Health Care? Who Cares?

by Kris Peterka and Vince Bushell As the election runs its course, health care – and its lack – continues to be  on our minds. It will certainly be a topic for the new federal administration.   What to do while the great behemoth of the federal government grinds its gears to solve this ever mounting problem? Is there any “care” in sight for Wisconsinites at the state level? Is there a coordinated campaign on the national level for universal coverage?  See below at the end of this article for information about Health Care for America Now! (HCAN) and their national campaign. You’ll also find contact information for the local coordinator with Wisconsin Citizen Action, Brian Rothgery. `But before you make your move to get involved with this vital issue, take a moment for some education.  First let’s look at some sobering statistics of where we are now regarding health care.  Is this you? 25-44 yrs old, no kids?  In 2000 the World Health Organization ranked the health systems of 191 countries. Italy and France took the top two spots. The United States ranked a troubling 37th.  According to the Census Bureau’s 2005 current population survey there were 45.8 million uninsured individuals in the United States. The largest group of uninsured in the US is childless adults ages 25 to 44 and who are full time workers. The 2000 Census shows that in the Riverwest neighborhood, the age group with the highest majority of individuals is 25 to 44 years old (35.9%), most of whom are childless (87% of the total population have no children under 18).  Access To Care in Wisconsin  The state of Wisconsin presently offers the Medicaid benefit program Badgercare (badgercareplus.org) for families who earn income up to 200% of the federal poverty level (FPL), pregnant women up to 300% FPL and all documented children regardless of income. (See chart on page 2 for income level eligibility.)  There is no state program to cover childless adults unless they are disabled, elderly or coming out of foster care. Milwauikee County offers the General Assistance Medical Program (GAMP) for childless adults; a health insurance program for those individuals who earn an income up to 100% FPL ($900 per month).  On the state level Governor Doyle’s hope is to expand BadgerCare coverage to childless adults for the entire state beginning in 2009. But due to the current economic crisis, the waivers to expand the program have been held up at the federal level. Now, given the $3 billion deficit the state faces, the expansion hangs in the balance.  It’s depressing that recent economic woes may delay any significant change from occuring even on the state level. But locally, Common Ground, a new activist group, may help bring needed change to how small businesses, non-profits and the self employed are charged for insuring their employees.  Common Ground – Co-operative Solution  In 2004, Common Ground was formed by a group of religious, civic and business leaders who came together to address important social issues of Southeastern Wisconsin.  According to Common Ground president Bob Connolly, “the frustration and anger we heard from many small business owners, self employed people and non-profit organizations… (who have) a great deal of difficulty finding affordable health insurance” became the catalyst for making affordable health insurance one of the group’s priorities.  Connolly states, “small business owners pay about 18% more in premiums than do larger businesses”. The group’s hope is to take advantage of the unique 2003 Co-op Care Law in Wisconsin allowing co-ops to form in order to purchase group health insurance. Common Ground wants to co-op self employed individuals, small business and non profits with 2 to 200 employees to purchase a group health insurance plan. “We will have more power in the marketplace if we organize ourselves,” says Connolly.  Wisconsin is the only state to have such a law, and only one co-op exists in the state thus far: The Farmers Health Cooperative.  Common Ground’s efforts are still young. Their efforts are threefold:  1. Organize; they need self-employed, small business owners and non profits to sign onto their effort. Connolly said they need 2,000 to 3,000 covered lives to be able to begin to negotiate with an insurance company. At the moment they have 250.  2. Find an insurance company willing to cover the group.  3. Look for more seed money to offset marketing costs and help with sustainability.  Connolly hopes the premiums will start at “12% to 15% below the current market.”  Although Common Ground is not targeting universal coverage by its present efforts, it is attacking some of the real flaws in our present system. One target that always seems to come up when discussing health care is our present private insurance system. The companies that provide coverage, Connolly notes, charge individuals and small businesses and small non-profits a premium for coverage. The industry is resistant to the formation of cooperatives that would address this issue.  It seems clear from these examples that the insurance industry is more interested in profits than in providing affordable care to the majority of our citizens. This may be in part due to lack of regulation by our government.  The insurance industry is also guilty of “cherry picking,” trying to get low risk classes of individuals into programs while denying access to those with chronic illness or those who have higher risk factors. Unfortunately we are all human and eventually with age and varying heritage, without even considering lifestyle, all of us become higher risks.  Federal Poverty Levels (FPL)  Use the chart below to determine eligibility for state programs. All children are eligible for state coverage.  The first column designates family size. Figures refer to monthly income.  100%             150%         200%           300%  1 $ 866.67    $1,300.00   $1,733.33  $2,600.00  2 $1,166.67   $1,750.00  $2,333.33  $3,500.00  3 $1,466.67   $2,200.00  $2,933.33  $4,400.00  4 $1,766.67   $2,650.00  $3,533.33  $5,300.00  5 $2,066.67   $3,100.00  $4,133.33  $6,200.00  6 $2,366.67   $3,550.00  $4,733.33  $7,100.00  7 $2,666.67   $4,000.00  $5,333.33  $8,000.00  8 $2,966.67   $4,450.00  $5,933.33 $ 8,900.00  Questions?  The Riverwest Health Initiative helps Riverwest residents find health care resources  Contact Kris Peterka,  Community Health Liaison  414.263.8383 ext 139.    HCAN Health Care for America Now!  Statement of Common Purpose  We believe that all of us benefit from healthy communities, where we all have access to affordable, quality health care from a provider of our choice, at the time we need it, at a cost we can afford. Our mutual goal is affordable, quality health care for everyone in America and for our nation.  Our current health care system in America is not affordable for families, businesses or government. We need an American solution to secure our families’ health and a healthy economy. All of us, individuals, employers and government have a shared responsibility to realize comprehensive reforms in our health care system.  Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:  • A truly inclusive and accessible health care system in which no one is left out.  • A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.  • A standard for health benefits that covers what people need to keep healthy and to be treated when they are ill. Health care benefits should cover all necessary care including preventative services and treatment needed by those with serious and chronic diseases and conditions.  • Health care coverage with out-of-pocket costs including premiums, co-pays and deductibles that are based on a family’s ability to pay for health care and without limits on payments for covered services  • Equity in health care access, treatment, research and resources to people and communities of color, resulting in the elimination of racial disparities in health outcomes and real improvement in health and life expectancy for all.  • Health coverage through the largest possible pools in order to achieve affordable, quality coverage for the entire population and to share risk fairly.  • A watchdog role on all plans, to assure that risk is fairly spread among all health care payers and that insurers do not turn people away, raise rates or drop coverage based on a person’s health history or wrongly delay or deny care.  • A choice of doctors, health providers and public and private plans, without gaps in coverage or access and a delivery system that meets the needs of at-risk populations.  • Affordable and predictable health costs to businesses and employers. To the extent that employers contribute to the cost of health coverage, those payments should be related to employee wages rather than on a peremployee basis. • Effective cost controls that promote quality, lower administrative costs and long term financial sustainability, including: standard claims forms, secure electronic medical records, using the public’s purchasing power to instill greater reliance on evidence-based protocols and lower drug and device prices, better management and treatment of chronic diseases and a public role in deciding where money is invested in health care. For more information visit www.healthcareforamericanow.org or contact Brian Rothgery, HCAN campaign coordinator, at brian.rothgery@citizenactionwi.org 414.476.4539