-
https://clinton.presidentiallibraries.us/files/original/f27c0ae194421b04036716f4232add49.pdf
687c3adb0cffcb1a65bb09c56f7a04fd
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Tarmey
Subseries:
OA/ID Number:
1985
FolderlD:
Folder Title:
[Letters to HRC from State Officials re: Health Care] [loose] [Folder 3] [3]
Stack:
Row:
s
56
Section:
Shelf:
4
Position:
�KJ
/
s
�METROPOLITAN DADE COU NTY-FLORIDA
METRO•DADE
111 N . W. FIRST
ALEXANDER PENELAS
MIAMI.
FLORIDA
(305)
CENTER
STREET. S U I T E
220
331281963
375-5071
Febuary 3, 1993
Mrs. H i l l a r y Rodham C l i n t o n
Chairperson
P r e s i d e n t ' s Task Force on N a t i o n a l
H e a l t h Reform
The White House
Washington, D.C.
20500
Dear Mrs. C l i n t o n :
C o n g r a t u l a t i o n s a g a i n t o you and P r e s i d e n t C l i n t o n on
t h e e l e c t i o n and f a b u l o u s I n a u g u r a t i o n ceremonies.
I am p l e a s e d t o be w r i t i n g t o you i n your c a p a c i t y as
C h a i r p e r s o n o f t h e P r e s i d e n t ' s Task Force on N a t i o n a l H e a l t h
Reform. Dade County has been s t r u g g l i n g w i t h t h e i s s u e o f
h e a l t h c a r e f o r many y e a r s .
Accordingly, I wish t o i n f o r m
you o f some o f o u r e x p e r i e n c e s .
I a l s o want t o commit t o
a s s i s t i n g you, t h e Task Force and t h e P r e s i d e n t i n t h e
development and passage o f a u n i v e r s a l access h e a l t h p l a n .
A t t a c h e d f o r your r e v i e w i s a package o f i n f o r m a t i o n
c o n c e r n i n g a p r o p o s a l I sponsored c a l l e d "Health-Net."
This
p r o p o s a l i s a m u l t i - f a c e t e d approach t o s e c u r i n g u n i v e r s a l
access t o needed h e a l t h c a r e on a r e g i o n a l b a s i s . K i n d l y
review
t h e package and c o n t a c t me d i r e c t l y
a t (305)
375-5071, s h o u l d you w i s h t o d i s c u s s t h i s m a t t e r f u r t h e r .
C o n g r a t u l a t i o n s and best wishes.
Sincerely,
Alexander Penelas
County Commissioner
AP/st/clint
Attachments
�A Public-Private Health Care
Universal Access Initiative
January 16, 1992
Alexander Penelas
Dade County Commissioner
�For Release: January 16, 1992
PENELAS INTRODUCES HEALTH CARE REFORM PLAN
Metro-Dade Commissioner Alexander Penelas held a press
conference today, i n t h e Mayor's Conference Room a t t h e
Government Center, 111 N.W. 1 St., where he introduced a
comprehensive health care reform plan f o r Dade County.
Penelas"
"Health-Net" strategy provides "universal access"
to health care f o r a l l Dade residents.
The plan also c a l l s f o r reforming the Dade County
h e a l t h care d e l i v e r y and financing system i n order t o create
a basic package o f services f o r a l l Dade residents,
regardless o f a b i l i t y t o pay.
"Health care i s a r i g h t , not a p r i v i l e g e , " said
Commissioner Penelas. "My Health-Net strategy seeks t o
provide access t o a f f o r d a b l e health care coverage f o r a l l
Dade residents through a combination o f p u b l i c / p r i v a t e
sponsored programs and a f f o r d a b l e employer-based insurance
coverage."
The Board o f County Commissioners w i l l review t h i s
proposal at i t s Jan. 21 meeting.
Contact: Jackie R. Menendez
375-2830
COMMUNICATIONS
METRO-DADE CENTER • 111 NW 1st STREET* SUITE 2510 • MIAMI. FLORIDA 33128-1986 • 375-2836 • FAX 375-3968
�Agenda Item No.
RESOLUTION NO.
RESOLUTION ESTABLISHING GUIDELINES FOR THE
PUBLIC HEALTH TRUST TO REVIEW AND ADDRESS
IN DEVELOPING A LONG RANGE FIVE-YEAR PLAN
FOR MEETING THE HEALTH CARE NEEDS OF ALL
DADE COUNTY RESIDENTS; ESTABLISHING PRINCIPLES
AND PRIORITIES; RECOMMENDING PROGRAMS; AND
SPECIFYING PROCEDURES FOR PUBLIC INPUT
WHEREAS, the Board of County Commissioners recognizes that
access to basic health care should be available to a l l c i t i z e n s
of Dade County as a right, and not a privilege solely for those
who can afford i t , and that our community w i l l be judged i n part
by how we provide for the health care needs of our most
vulnerable and disadvantaged c i t i z e n s ; and
WHEREAS, the current health care delivery system and
supporting f i n a n c i a l mechanisms in Dade County contain many
deficiencies and are in c r i s i s because of spiraling costs and the
i n a b i l i t y to provide basic health care for many of those i n need;
and
WHEREAS, the number of uninsured individuals without access
to basic health care services continues to grow at an alarming
rate, and more than seventy-five percent (75%) of those uninsured
are employed or are dependents of those who are employed; and
WHEREAS, increasing health care costs have p a r t i c u l a r l y
�Agenda Item No.
Page No. 2
affected small businesses, resulting i n the i n a b i l i t y of many of
those employers to provide health care coverage for t h e i r
employees and dependents; and
WHEREAS, many middle c l a s s and poor families are finding i t
d i f f i c u l t i f not impossible to keep up with spiraling health care
insurance premiums; and
WHEREAS, the Dade County Public Health Trust (PHT) i s
currently in the process of developing a long range five-year
plan for the delivery of county-wide health care services.
N W THEREFORE, BE IT RESOLVED THAT:
O,
Section 1. As the PHT develops i t s long range five-year plan for
the delivery of county-wide health care services, t h i s Board
recommends that the PHT consider and address the following
p r i n c i p l e s and p r i o r i t i e s :
(a) the most effective means of reducing the medically
indigent population and thereby reducing uncompensated
health care i s by increasing the number of patients who
have health insurance coverage;
(b) individuals should be responsible for t h e i r own health
and are expected to contribute to the cost of their
own health care needs to the extent that they are
f i n a n c i a l l y able;
�Agenda Item No.
Page No. 3
(c)
the establishment of preventative, early intervention,
and primary health care programs and the most cost
e f f i c i e n t method to implement them in the long term;
(d) access to affordable and comprehensive primary care
which i s conveniently located and c u l t u r a l l y
sensitive to the community served;
(e)
implementation of system-wide a d m i n i s t r a t i v e and
operational cost e f f i c i e n c y measures which w i l l
contain the cost of health care services f o r Dade County
residents;
( f ) those p r i v i l e g e d t o p r a c t i c e medicine or operate a
h e a l t h care f a c i l i t y i n Dade County have a
r e s p o n s i b i l i t y t o provide at l e a s t a minimum l e v e l of
c h a r i t y care or f i n a n c i a l c o n t r i b u t i o n i n l i e u of such
care;
(g) the consideration to be given to the amount of indigent
care which a medical provider i s giving or f i n a n c i a l
contribution made in l i e u of such care;
(h) Metro-Dade has a responsibility in assisting employees
and employers in accessing affordable basic health care
coverage; and
(i) the manner and means of establishing a comprehensive
and systematic change in the delivery and financing of
health care services that w i l l provide effective cost
containment and universal access to basic health care
�Agenda Item No.
Page No. 4
services for ALL Dade County residents.
Section 2.
The PHT s h a l l also consider the f e a s i b i l i t y of
establishing the following programs in the long range five-year
plan:
(a) a comprehensive program for universal access to prepaid
basic health care services for ALL Dade County
residents, especially the medically indigent, through
public-private sponsored programs and affordable
employer-based insurance coverage funded through a
combination of the following:
(1)
income-based s l i d i n g scale premiums paid by
enrollees;
(2)
a contribution of private dollars currently i n the
health care system allocated on an equitable basis
(e.g., a voluntary "set aside" of payments by a l l
private sector purchasers and payors to hospitals,
physicians, home health agencies, laboratories, and
pharmacies);
(3)
to the extent permitted by law, a portion of the
county general revenue of eighty percent
(80%)
maintenance of effort to the PHT to defray cost
of services and supplies provided to medically
indigent persons;
(4)
private charitable contributions; and
�Agenda Item No.
Page No. 5
(5)
(b)
other p u b l i c ( l o c a l , s t a t e and f e d e r a l ) funding.
establishment of a regional purchasing
cooperative to consolidate the purchasing power of
public and private e n t i t i e s ;
(c)
establishment of a p u b l i c - p r i v a t e program t o
encourage and a s s i s t small businesses i n securing
a f f o r d a b l e group insurance coverage f o r t h e i r
employees and
(d)
dependents;
expansion of operational hours a t those primary
care centers and p u b l i c health u n i t s which are most
overburdened;
(e)
development of primary health care centers i n
geographic areas of growing need, i n c l u d i n g but not
l i m i t e d t o Overtown, West Perrine, L i t t l e H a i t i ,
and L i t t l e Havana;
(f)
expansion of the JMH Health Plan network t o make
i t more marketable and competitive.
