, quality health coverage for all.

As the nation's largest health care union, SEIU, along with Senator Paul Wellstone (D-MN), will unveil the Health Security for All Americans Act in July.

The SEIU plan would among other things

• Provide affordable, quality coverage to those who don't have it now,
• Guarantee coverage even when employees' life circumstances change and when they have special health care needs,
• Establish a fair system of financing,
• Provide freedom of choice of doctors and hospitals,
• Give health care employees the staffing levels they need to provide quality care.

Step One: Expanding Coverage

During the first four years of this program, the Child Health Insurance Program established by Congress in 1997 would be expanded to provide access to affordable coverage to uninsured adults and children in families with income under $50,000 per year. Benefits would be based on the standard Blue Cross/Blue Shield plan and equal to those received by members of Congress. Premiums and out-of-pocket costs would be based on income, with no premium for families earning below $25,000 a year.

The federal government would provide states with extra funding from a variety of sources, and states would have broad options for funding their share. States could expand Medicaid, set up one or more separate insurance funds with a choice of plans, or expand their public employee health benefit plan.

Step Two: Coverage for All

After four years, states would have to make sure that everyone is covered. Families would get coverage either through their employer, or from a plan offered through a state insurance pool designed to help workers and employers pool their money to provide more efficient and secure coverage. Employers would have to provide at least 80 percent of the premium cost, and union members could negotiate with their employers to cover the employee share of the premium and co-payments.

The current crisis in health care in this country demands that elected leaders, the providers, the health care advocacy community, and unions act responsibly now to create a new health care system which can meet the needs of all Americans.

Anne Hill is the Executive Director of SEIU District 925 in Cleveland.

From the Director, Larry Bresler

Currently about 1.7 million Ohioans are without health insurance. Although this situation is disgraceful, the worse is yet to come. The number of uninsured Ohioans is expected to increase significantly beginning in October when the first families on public assistance are cut off from cash assistance.

On October 1 about 13,000 Ohioans will have reached their three year limit for public assistance; by the year's end, some 40,000 will be off the welfare rolls -- and that number will increase. Studies have shown that those leaving welfare for employment have, in general, landed low wage jobs with no health care benefits.

Everyone who leaves welfare is eligible for transitional Medicaid for six months to a year; many are also eligible for other, income-related Medicaid programs. Health care coverage through Medicaid has been delinked from cash assistance (welfare). However, former welfare recipients are not being made aware of their continued Medicaid eligibility. In addition, many of their children are not being enrolled in the State Children's Health Insurance Program (SCHIP).

A recent study by Families USA documented the drop in Medicaid enrollment of Ohio parents: a decrease from 226,612 in January 1996, to 130,758 in October 1999. This is a decline of 95,854 (42 percent). This drop was the third largest percentage decline among the 15 most populous states. Although Ohio is raising Medicaid eligibility levels for parents from about 80 percent to 100 percent of the federal poverty line on July 1, 2000, the lack of commitment by the state to enroll more parents is reflected to date by the lack of any publicity or outreach about parent eligibility. Consequently, the additional eligibility limits for parents will have a marginal effect in increasing parents on Medicaid, and will be more than offset by the increased numbers being terminated from public assistance.

The state of Ohio and its counties can implement some fairly easy steps to mitigate the expected increase of those without health insurance leaving public assistance.

1. Transitional Medicaid should systematically be provided to all that are leaving public assistance in Ohio.
2. CHIP outreach needs to be broadened with enrollment made easier. The state intends to send home CHIP enrollment information with every school child at the beginning of school. This is a good beginning.
3. Medicaid parent eligibility levels should be raised to a minimum of 150 percent with appropriate outreach of its availability.

A primary objective of welfare reform has been to promote self-sufficiency. Real self-sufficiency is not promoted by a system that leaves former welfare families without the health care coverage they relied on.

Work in Progress

A report on organizational activities

CLEVELAND

Broadway Area Begins Health Care Organizing

The public awareness of health care access issues that was raised by the successful community efforts to save St. Michael and Mt. Sinai East hospitals has resulted in a new recognition by community based organizations in Cleveland of the need to organize to protect and expand health care resources and services.

Slavic Village Development Corporation's efforts to mobilize around health issues is a prime example. Slavic Village Development Corporation was the key organizing group in the recent and successful effort to save St. Michael's Hospital. They recognize that this was only the beginning.

Now, they are now organizing a wide-based community coalition to identify and address community unmet health care needs. With assistance from UHCAN Ohio, Slavic Village is conducting a community health needs survey this summer. They will use the results to negotiate and collaborate with the new St. Michael's administration and with other health care institutions to assure that those unmet health care needs are addressed.

Community Partnership Proposes Advisory Council

UHCAN Ohio continues to be part of the Community Partnership for Affordable, Accessible Health Care. This coalition of community groups came together last year to improve communication between MetroHealth Hospital, the public hospital in Cuyahoga County, and the communities it serves.

After a successful hospital/ community forum, the group worked at a way of continuing the dialogue with MetroHealth. The Partnership is proposing the formation of a Community Advisory Council to advise and assist the MetroHealth Board of Trustees in providing affordable and accessible health care to all residents of the County, regardless of their ability to pay. The Council would bring the board information about the needs and concerns of patients, act as a liaison between the board and underserved communities, and assist the board in securing adequate funding and promoting legislative reform. UHCAN Ohio and its other Community Partnership members want the makeup of the Advisory Council to reflect the neighborhoods from which MetroHealth draws the majority of its patients.