Section 3.
The PHT s h a l l include the f o l l o w i n g components i n the
long range plan:
(a) an inventory and description of a l l health care
services available in Dade County;
(b) recommendations on which services can best be
coordinated t o achieve maximum b e n e f i t s t o the
medically indigent i n Dade County;
(c) an inventory of existing and potential Federal,
�Agenda Item
Page No. 6
No.
State, and Local funding sources f o r indigent h e a l t h
care services, i n c l u d i n g funding a v a i l a b i l i t y by
revenue source, p o t e n t i a l funding r e s t r i c t i o n s and
u n c e r t a i n t i e s , and p o t e n t i a l p r i v a t e funding sources;
and
(d) recommendations on governmental l e g i s l a t i v e
initiatives.
Section 4.
The PHT
s h a l l include the f o l l o w i n g as p a r t of the
planning process leading t o the s u b m i t t a l of a long range plan t o
the Board of County Commissioners not l a t e r than July 31,
1992:
(a) establish a timetable for public input and conduct
public hearings including:
(1) identification of
and
meetings with interested community groups and
organizations, (2) consultation with various County
sponsored Committees and Councils,
including but
limited to the Health Council of South Florida
not
and
the Indigent Health Care Task Force, (3) review by
. County Departments for planning purposes, and
(4)
closing of the public input period;
(b) make a v a i l a b l e the proposed d r a f t f o r the long range
plan t o the community i n a v a r i e t y of "accessible"
formats, e.g.,
audio cassette, large p r i n t , and word
processing f i l e , as w e l l as standard paper copies f o r
c i t i z e n s requesting them;
�Agenda Item No.
Page No. 7
(c) hold, at minimum, one televised public hearing in the
Commission Chambers on the proposed long range plan.
The foregoing resolution was offered by Commissioner
, who moved i t s adoption.
was seconded by Commissioner
The motion
, and upon being
put t o vote, the vote was as f o l l o w s :
Mary C o l l i n s
Charles Dusseau
Joseph M. Gersten
Larry Hawkins
Alexander Penelas
Harvey Ruvin
Arthur E. Teele, J r .
Sherman S. Winn
Stephen P. Clark
The Mayor thereupon declared the r e s o l u t i o n duly passed and
adopted t h i s
DADE COUNTY, FLORIDA
BY ITS BOARD OF
COUNTY COMMISSIONERS
MARSHALL ADER, CLERK
Approved by County Attorney as ^ - By:
to form and legal sufficiency.
Deputy Clerk
�HEALTH-NET
A Public-Private Health Care Universal Access I n i t i a t i v e
White Paper
The
first
step t o s o l v i n g the complexity of problems
t h a t encompass the health care d e l i v e r y and finance c r i s i s
i n Dade County was taken t h i s past July when the membership
of
the Public Health Trust
scope of r e s p o n s i b i l i t y
("PHT") was expanded and i t s
broadened beyond Jackson
Memorial
Hospital t o include the d e l i v e r y of county-wide health care
services.
The next step i s a systematic review of Dade's
health care finance and d e l i v e r y system,
i n c l u d i n g primary
care services, emergency medical services, and acute care:
secondary and t e r t i a r y care services.
The
Initiative
care
Public-Private
("Health-Net")
delivery
system
Health
calls
Care
Universal
Access
f o r reform of our h e a l t h
and funding mechanisms i n order t o
create a basic package of services t o ALL Dade r e s i d e n t s ,
regardless
of a b i l i t y
t o pay.
In effect,
Health-Net
increases the number of Dade residents who have access t o
a f f o r d a b l e health care coverage
and thereby p r o p o r t i o n a l l y
reducing the medically indigent population and c o n t r o l l i n g
uncompensated health care costs.
(1)
�Introduction
Public support for a state and/or national solution to
our health care c r i s i s i s now at an a l l time high.
Surveys
reveal that the great majority of Americans favor reforming
the health care system.
Support for reform now crosses many
boundaries, including business,
doctors
and
consumer groups.
labor, insurance, hospital,
In fact, for the f i r s t time
the American Medical Association has called for a complete
overhaul of our system of health-care financing.
I t appears that the concerns with
the current
system
are not based on d i s s a t i s f a c t i o n with the quality of health
care services.
regarding
Rather, discontent i s based on uncertainties
the a v a i l a b i l i t y and timeliness of such care
and
the future of health benefits in our largely employer-based
system of insurance.
increased
For example, r i s i n g costs have led to
out-of-pocket
expenditures
for
individuals
and
decreased benefits provided by the government and employers.
In March 1991,
the Florida Task Force
Financed Health Care issued
i t s final
on Government
recommendations to
Governor Chiles setting out a policy framework.
Force's
stated goal was
mandate
Task
universal access to primary health
care for a l l Floridians by 1996.
recommendations
The
that
by
S p e c i f i c a l l y , the formal
1996,
state
and
local
governments, in cooperation with the private sector, s h a l l
(2)
�ensure t h a t at least 95 percent of unemployed,
persons
have
access
Similarly,
by
dependents
must
to
1996,
95
primary
health
low
care
care
services.
employees
primary health
have
percent of
income
and
their
coverage
or
employers s h a l l be mandated t o provide such coverage.
To
t h i s end, the Task Force set as a p r i o r i t y the development
of
community
based
model
delivery
systems
to
provide
innovative primary health care coverage t o i n d i v i d u a l s
are
i n e l i g i b l e f o r Medicaid.
In Dade County,
care
who
is directly
health
care
the issue of access t o basic
related
delivery
to deficiencies
system
and
of our
supporting
health
current
financing
mechanisms.
F i r s t , there are increasing numbers of persons in Dade
County without access to basic health care, in part due to
the fact that health care costs continue to r i s e at a rate
well
above
that
of
inflation.
Statewide,
there
are
an
estimated 2.2 million uninsured Floridians; 34 percent are
Hispanic, while 26 percent are African-American.
In Dade,
there are an estimated 145,000 individuals under the age of
65 who
are uninsured, and
minorities.
Another
44,000
the percentages
Dade
residents
insured, bringing the combined total
uninsured
to approximately
189,000.
(3)
are worse for
are
partly
of underinsured
The
total
and
number i s
�projected
to
substantially
increase within
the
next
few
years.
Second, r i s i n g
costs have had
an
small businesses' a b i l i t y to provide
for t h e i r employees.
less bargaining
adverse impact
on
health care coverage
Smaller businesses t r a d i t i o n a l l y have
power with health care coverage
providers
and cannot afford the group health plans that are available
in today's world of r i s i n g health care costs.
small
businesses
choose
not
to
coverage for their employees.
offer
In turn, many
health
insurance
Consequently, 75 percent
of
uninsured Floridians are workers or dependents of workers.
Although
reform, there
there
i s no
agree that there are
may
be
a
consensus
agreement on
for
health-care
the 'approach.
Experts
four major approaches for extending
health insurance coverage to the
uninsured:
I.
The government requires that every employer
provide health insurance to i t s employees, and the
government insures a l l nonworkers and poor people;
II.
The government gives employers the choice of
either providing insurance to their employees or
paying a tax for the government to provide those
employees insurance, and, again, the government
insures a l l nonworkers and poor people;
I I I . Individuals are given income-related tax credits
to purchase their own health insurance,
independent of their employers or the government;
or
IV.
The government provides health insurance for
everyone, similar to the Medicare program for the
elderly.
(4)
�These
approaches
containing
differ
cost,
primarily
redistributing
in
ensuring
income
and
access,
methods
of
financing.
Certainly,
the ever-increasing
concern
health care coverage i s well-founded.
social,
cultural,
economic,
and
f o r adequate
Unfortunately, due t o
regional
differences,
n a t i o n a l s o l u t i o n may be unattainable and/or
State and l o c a l governments, i n cooperation
a
impracticable.
w i t h the p r i v a t e
sector, must now act responsibly and e f f e c t i v e l y i n order t o
adequately address our current health care c r i s i s .
At minimum, a long range strategy must be developed t o
address our current
system d e f i c i e n c i e s i n a manner t h a t
reviews a l l major components of our health
system
and
financing mechanisms.
The
care d e l i v e r y
r e s u l t must be
an
i n t e g r a t e d strategy t o ensure a f f o r d a b l e basic health care
coverage f o r ALL Dade residents t h a t promotes q u a l i t y care
and f a c i l i t a t e s e f f e c t i v e cost c o n t r o l s .
A d d i t i o n a l l y , the
s t r a t e g y must feature i n t e g r a t e d a d m i n i s t r a t i o n i n order t o
reduce o v e r a l l costs, coordinate
provider
participation,
payment
to
instituted
providers.
f o r providers
and
a v a i l a b l e funding, manage
ensure
Finally,
e f f e c t i v e and
incentives
prompt
should
be
t o p a r t i c i p a t e i n cost e f f e c t i v e
and managed health service s e t t i n g s .
(5)
�Health-Net Strategy
Health-Net
i s an
innovative
universal
health
care
access model t h a t promotes c o s t - e f f e c t i v e a l t e r n a t i v e s t o
traditional
methods of health
care d e l i v e r y
and funding.
The p r i n c i p a l element of the strategy i s the c r e a t i o n of a
Dade County universal access program, which along w i t h the
JMH health complex, w i l l serve as a health care safety net
f o r ALL Dade residents.
Health-Net would ensure affordable health care services
to ALL Dade residents and would provide access t o a broad
range
of health care services f o r the medically i n d i g e n t ,
including,
but not l i m i t e d
care, and h o s p i t a l care.
a continuity
t o , primary
care, preventive
Great emphasis has been placed on
of care i n the most c o s t - e f f e c t i v e
setting,
t a k i n g i n t o consideration both a high q u a l i t y of care and
geographic access ( d e c e n t r a l i z a t i o n ) .
For
the
purpose
of
this
discussion,
"medically
indigent" i s defined as persons having i n s u f f i c i e n t income,
resources, and assets to pay for needed health care without
using resources
required to meet basic needs for shelter,
food, clothing, and personal expenses; or not being e l i g i b l e
(6)
�f o r government sponsored coverage (Medicare
and
Medicaid),
or s u f f i c i e n t t h i r d - p a r t y insurance coverage.
In formulating a long term universal health care access
solution,
the
Health-Net
strategy
adopts
the
following
policy pre-requisites articulated by the Health Council
South Florida's study of local financing of indigent
of
care:
1.
Health care i s a r i g h t , not a p r i v i l e g e ;
2.
I n d i v i d u a l s are responsible f o r t h e i r health and
are expected t o c o n t r i b u t e t o the cost of t h e i r own
health care t o the extent t h a t they are f i n a n c i a l l y
able;
3.
Access t o a f f o r d a b l e and comprehensive primary care
i s paramount. I t should be provided at various
p r i c e l e v e l s , conveniently located, and c u l t u r a l l y
sensitive;
4.
R e s p o n s i b i l i t y f o r f i n a n c i n g indigent care must be
shared by f e d e r a l , s t a t e and l o c a l government.
Every e f f o r t t o coordinate b e n e f i t s must be
pursued;
5.
The number, v a r i e t y and l o c a t i o n of professionals
and f a c i l i t i e s serving the indigent must be
expanded;
6.
Professional associations of physicians, dentists,
and other health professionals and hospitals should
provide leadership necessary to assure greater
participation in the provision of services on both
voluntary and s l i d i n g fee bases; and
7.
Services should be provided a t the l e a s t i n t e n s i v e ,
l e a s t expensive and most appropriate l e v e l t o
assure most cost e f f e c t i v e use of a v a i l a b l e
resources.
Consistent
without
into
limitation, reimbursement methodologies that
account
patients,
with these objectives, Health-Net promotes,
the
cost
recognizes
of
services
hospitals
(7)
rendered
that
to
take
eligible
render
a
�disproportionate
incentives
share of indigent
care,
t o promote the d e l i v e r y
requires cost
of c h a r i t y
containment i n c l u d i n g ,
case management.
provides
other
care, and
but not l i m i t e d t o ,
I t also promotes t h a t a l l h o s p i t a l s and
other health f a c i l i t i e s i n Dade County a f f o r d p u b l i c access
t o a l l q u a l i f i e d residents of Dade County.
Health-Net Universal Access Program
Health-Net would reform Dade's health care delivery and
financing
system
health care
health
to provide universal
for ALL Dade residents
care
services,
including
access
to prepaid
in the form of basic
but
not
limited
to,
physician care, hospital inpatient and outpatient services,
prescription medications, and laboratory and x-ray services.
The program would provide a low cost, accessible, managed
care, prepaid health coverage plan to be contracted on a
competitive basis with regional providers and administered
by the PHT.
Every resident
receive
program.
basic
health
of Dade County would be e l i g i b l e t o
care
services
under
the Health-Net
Enrollees would be required t o pay premiums on an
income-based s l i d i n g scale.
Premiums w i l l be set by the PHT
based on a market analysis,
negotiations w i t h
providers and sound a c t u a r i a l methods.
interested
Employers would be
permitted t o p a r t i c i p a t e i n the payment of a l l or a p o r t i o n
of
their
employee's
premiums.
(8)
A
separate
component of
�Health-Net would provide an affordable group plan for small
businesses,
including
premium
subsidies
for
medically
indigent employees and dependents.
The Health-Net universal access program could be funded
through a combination of the following sources:
(1)
income-based sliding scale premiums paid by
enrollees;
(2)
a contribution of private dollars currently in the
health care system allocated on an equitable
basis; (e.g., a voluntary "set aside" of payments
by a l l private sector purchasers and payors to
hospitals, physicians, home health agencies,
laboratories, and pharmacies);
(3)
to the extent permitted by law, a portion of the
county general revenue eighty percent (80%)
maintenance of effort to the PHT to defray cost of
services and supplies provided to medically
indigent persons;
(4)
private charitable contributions; and
(5)
other public ( l o c a l , state and federal) funding.
The
PHT
following:
and
would
(a)
subsidies;
administration,
be
responsible
for
establishing
the
budget and policy guidelines; (b) premiums
(c)
covered
services
monitoring, and
other
offered;
related
and
(d)
operational
and management duties of the plan.
The PHT
s h a l l also define operational requirements for
contracting the prepaid
health plan(s),
limited to the following:
(9)
including but
not
�(a)
service area of the plan
(b)
marketing program
(c)
enrollment and disenrollment procedures
(d)
case management system
(e)
out of plan use provisions
(f)
a v a i l a b i l i t y and a c c e s s i b i l i t y of services
(primary care, emergency, etc.)
(g)
grievance procedures
(h)
q u a l i t y assurance programs
( c l i n i c a l & administrative)
(i)
f i n a n c i a l r i s k and insolvency p r o t e c t i o n
(j)
r e p o r t i n g requirements
The PHT s h a l l determine which prepaid services w i l l be
required under the plan, s p e c i f i c a l l y :
I n p a t i e n t Hospital Services
Outpatient Hospital and Emergency Services
Physician Services
Independent Laboratory and X-Ray Services
Prescribed Drug Services
Family Planning Services
Home Health Services
Early and Periodic Screening, Diagnosis and
Treatment Services
Transportation Services
Visual Services
(10)
�Hearing
Services
Dental Services
Plans should not be l i m i t e d t o the b e n e f i t l e v e l s o r d i n a r i l y
applied t o services provided under other government
fee-for-service
programs
(e.g.. Medicaid).
funded
However, the
service b e n e f i t s o f f e r e d by the PHT plan should not be more
restrictive
than
those
f e e - f o r - s e r v i c e program.
whether
expansion
responsive
offered
i n the F l o r i d a
I n f a c t , the PHT should
i s necessary
t o make
t o the community needs.
Medicaid
consider
the plan
more
Moreover, c o n t r a c t o r s
should be encouraged t o expand covered services and provide
services
not covered
under the program i n order
t o make
plans more a t t r a c t i v e t o p o t e n t i a l e n r o l l e e s .
Cost Analysis
Assuming
approximately
a
first
10,000
year
target
enrollment
of Dade County's medically
population, the Health-Net universal access
cost approximately $15 million.
a basic prepaid
$109.71
prepaid program.
$13 million.
indigent
program would
The projection assumes that
health care plan could
per month rate
of
contracted
be secured
at the
by the Medicaid AFDC
At that rate, total premium costs would be
Approximately $2 million would be budgeted for
administration, monitoring, and marketing of the program.
(U)
�The Health-Net program could be funded by three major
sources employing a 2:2:1 matching r a t i o .
enrollee portion
could
represent, on
S p e c i f i c a l l y , the
average,
$25.00 per
month per enrollee contribution (actual premiums would
be
based on an income s l i d i n g scale with a minimum of $10.00
per month).
Another 40 percent of the total cost, equalling
$6 million, could be absorbed through a variety of
sources,
including a reallocation
industry
dollars,
state
charitable contributions.
remaining
and
of private health care
federal grants,
The PHT
funding
and
private
could contribute in the
$6 million through a reallocation of a portion of
the general revenue 80 percent maintenance of effort.
Small Business Access Program
The number of workers and families in the United States
without
adequate health care coverage continues to grow at
an alarming rate.
The "working uninsured" r e f l e c t a c r i s i s
in health care financing, particularly in the nation's small
business
community.
Currently,
over
50
percent
of
the
"working uninsured" are employed by small businesses.
Although many small businesses
health
insurance
expensive
coverage
premiums,
to
surveys
choose not
their
indicate
to offer
employees
that
most
due
to
small
business employees would obtain health coverage at work i f
it
were available.
A recent Gallup Poll reveals that
(12)
57
�percent of U.S.
availability
small businesses l i s t health care costs and
as
their
primary
concern.