COLUMBUS

Getting the Word Out about Hospital Free Care

People who do not know they can get free care at hospitals will fall right past the free care safety net that should have caught them. Under HCAP (Hospital Care Assurance Program), the state law that requires hospitals to provide medically necessary free care to patients with incomes under the poverty level, hospitals are required to post notices in major waiting areas throughout the hospital. In addition, HCAP states that notices are to be posted in major languages that are common to the population of the areas serviced.

But the law is no good if it is not enforced. In a recent meeting with the Ohio Department of Human Services about revisions to the HCAP law, UHCAN Ohio in Columbus complained that some hospitals were not in compliance with the section on posted notices. In response, ODHS expressed concern and asked UHCAN Ohio to inform them of any violations. If your local hospital is not posting notices about HCAP in English or major languages in the area, give us a call at (614) 253-4340.

Free Care Handouts Publicize Programs

UHCAN Ohio went one step further regarding HCAP. We asked hospitals to provide handouts. In response, Doctors Hospital North and OSU University Hospitals East have both agreed to publish easy-to-read handouts on HCAP and their in-house free care programs. This is a significant step in making free care accessible to patients without the money to pay hospital bills.

UHCAN Ohio to Distribute Brochures on Free Clinics

Like hospitals and HCAP, what good are free clinics if nobody knows they exist? In an effort to move people away from using the emergency room for basic medical care, UHCAN Ohio compiled information on free and sliding scale clinics in the city and published it through brochures, posters, and magnets. We are now ready to get the word out. Two medically under-served areas in Columbus, the Near East Side and the Short North-University Area, are targeted. The project was made possible through a grant from the Columbus Medical Association Foundation.

As part of its organizing effort to involve community agencies in the fight to connect everybody to health care outlets, UHCAN Ohio will train frontline providers on how to get information on free care into the hands of the people who need it. If you would like a brochure, call the office at (614) 253-4340.

Ohio Legislation Highlights

For more information on pending bills, call UHCAN Ohio's policy director, Cathy Levine, at 614/ 253-4340. Full texts and summaries of bills are available on the state's website:
www. legislature.state.oh.us.

SB 264 (Sen. Roy Ray, R-Akron) would distribute $50 million per year to Ohio hospitals to reimburse them for their uncompensated care to people above poverty level. Hospital uncompensated care is rising in Ohio because our uninsured population has grown to over 1.7 million. Uninsured people often delay seeking care until they are sicker, and then they use expensive emergency rooms for care instead of making less expensive primary care visits. Basing reimbursement on all uncompensated care above poverty level, SB 264 also covers "bad debt" ­ unpaid bills from people who could pay, but won't, or care that an insurance company refuses to cover.

Ohio could get a much bigger bang out of $50 million by spending it on expanding health coverage to the uninsured working poor. For instance:

• With a Medicaid expansion, $31 million in state funds becomes $74 million, with federal matching funds -- enough for Ohio to expand Medicaid coverage to working parents with incomes up to 150% of poverty.
• For $5 million, Ohio could provide primary care, with a medical home, to many thousands of people at our community health centers; that would reduce many unnecessary, expensive emergency room visits.
• For $5 million, we could raise the Medicaid "Needs Standard," which would free many people with disabilities from "Spenddown" ­ payments (usually small) to the department of human services that people must make each month to get their Medicaid cards.

So why spend $50 million on a bandage solution instead of applying the same money to expanding health coverage to reduce preventable hospitalizations? Ask your legislators.
Status: SB 264 passed out of the Senate Finance Committee and is in the Rules Committee before going to vote on the Senate floor and, if passed, to the House.

Health Systems Agencies Fight for Their Lives -- and Our Health

Ohio's ten Health Systems Agencies (HSAs) are regional, independent health planning agencies established under Ohio law. Many local health departments do not have the funding or resources to assess local health needs or to do health planning. The HSAs have the expertise to assist local health departments. Also, as regional planning bodies, they can assist in regional planning to ensure access to all needed care and improve public health.

HSAs used to conduct local Certificate of Need (CON) hearings -- public hearings to determine whether hospital expansions, relocations or closures should be approved. Because the legislature phased out CON in 1995, many lawmakers want to stop funding HSAs. But HSAs have a vital role in protecting consumers.

Without CON, Ohio is not regulating where hospitals are built, expanded or closed. Thus, you have inner city communities losing safety-net hospitals such as Mt. Sinai, in Cleveland, while University Hospitals and Cleveland Clinic vie for marketshare in the suburbs. The HSAs are the only public body in a position to monitor the impact of these marketplace changes on health care access, quality and cost.

The HSAs are also a unique resource for providing community groups and the public with vital information and data and a forum for debating local issues. Unfortunately, most HSAs are not well known -- partly, because of their low budgets. The HSAs need to do more outreach to the public, but we cannot afford to lose them.

In the last budget, the legislature ignored the recommendation of a bipartisan committee to retain HSA funding and provided phase-out funding. All but a few have closed their offices (although most boards continue to meet). Health care activists need to get behind the HSAs. They are the only public accountability mechanism for the health system in Ohio.

UHCAN Ohio
CLEVELAND -- 216/241-8422 or 800/634-4442
COLUMBUS -- 614/253-4340
www.uhcanohio.org