There
are
approximately 50,000 small businesses with between 1 and
19
employees in Dade County which could be targeted for this
program.
The existence of an accessible, low cost, managed care,
health group plan f o r small businesses i s a key component of
the Health-Net strategy.
The program i s designed t o reduce
high small group premiums by pooling groups and absorbing
the a d m i n i s t r a t i v e and marketing costs.
The
Health-Net small business access program
will
be
based upon p u b l i c - p r i v a t e cooperation, whereby the County
w i l l market, coordinate and administer the program, as w e l l
as
provide
limited
income c r i t e r i a .
contribute
a
subsidies t o
individuals
based
upon
Small businesses accessing the plan w i l l
nominal
sum
to
assist
the
County
in
administering the program (e.g., $1 per employee).
Eligibility
determined
by
negotiations
requirements for small businesses w i l l
the
with
PHT
be
based upon a market analysis and
interested providers.
A
precise group
should be targeted in order to more effectively market the
program.
(13)
�Total premium costs are p a r t i c u l a r l y important t o the
successful
marketing
of the plan,
premiums may prevent
because
some businesses
from
unreasonable
participating.
Employers w i l l be required t o pay 50 percent of the premiums
of
a l l their
employees
covering 100 percent.
but w i l l
not be precluded
from
Employers w i l l be encourage but not
required t o pay a p o r t i o n of dependent coverage.
A County
subsidy f o r such coverage s h a l l be established by the PHT,
based on market analysis and income c r i t e r i a .
This access mechanism has proven
t o be an e f f e c t i v e
measure of p r o v i d i n g a f f o r d a b l e group health coverage t o
uninsured
individuals
proportionally
and t h e i r
dependents; and thereby,
reducing
the medically i n d i g e n t population
and uncompensated care.
A d d i t i o n a l l y , t h i s mechanism.is a
model of p u b l i c - p r i v a t e cooperation whereby the b a r r i e r s t o
uninsured i n d i v i d u a l s t o access a f f o r d a b l e basic h e a l t h care
services,
and consequently
eliminated
by spreading
a
better
health s t a t u s , are
responsibility
t o the r e c i p i e n t ,
employer, government and h e a l t h care providers.
Regional Purchasing Cooperative Program
The other feature element of the Health-Net strategy i s
the development of a regional purchasing cooperative
to pool
the purchasing power of public and private e n t i t i e s within
the
region.
local
This
governmental
"pooled" purchasing power should
and private
(14)
entities
to offer
allow
better
�health coverage to employees.
for
participants.
participating
initial
The program would be optional
Funding
entities,
would
although
term may be obtained
start
be
provided
up costs
by
for an
through the PHT (or even the
State).
A state cooperative
was organized
this past year to
pool state employees, prison inmates, e t c . This existing
program w i l l
serve as a useful guide i n developing Dade's
regional concept.
Conclusion
It
care
i s no secret that our current
delivery i s i n c r i s i s .
health
care
spending
from
Despite
"system" of health
large increases i n
individuals,
employers,
government, access to basic health care i s declining.
and
more families are discovering that they
and
More
are becoming
members of the growing class of medically indigent -- those
who are uninsured or underinsured.
There are no easy solutions to the complexity of health
care access problems.
Solutions w i l l
require
cooperation
between individuals, employers, government, and health care
providers to ensure access to basic health care services for
ALL Dade residents.
cooperation
Health-Net i s a model of public-private
whereby the barriers to the medically
(15)
indigent
�to
access
spreading
basic
health
responsibility
care
services
are eliminated
t o a l l involved.
I f we
by
truly
believe t h a t access t o basic health care i s a r i g h t f o r a l l
our r e s i d e n t s , then Dade County must take r e s p o n s i b i l i t y and
act now.
(16)
�UNIVERSAL ACCESS PROGRAM
ELIGIBILITY:
— ALL Dade County residents.
PROGRAM SUMMARY:
— provide the medically indigent, as well as ALL Dade residents, access to low cost,
managed care and prepaid health care services;
— contracted on a competitive basis with regional providers and administered by the PHT;
— enrollees will be required to contribute to the payment of premiums on an income-based
sliding scale;
— employers may participate in the payment of all or a portion of premiums for their
employees; and
— government subsidies will be provided to individuals based on income criteria.
NEEDS ANALYSIS:
— poor uninsured: The number of individuals who are economically disadvantaged when it
comes to affording adequate health care coverage continues to rise at an alarming rate.
— these are unemployed individuals without access to health care coverage and working
individuals whose income cannot withstand premium payments for coverage and cannot
qualify for government sponsored programs (Medicare or Medicaid).
— in Dade County, 189,000 individuals are uninsured or partially insured; and
— the uninsured generally suffer from lower health status.
PROGRAM IMPACT AND OBJECTIVES:
— increase in the number of Dade residents with health coverage resulting in transparency
of their medically indigent status;
— cost containment through the benefits of prepaid managed care;
— better access to preventative and early intervention care;
— reduction of uncompensated care;
— "cost shifting" opportunities for JMH and other facilities for uncompensated care; and
— decentralization of health care delivery and decompression of JMH.
FUNDING:
— income-based sliding scale premiums paid by program enrollees;
•
— private industry contribution thru a variety of options, e.g., voluntary set-a-side of private
dollars currently in the health care system allocated on an equitable basis;
— a portion of the county general revenue eighty percent maintenance of effort to the PHT
to defray the cost of services and supplies provided to medically indigent persons;
— other public (local, state and federal) funding; and
— private charitable contributions.
�SMALL BUSINESS ACCESS PROGRAM
ELIGIBILITY:
— small businesses in Dade County with between 1'and 25 employees.
PROGRAM SUMMARY:
— pooling small businesses to consolidate purchasing power and increase access to
affordable group insurance coverage;'
— reduce the high escalating insurance premiums for small businesses;
— County absorbing administrative and marketing costs;
— employers contribute minimum of 50% of premiums (cover all employees);
— the PHT will administer, coordinate, and market the program; and
— subsidies to individuals and dependents based on income criteria.
NEEDS ANALYSIS:
— over 75% of the uninsured are families with at least one working adult ("working
uninsured");
— over half of the "working uninsured" are employed by small businesses;
— Dade County has approximately 59,000 businesses with an estimated 53,000 being
small businesses with less than 20 employees, and over 45,000 having less than 10
employees; and
— small businesses employ over 250,000 individuals in Dade County, accounting for
approximately 33% of the workforce.
PROGRAM
—
—
—
—
IMPACT AND OBJECTIVES:
access for small businesses to affordable group insurance coverage;
reduction of "working uninsured" population;
containment of overall health care costs; and
other advantages resulting from universal access, e.g., decentralization and
decompression of health care delivery, cost shifting, preventative care emphasis, better
health status and cost containment.
FUNDING:
— income-based sliding scale premiums from program enrollees;
— small business fee for administrative costs;
— State contribution for administrative costs, e.g., the State currently funds a similar
program through the State of Florida Health Access Corporation; and
— County subsidy to employees and dependents on an income-based criteria.
�PURCHASING COOPERATIVE PROGRAM
ELIGIBILITY:
— all public entities, primarily municipal, county, school system, state and federal
employees; and
— medium to large size private entities.
PROGRAM SUMMARY:
— pooling purchasing power of public and medium to large private entities within the region;
— offer participants cost effective and expanded health benefits for employees; and
— voluntary participation with a specified minimum enrollment period requirement.
NEEDS ANALYSIS:
— increasing numbers of businesses are reporting changing benefit plans to reduce costs;
— many medium sized businesses have been eliminating benefit plans altogether;
— higher out-of-pocket expenses (co-payments, deductibles, and dependent coverage) due
to businesses changing benefit plans; and
— health care costs are rising at a rate nearly twice that of inflation.
PROGRAM IMPACT AND OBJECTIVES:
— increased and more cost effective health care coverage for participating entities and their
employees;
— overall health care cost containment; and
— other advantages resulting from expanded access.
FUNDING:
— start-up grants from participating public entities; and
— fees from participating entities.
�State of Florida
PR E T
E CN
UNU E
NS RD
I
I EC
N AH
R C EH C
A ET N
/ I
GOP 19
R U 90
Source:
Florida Task Force on
Government Financed
Health Care:
Final Report March 1991
34.3%
30
26.5%
/--
20
17.9%
10
White
Non-White
Hispanic
All Floridians
�•
PROJECTED COSTS
National Average Family Health Costs
10/^
$9,397
8
$6,163
T
0
6
u
s
$4,296
A
N 4
D
S
$2,731
$1,742
• • M M * IMSSSI
n 1 ••HHB mma
m
wmummmmmmi wmmmi mmm\
^•••••••III
mmmm' mmm
nviMiBBBBiiiB imms immm 0
irjaniiavniiB, mm nwmm
•'I'nr'iivjiBiri ^fii" Hiwmm
1980
1985
nmmimmmmaaik " isssidivrj
m dmmmm^ Maaun^i jimmmm
i wmmm-**, 'mmmm* ^mmm
•k. ^ISk aaBBHk BBI Source: Families USA Foundation
•BBM
J B ^ ^ B B B B I BBI
1990
1995
2000
!/
�NATIONAL HEALTH CARE SPENDING
Average Family Spent $4,296 in 1990
General taxes
39%
($1,675)
Out-of-pocket
32%
($1,375)
Medicare premiums
3%
($129)
Medicare payroll tax
9%
($387)
��HEALTH CARE TASK FORCE SORTING SHEET
CODER:
TYPE OF MATERIAL:
General mail
Personal stories
Letterhead
.Offers to help
Letter Campaign
.Policy
Casework
Employment
.Advocacy
_Re quests:
-speech
-meeting
Other
Explanation:.
ADVISORY PANEL?
physician
.large employers
.other health provider
small business
seniors
other consumers
Explanation:.
PRIMARY INTEREST:
COST ISSUES
Drug Prices
Physician Fees
Hospital Fees
Unnecessary Procedures
Medical Equipment
Fraud and Abuse
.PUBLIC HEALTH/SPECIAL POPULATIONS
Prevention
AIDS
Women's Health
Immunizations
Rural
Urban
COVERAGE
Working Families
Unemployed/Low Income
Benefits
Providers
GOVERNMENT PROGRAMS
Medicare
Medicaid
Veterans
DoD
ORGANIZATION
Insurance Premiums
Insurance Reform
Insurance Pools
Boards and Oversight
INFRASTRUCTURE/WORKFORCE
Quality Assurance (Guidelines)
Administration, Reimbursement
& Patient Information Systems
Malpractice & Tort Reform
Manpower Issues (Training)
LONG-TERM CAKE
MENTAL HEALTH
FINANCING
OTHER
Explanation:.
PTAN P R E F E R E N C E : (Support = +; Oppose = - )
CP
SP
OP
Clinton Plan
Single Payer
Other Plan
MC
PP
CV
Managed Competition
Pay or Play
Credits, Vouchers,
Medical Savings Accts.
CA
BR
GE
Canadian
British
German
�STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
1016 Ens! First St. B5-1
1
I'ort Aimelcs. II asliin-'ton <)Ho62-li)9 .'
January 26, 1993
Hillary Clinton, F i r s t Lady
The White House
1600 Pennsylvania Ave. N W
..
Washington, D.C. 20500
Re:
HEALTH CARE ACCESS FOR LOW-INCOME PEOPLE
Dear Mrs. Clinton;
Thank you for your s o l i c i t a t i o n of input concerning the health
care c r i s i s in our country. I would like to share some of our
experiences and solutions that we have developed at a local
level.
BACKGROUNP
Clallam County i s located on the Olympic Peninsula in Washington
State.
The economy i s timber-based with fishing and tourism
adding some. We are a rural county with a population of 55,000.
Approximately 17000 people have no medical coverage nor do they
qualify for Medicaid.
Approximately 4000 people are receiving
some sort of public assistance.
Approximately 5000 people are
retirees from out-of-State are clustered in the Sequim area.
The are two public hospitals and three Tribal c l i n i c s . There are
f i v e Tribes located on the Peninsula. There are approximately
110 physicians of a l l s p e c i a l t i e s in the area. Approximately 900
children are e l i g i b l e for EPSDT but are not u t i l i z i n g the
program. W are a conservative Democrat County where people tend
e
to vote for their pocketbooks and jobs rather then for larger
issues.
THE ISSUES
The people in Clallam County either have money or they don't.
Despite the high number of physicians in the County, none of
them are taking new Medicaid r e f e r r a l s and those who are s t i l l
carrying Medicaid c l i e n t s on their caseloads, are incredibly
overloaded. There are only 8 physicians who are currently seeing
Medicaid recipients.
People are often forced to use the
emergency room to receive primary care,
Pregnant women and
children are able to receive care however, the problem i s adult
care.
EFFORTS
The Clallam County Medical Care C r i s i s Task Force was convened 18
months ago to address these issues as a community. Providers,
p o l i t i c i a n s , and consumers were invited to a workshop to devise
local solutions. (see attached)
The Clallam County Medical
Society has j u s t begun a process of addressing members who choose
�HEALTH CARE ACCESS PAGE TWO
not t o see poor people v i a sanctions. We at the local Community
Services O f f i c e met w i t h an HMO i n order t o coax them over t o the
Peninsula from the urban areas. They chose t o put o f f making a
decision f o r two years.
We also approached two T r i b a l c l i n i c s
and asked them t o consider expanding
services t o non-Native
c l i e n t s . We, the CSO, have had an ongoing VISTA program in-house
addressing various needs such as teen pregnancy and low-income
housing so l a s t year,
we asked ACTION t o give us a one year
p o s i t i o n t o expand the Healthy Kids Program (EPSDT) and they
approved one VISTA volunteer t o work on expanding
capacity f o r
Healthy Kids beginning l a s t August.
The H O decided not expand services in our area as previously
M
stated but....the Lower Elwha S'Klallam Tribe and the Quileute
Tribe have decided to contract with the State of Washington
d i r e c t l y and w i l l be seeing non-Native Medicaid c l i e n t s beginning
t h i s Spring
. W w i l l be paying them on an "encounter rate"
e
basis which i s $86.00 per v i s i t .
Unfortunately we can only do
t h i s with 638 Status c l i n i c s which are mostly located on
Reservations. W
e are hoping that the Tribes can serve the nonemergent needs of Medicaid c l i e n t s since the medical community
chooses not to.
SUGGESTIONS
The descriptions of the President's proposals in the press are
good but I also r e a l i z e that not everyone f e e l s positive about
s o c i a l i z i n g medicine and that you are in for a f i g h t .
Capping
costs,
u t i l i z i n g a s i n tax to raise revenue, taxing employers,
etc. are good approaches in theory however,
the consumers
t y p i c a l l y don't
have advocates nor do they advocate for
themselves; insurance companies and medical corporations do.
What works are local i n i t i a t i v e s coupled with National and State
leadership.
A two-pronged approach
towards education and
l e g i s l a t i o n j u s t might move us into the 21st Century with a
health care system s i m i l a r to what the rest of the i n d u s t r i a l i z e d
nations have.
M suggestions
y
are;
A)
Start with county task forces that represent providers,
consumers, and governmental personnel to create a local plan
that would be incorporated into a State-wide plan.
B)
Facilitate
the implementation
of State-wide
plans,
eg;establish timelines that need to be adhered to, give the
States the framework of Federal
laws and regulations and
allow them to f i l l in the missing pieces, build in
�HEALTH CARE ACCESS PAGE THREE
f l e x i b i l i t y t o meet regional needs.
C)
Force the issue w i t h the medical industry
and sanctions i f needed.
via legislation
D)
Provide i n c e n t i v e s t o State and l o c a l agencies develop new
preventative programs and enhance e x i s t i n g ones over a f i v e
to ten year period as opposed t o a year or two year period.
The real cost savings w i l l be r e a l i z e d down the l i n e .
E)
Downsize the m i l i t a r y .
The c u r r e n t cost of one B-1 bomber
w i l l found Children's Services i n a l l f i f t y States at double
t h e i r e x i s t i n g budgets.
F)
Expand the provider base t o n o n - t r a d i t i o n a l
practitioners.
IE nurse p r a c t i t i o n e r s , midwives,
e t c . i n order t o reduce
o v e r a l l costs.
G)
Don't give up.
Grassroots o r g a n i z a t i o n w i t h Federal backing w i l l be the key t o
success. Call me a t (206) 457-2640 M-F 8-5 P a c i f i c time i f I can
be of f u r t h e r help. Good luck.
»spectfully submitted,
Roger Lern&ferbm, Supervisor
Social Services DSHS Port Angeles
�MEDICAL CARE CRISIS TASK FORCE
MEETING AGENDA
November 21, 1991
9-9:50 a.m. - I n t r o d u c t i o n and Overview
- A c t u a l Numbers
- County Resources
10-11 a.m.
-
Focus Group D i s c u s s i o n
Problem I d e n t i f i c a t i o n
Solutions
Next Steps
Synthesis
11-12 a.m.
-
Solution I d e n t i f i c a t i o n
Group P r e s e n t a t i o n s
Next Steps
Close
�STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND
HEALTH SERVICES
1016 Last Fir.il St. B5-I • Port A nonius. Washin/rton 98362-1099 - (206) 4 ~ 2. . H
> -y> I
MEDICAL CARE C R I S I S TASK FORCE
I N I T I A L FINDINGS
NOVEMBER 2 1 .
1991
The f i r s t meeting of the Medical Care C r i s i s Task
attended by 28 community members who spent t h r e e very
hours d i s c u s s i n g problems i n access t o h e a l t h care by
people.
Force
was
productive
low-income
The a t t e n d e e s broke down i n t o t h r e e working groups t o i d e n t i f y
b a r r i e r s , purpose s o l u t i o n s , and prepare a p r e s e n t a t i o n i n order
t o determine d i r e c t i o n s the Task Force needed t o go t o address the
problems.
The
b a r r i e r s t o h e a l t h care access were i d e n t i f i e d
as:
1.
Reimbursement r a t e s f o r Medicare do not a c c u r a t e l y
r e f l e c t the a c t u a l c o s t s of p r o v i d i n g s e r v i c e s ,
2.
The paperwork r e q u i r e d f o r reimbursement i s
s t a g g e r i n g and o f t e n incomprehensible. Changes i n
procedure occur too f r e q u e n t l y and the t o l l - f r e e
p r o v i d e r h o t - l i n e i s o f t e n l e s s than h e l p f u l ,
3.
P a t i e n t s o f t e n lack basic h e a l t h care e d u c a t i o n
p r e v e n t i o n and s e l f - c a r e . This o f t e n leads t o
"premature" or overuse o f Medicare s e r v i c e s ,
4.
in
Non-physician medical p r a c t i o n e r s (nurse p r a c t i o n e r s ,
e t c . ) are unable t o be reasonably reimbursed or not
a t a l l , f o r the p r o v i s i o n of s e r v i c e s ,
5.
The h i g h cost of m a l p r a c t i c e insurance causes some
OB-GYN's t o t h i n k t w i c e about t a k i n g on w e l f a r e c l i e n t s ,
6.
The lack of c o n s u l t a n t s
confirming diagnosis,
7.
P h y s i c i a n s and c l i n i c s cannot b i l l f o r "no shows".
P a t i e n t s using Medicaid miss a l o t of appointments
t o the p o i n t t o where i t i s n o t i c e d county-wide,
8.
I n a p p r o p r i a t e use of the emergency rooms a t our
l o c a l h o s p i t a l s . H o s p i t a l s w i l l not t u r n away c l i e n t s ,
and t h i s d r i v e s c o s t s up,
9.
Burnout. Several p h y s i c i a n s f e e l an o b l i g a t i o n t o
see a l l p a t i e n t s and end up s h u t t i n g out w e l f a r e
p a t i e n t s c o m p l e t e l y when they see t h e i r c o l l e a g u e s not
p i c k i n g up a " f a i r share" of the w e l f a r e caseload,
i n t h i s area i s a b a r r i e r t o
�TASK FORCE - PAGE TWO
10.
Misuse o f resources. Many Medicaid r e c i p i e n t s are
viewed as a b l e - b o d i e d and are " m i l k i n g " t h e system,
11.
A t t i t u d e s i n the community towards w e l f a r e r e c i p i e n t s
range from i n d i f f e r e n c e t o o u t r i g h t h o s t i l i t y ,
12.
P h y s i c i a n s f e e l an o b l i g a t i o n t o see i n i t i a l GA-U
e v a l u a t i o n c l i e n t s may s p i l l over i n t o the i n c a p a c i t y
d e t e r m i n a t i o n process,
13.
DSHS i s t o o slow i n responding t o the needs o f s e r v i c e
provi ders,
14.
Community as a whole f e e l s powerless and unable t o do
a n y t h i n g about t h e d e t e r i o r a t i n g economy and the h i g h
c o s t o f h e a l t h care.
The s o l u t i o n s t h a t were proposed i n c l u d e :
1.
The e s t a b l i s h m e n t o f a w a l k - i n c l i n i c w i t h r o t a t i n g
p h y s i c i a n s t h a t would serve low-income o r Medicaid
clients.
The best e x i s t i n g s i t e c u r r e n t l y i s a t the
Olympic Memorial H o s p i t a l ,
2.
Medicare c l i e n t s be r e q u i r e d t o p r o v i d e a small copayment f o r each v i s i t ,
3.
Expansion o f the Basic H e a l t h Care Plan,
4.
Increase paternal r e s p o n s i b i l i t y .
Ensure absent
f a t h e r s are i n c l u d e d i n t h e h e a l t h care process,
5.
B r i n g back the Medical C l e r k p o s i t i o n i n the l o c a l
CSO t h a t would be funded by DMA,
6.
E s t a b l i s h case management s e r v i c e s f o r h i g h r i s k
medical cases,
7.
I n c r e a s e e d u c a t i o n a l and v o c a t i o n a l s o c i a l
s e r v i c e s t o GA-U and SSI r e c i p i e n t s ,
8.
I n c r e a s e communication between emergency room
p h y s i c i a n s and primary care p h y s i c i a n s ,
9.
Ongoing t r a i n i n g and e d u c a t i o n f o r medical
clerks,
work
billing
�TASK FORCE - PAGE THREE
10.
S i m p l i f y r e p e t i t i o u s paperwork i n regards t o b i l l i n g ,
11.
Process medical
12.
Subsidize malpractice insurance,
13.
Create a l o c a l t o l l - f r e e number f o r r e f e r r a l s ,
14.
E s t a b l i s h a " d r o p - i n " , no o r l o w - c o s t , daycare i n a
c e n t r a l i z e d l o c a t i o n f o r p a t i e n t s needing t o v i s i t
a physician,
15.
utilize
16.
Develop an e d u c a t i o n a l program f o r c l i e n t s t h a t would
emphasize p r e v e n t i o n and s e l f - c a r e ,
17.
Create an a c t i v e pool o f r e t i r e d p h y s i c i a n s t o a c t
as a c o n s u l t i n g resource.
claims
locally,
a DSHS p h y s i c i a n f o r GA-U e v a l u a t i o n s ,
Several o f t h e suggested s o l u t i o n s are "do-able" a t a l o c a l l e v e l .
DSHS can begin a t r a i n i n g c y c l e f o r b i l l i n g c l e r k s and OMH i s
a c t i v e l y p u r s u i n g the e s t a b l i s h m e n t o f a w a l k - i n c l i n i c .
The next Task Force meeting i s t e n t a t i v e l y s e t f o r Tuesday n i g h t
between 7 and 9 on January 14, 1992, a t the County Courthouse.
RL:cfa
�- <y
ACT/oNS
t^cehS
a check-up have been made easier for children up
those from the Adult Action Center reported such
to age eighteen with Medicaid coverage through a
changes preceded their entry into the programs.
Again, shortfalls in services which would allow federal program providing extended reimbursepeople to sustain themselves in a home setting will ment for physicians. Adult dental care has been
precipitate their premature use of more expensive returned as a benefit of Medicaid coverage. Comservices outside the home in hospitals and nursing munity Action Council has established a Health
homes. Recent state lids on numbers of new nurs- Care Access Program to provide funding for uring home beds are likely to exacerbate this prob- gently needed medical and dental services not
lem, putting an even greater emphasis on adequate covered under some other program. The program
home care options. With difficulties in attracting includes a voluntary referral network of providers
available to give no-cost care on a limited basis.
and keeping staff for these services already a
problem because of low pay, increasing demands
That's the good news. The bad news is that the
for home care services are likely to result in some low-income population of Clallam and Jefferson
forms of service cutbacks or additional
Counties continue to report a number of signifiprioritization. Emphases on the critical needs of cant health care service needs. Clients identified
children and the elderly may mean
needs for help in the health services area
that other family membersfindlittle
which were comparable to those reassistance for their needs: there are
ported for housing and subsistence needs.
we still
really no services directed specifiThere have been improvements in gethave a considcally to adults. The situation deting health care services to the poor; as
erable way io
scribed by arespondent to the Client
dismal figures on infant mortality and
go before being
Survey is all too typical:
the poor health status of poor children
poor does not
and adults illustrate, we still have a
also mean
considerable way to go before being
"The programs for kids are
poor does not also mean being sicker
being sicker
great,"
and dying younger.
she writes, but "my husband
and dying
ff
and I are falling apart at the
younger..
seams."
Among the most notable continuing
problems pointed out by providers is the
Finally, there are shortages of services for lowdifficulty, even with a source of payment, in
income families where dissolution is the aim.
finding a dentist or physician to provide care. With
Legal services for contested divorces or those with Medicaid reimbursement policies covering a
child custody issues are a low priority for legal aid shrinking proportion of the costs of care, estimated
providers. Poor women trying to escape a domes- at forty to fifty percent of the usual fee level, more
tic violence situation may find themselves unable
and more providers are limiting the numbers of
to pay the costs required to terminate the relation- such patients they serve, refusing to add new
ship and keep their children.
patients with Medicaid coverage to their caseload,
or refusing altogether to accept Medicaid coupons.
The problem is particularly acute for dental and
HEALTH CARE SERVICE NEEDS
obstetric care. There is some early indication that
Needs for assistance with the high cost of medi- problems may be developing in pediatric care as
well.
cal and dental care dominated the conclusions of
Community Action's previous needs assessment.
Other shortcomings in the health care system
In the intervening four years, there has been a good result from the differing restrictions and limitadeal of progress in meeting these needs. Washing- tions placed on what is actually covered under the
ton State has implemented a Basic Health Plan
various programs available. The Basic Health
which enables low-income families who do not
Plan, for example, does not provide coverage for
qualify for Medicaid to purchase health insurance mental health services. At the community mental
on a sliding fee scale. Still in its early stages of health centers, state funding dictates that clients
implementation, this program is available in Clal- with chronic and emergency problems be served
lam County: Jefferson County residents do not
first: low-income persons who need mental health
have access to the program. Visits to a doctor for care for other reasons cannot readily receive ser-
�vice. Few services are available for those suffering
from both mental illness and substance abuse.
There are no alternatives to Medicaid or donated
care for low-income families needing dental work
and here too the emphasis is on providing emergency or critically needed services rather than
preventative care.
Some clients who would otherwise qualify for
Medicaid coverage find themselves caught in
Department of Social and Health Services requirements for documenting a particular level of medical services expenses: without coupons, they cannot get treatment; without showing treatment expenditures, they cannot qualify for coupons. Some
persons with insurance coverage cannot readily
cover the required deductible, and so avoid going
for care. Others need medications or medical
supplements not covered under any program. In
this regard, Community Action's Health Care
Access Program, which is directed to urgent need,
cannot well meet these requirements for an ongoing expense. Finally, patients and providers are not
always well informed about the often confusing
array of programs and regulations for their use.
Some newer programs improving coverage for
children are not being used as fully as needs
indicate, apparently due to lack of knowledge
about their availability. Many of these difficulties
are evident in the responses to client surveys.
SURVEY RESULTS
• Thirty-five percent of the respondents to the
Client Survey reported they had no assistance with
medical bills; forty-eight percent no assistance
with dental bills. Medicaid or Medicare provided
help paying medical costs for thirty-nine percent
and dental costs for thirty-six percent; nine percent
held private or employer provided medical insurance and eight percent private or employer dental
coverage.
ment option.
• Respondents who held full-time employment
were most likely to have private or employer
medical insurance (forty percent) or to participate
in the Basic Health Plan (thirty percent). Those
who had been unemployed for less than six months
were most likely to have no health care assistance
(sixty-one percent); thirty-five percent of those
unemployed for more than six months also reported no assistance with medical coverage.
• Respondents to the Re-Employment Support
Center (RSC) Survey were asked if health insurance expenses were a current or a likely future
problem for their households: thirty-five percent
indicated this was a current problem; another
twenty-one percent expected it would become a
problem.
• Most Client Survey respondents were unaware
that Community Action provided any medical or
dental assistance services: fifty-two percent said
they did not know these services were available
when asked if they had used them during the past
year; thirty percent indicated they did not need
these services; fourteen percent had used the program.
• Given the above, it is understandable that thirtynine percent of the Client Survey respondents
indicated they needed insurance or help to pay
medical bills; thirty-four percent needed assistance with dental bills; thirty-three percent needed
assistance paying for prescription drugs. Unemployed respondents were most likely to indicate
they needed help.
• Care needs were greatest for immediate needs:
thirty-four percent for a current dental problem;
thirty-two percent for vision or hearing care; and
thirty-one percent for routine medical needs. Respondents also needed preventative dental care,
•
Just eleven percent of the Client Survey
respondents were participants in the Washington checked as a need by thirty-three percent. Larger
Basic Health Plan, a program whose minimal costs households were most likely to report needs for
may have been too much for these low-income routine medical assistance.
families to afford: seventy-two percent indicated
they could afford to pay no more than $8.00 a
• Clients were less forthcoming about their needs
month for health insurance coverage. Capacity to for mental health assistance: nineteen percent
pay for health insurance was significantly related indicated they needed stress management; eighto income, with those in the lowest income brack- teen percent checked a need for improved selfets most likely to select the least expensive payesteem; thirteen percent (twenty-four clients) noted
�a need for mental health counseling. Respondents
with more education as well as respondents aged
thirty-one to forty-five were more likely to identify mental health needs than other groups.
• Among respondents to the Senior Survey, those
receiving Home Care services were most equivocal about their "emotional well-being," with
sixty-nine percent indicating it was "okay, and
eighteen percent that it was "not good." RSC
Survey respondents tended to be up-beat, but
twenty-five percent did report that they felt more
depressed than excited about their future.
• Older respondents to the Client Survey were the
least likely age group to identify needs for help
payingmedical billsbut most likely to report needs
for care for a chronic condition and needs for care
for vision or hearing problems.
health care supplies or equipment; other seniors
sampled were considerably below these levels of
reported need. Some senior respondents labeled
their physical health as "not good," particularly
those in the Home Care program: sixty-two percent of the sixty-one respondentsfromHome Care
said their health status was not good, considerably
more than other sample participants.
• Change in health status was, however, a significant factor in generating the need for the services
Senior Survey participants were involved in: either an acute medical condition or deterioration of
a chronic medical condition were the precipitating
events leading to service use for some seventy
percent of the respondents receiving Home Delivered Nutrition and Home Care services.
Table 4 gives responses from the Client Survey
for health care needs:
• Senior Survey respondents typically did not
identify themselves as having any health care
needs. One-fourth of the twenty persons included
in the sample from the Adult Action program
indicated they needed medical or dental care, or
TABLE 4
HEALTH CARE NEEDS
Insurance or help to pay medical bills
Insurance or help to pay dental bills
Care for a current dental problem
Yearly visits for preventative dental care
Assistance paying for prescription drugs
Vision and hearing care
Care for routine medical needs
Essential Orthodontic services
Assistance paying for restorations/dentures
Care for a chronic medical problem
Specialist care
Transportation to medical care
Other
None of the above
Source: 1991 Community Action Client Survey
39%
34%
34%
33%
33%
32%
31%
19%
15%
14%
11%
10%
2%
21%
�in Clallam County has been capped since April of
1991: 1,074 persons were covered by the program
as of July of this year. This limitation in program
Community Action Council's Health Care Ac- availability is another factor, besides cost, which
cess Program served 1,277 persons in 1990 with a restricts access to health care coverage through
this program. The modest costs for coverage still
broad range of financial help for medical needs:
two hundred seventy-eight people received assis- exceed thefinancialcapacity of the county's poortance with dental care costs, one hundred ninety- est residents, leading one provider to describe it as
seven help for medical care expenses, three hun- "helping the upper level of low-income level
people."
dred sixteen were assisted with transportation to
medical services, three hundred thirty-seven obFor Jefferson County residents, who cannot be
tained help for medication costs, eighty-three
covered by the Basic Health Plan, prospects for
needed medical equipment, and fifty received
assistance with medical bills are even more limsupport to pay laboratory expenses.
ited: there are no immediate plans for extending
Fifty-one percent of those assisted came to the coverage to Jefferson.
A waiting list has been established
Port Angeles office, three percent were
for new applicants to the Clallam
in the Forks area, and the remaining
County program but no enrollment
forty-six percent sought assistance in
by previously uncovered families
Port Townsend.
... Health
has been allowed: statewide the
Clients in the Health Care Access
Care Access is
waiting list for Basic Health is about
Program make up the majority of those
needed to fill
19,000. The 1991 Legislature alloserved through Community Action's
gaps of critical
cated some additional funding for
Community Resource and Referral
importance...
the program in the new state budget;
Division. Sixty-seven percent of these
this is less than needed to meet
clients are single heads of their houseexisting demand and is unlikely to
hold; thirty-four percent obtain some of
resolve the above issues. With comtheir household income from employpetitionfromother counties for limment; twenty-seven percent obtain
assistance from welfare payments; and forty-four ited funds, Clallam County is likely to add little to
its current program level despite its designation as
percent receive food stamps. These clients typically have multiple needs, and are represented in a high need area because of timber industry cutstatistics for a variety of Community Action ser- backs. It is particularly unfortunate that residents
vices as well as those delivered by other agencies. of the Forks area were not included in the program
until recently and thus did not begin program sign
Community Action staff assist clients directly
with support for urgently needed medical or dental up until shortly before it reached capacity.
services, and indirectly by helping them maximize
In another approach to improving health care
the benefits from other services for which they
services for the poor, a program to improve access
may be qualified. Sometimes medical costs can be to care for Medicaid recipients was implemented
covered by finding support for another expense,
in Clallam County in the fall of 1989. Following
thereby reallocating some of the client's own
a health maintenance model, patients would sign
scarce resources. Like many other Community
up with a specified provider who would have
Action programs. Health Care Access is often
overall management of the patient's medical care,
needed to fill in the gaps not covered by other
and who would be paid a set fee, regardless of
services, gaps which can be of critical importance whether or not services were delivered. Participatwhen the need is for health care services. Also like ing physicians in this program felt that they were
other programs, restricted availability of funds
losing money, in part because they could not
means that non-emergent needs cannot be adcontrol patients' high use of emergency room
equately addressed.
services. All doctors who had signed up as providThe Basic Health Plan promises to provide a way ers had discontinued participation as of January of
1991. Ironically, this same programmatic idea
for low-income families to self-pay their own
implemented in another state was recently highhealth insurance and thus maintain their own
health care safety net. Unfortunately, enrollment lighted by a national news show as an effective and
Service Indicators
�and its resulting social distress.
Clallam County's west end surrounding the city
of Forks is likely to be hardest hit by timber
industry dislocations. Residents in Jefferson
PROVIDING FOR THE FUTURE
County's west end will be similarly affected, as
will those still engaged in timber-related work in
An assessment of this sort should do more
than pinpoint needs at a given point; it also should the Quilcene area. Port Angeles has a substantial
make projections for the future status of the popu- population of timber-dependent workers, but the
lation under consideration. This attention to what greater economic diversity of that community is
will be as well as what is seems particularly expected to reduce the severity of the effects of
important when the community is in the process of dislocations, but county services dependent on
major changes. Such is the case in Jefferson and timber tax revenues may not fare so well.
Clallam Counties, and by extension, changes will
There are, as discussed previously, a number of
come for their low-income residents as well. A
consequences in these economic shifts for the lowmajor thrust of this needs assessment has been to income residents of the North Olympic Peninsula.
collect informationfromclients and
Loss of timber-dependent jobs will inservice providers which will concrease the competition for the jobs that
tribute to projections about the shape
remain. A cumulative effect throughout
and consequences of these changes
...the
bulk of
the job market, culminating in more
for the counties' poorest residents.
hardships for those most marginally
employment
employed, is likely. Some of these people
Two groups are singled out for
dislocation is
are already Community Action clients
particular attention here: dislocated
expected to
and will have expanded service needs;
workers and senior citizens needing
take place
others, who were previously able to
supportive services. Both represent
within the next
manage without assistance, are likely to
distinctive segments of the populayear or two.
now need Community Action's and
tion, both are likely to experience
other low-income services.
increases in service needs in the
The workers who will be losing timnext four years, and neither will be
ber-related jobs will probably present a broad
adequately served by the existing service strucrange of service needs. Some will take other jobs
ture.
here or elsewhere and need no services, others will
use employment-related services but not require
Population Indicators:
social or emergency services, and still others are
likely to require the full complement of available
Those parts of the North Olympic Peninsula
social and economic services.
economically dependent on the timber industry
have experienced restrictions for the past several
Clallam-Jefferson Community Action Council
years as a result of both market and environmental was granted a program in July of 1989 to provide
factors. Technological changes also have contrib- support and referral services to dislocated workers
uted to a reduction in the timber-related workforce. and other unemployed and under-employed perThe federal mandate to preserve habitat for the
sons. The Re-employment Support Center (RSC)
spotted owl has recently added dramatically to
service was intended to fill the needs of these
these other forces causing industry declines and is workers for information about support and other
expected to contribute to overall job losses in this services, to provide referral and help with access
area, estimated to be in excess of2,000jobs. Some to such services where available, and to give
of this employment dislocation has already oclimited direct assistance when other services were
curred; the bulk of it is expected to take place
not available. By the end of 1990, the program was
within the next year or two. Precise estimates of in contact with an average of eighty clients a
when and how many jobs will be lost are depen- month, a number that has continued to expand.
dent on court and governmental decisions not yet Most of these clients were served through the RSC
made. What is known, and what is already evident, office in Forks; others were assisted by a RSC staff
is that timber-dependent communities and their
person in Port Angeles.
residents are entering a period of economic stress
A total of four hundred twenty-five clients were
creative solution to health needs of low-income
families.
�Medical Care C r i s i s in Clallam County
by
Roger Lemstrom, Social Services Supervisor
Division of Social and Health Services
Port Angeles, Washington
November 6, 1991
Adequate health care for the low income c i t i z e n s in Clallam
County i s becoming harder to find as State resources for Medicare
become scarcer.
55 cents of every State assistance dollar
currently goes to providing medical services to people who
receive
Medical coupons and the reimbursement rates for those coupons does
not r e f l e c t the actual cost of services. Many physicians and
c l i n i c s often find themselves in a dilemma when a Medicare c l i e n t
walks into their waiting room and often find themselves needing
to choose between keeping their doors open for business or turning
a c l i e n t away.
The c l i e n t needing help often contacts several
physicians attempting to receive care and often winds up in an
emergency room of a hospital which has no choice but to accept
them. The hospital often absorbs the costs or b i l l s the State at
an extremely high cost to the taxpayers for something that should
have been handled by a family doctor.
Over 2200 people in Clallam County alone, receive some sort of
medical help from the State.
DSHS served over 650 pregnant women
alone in the l a s t 18 months.
Feelings over t h i s c r i s i s run high. Clients are angry about not
�being able t o locate medical care f o r themselves or t h e i r f a m i l i e s .
The medical community i s upset about the low rates of reimbursement
and the seemingly uncomprehensible g l u t of paperwork required f o r
reimbursement.
C l i e n t advocates are f r u s t r a t e d by the bureacracy
and perceived unresponsiveness of State social workers.
The State
l e g i s l a t u r e i s seen by a l l p a r t i e s as being unconcerned w i t h the
p l i g h t of the low income f a m i l i e s of the county.
The business
community f e e l s pinched by taxes t h a t seem t o disappear down a
black hole w i t h no a c c o u n t a b i l i t y f o r the spending.
Every community i n the United States i s f a c i n g the same
challenge i n the decreasing accessabi1ity i n health care.
Solutions t o these challenges work best when developed
locally.
The Port Angeles o f f i c e o f the D i v i s i o n of Social and Health
Services has asked the medical community and other s e r v i c e
providers t o meet t o form the Medical Care C r i s i s Task Force of
Clallam t o examine the problems and develop workable local
solutions.
The L e g i s l a t u r e , local government, and the c i t i z e n s of
Clallam County w i l l be working c o l l a b o r a t i v e l y i n a series of
working meetings over the next year t o create a f r i e n d l i e r
of health care.
system
�HEALTH CARE
REFORM
Except where noted (*) these provisions are based on the pending recomniendations of the
Washington State Health Care Commission (Redmond Commission).
Basic to this proposal is the concept that individuals, employers and the public sector must
accept more responsibility for controlling costs, promoting health andfinancinghealth care.
I.
COST CONTROL
An independent state agency, the Health Care Services Commission is created with
responsibilities and authorities over both the public and private health care systems.
A.
Governance
Five members; fulJ time; Chair the chief administrator of the agency and
serving at the pleasure of the governor.
B.
Powers
1.
Establish a core benefit plan, including individual cost sharing
standards.
2.
Determines a maximum premium for the core benefit plan.
3.
Develops standards to simplify billing, claims and utilization
management.
4.
Approves provider payment methods.
5.
Develops methods to control unnecessary technology and capital.
6.
Cenifies insurers or plans.
7.
Prioritizes new funds for community based public health and preventive
services.
8.
Sets policy for an improved and more closely integrated health
information system. •
9.
Promotes and oversees quality of care and provider accountability. *
�10.
11.
II.
Designated as the lead agency to seek waivers with the federal
governnaent for inclusion of federal programs in any cost containment
and access improvement efforts of the state. •
Recommend to the legislature improvements in the health care
system.*
INSURANCE REFORM
More equitable standards must be adopted for the health insurance industry,
especially as they apply to small business and their employees. Firms with fewer than
100 employees:
A.
B.
Community Rating would be required.
C.
Guaranteed issue and renewability for groups.
D.
III.
Pre-existing conditions would be eliminated.
Participating individuals or families would be guaranteed the right to
continuation if they terminate their employment.*
ACCESS
This proposal provides a schedule to achieve universal access. There will be a phasein period of four years.
A.
Individual Role: Every individual has a personal responsibility to maintain
their own health and to contribute to the cost of an affordable system based
on their ability to pay.
1.
2.
Other cost sharing as determined by the Commission.
3.
B.
Individuals responsible for a portion of the premium.
Incentives for healthy lifestyles developed by the Commission.
Employer Role: All employers must assume primary responsibility for a
healthy workplace andfinancingaffordable health care for their employees.
1.
Establish a mechanism so employers either direaly or indirectly finance
care for employees. *
2.
Provide assistance to smallfirmsthat are affected by this policy.
�C.
Public Role: State government will take responsibility for more of the
uninsured.
1.
Basic Health Plan: The BHP is expanded and re-located.*
a.
Allow small businesses the option to buy-in their employees at
no cost to the state.
b.
Increase subsidized enrollment in an orderly manner.
c.
Enroll employees of firms that opt to pay rather than provide
health insurance.
d.
Allow individual enrollees to continue their panicipation - at no
cost to the state - when gross family income exceeds 200 per
cent of poverty.
e.
Move the BHP into the Health Care Authority to achieve
administrative savings.
f.
Sunset is repealed and the program is expanded statewide.
Medicaid:
a.
Explore the possibility of decreasing cost shifting by increasing
the Medicaid payments more in line with Commission
determined premium levels.
b.
Give serious consideration, pending federal waivers, to the
de-linking of Medicaid from Welfare.* This should be done
only if:
possible expansion can be done less expensively than
providing Basic Health to the expanded population, and
if the change improves the health care system for the
poor and near poor.
�IV.
Tax: To accomplish these changes tax increases will be necessary. The proposal
requires tax mechanisms to accomplish the following goals.*
A.
Fund the activities of the Commission.
B.
Expand enrollment in the Basic Health Plan for low income unemployed and
part time employed people.
C.
Pay or play mechanism.
Office of the Governor
Olympia Washington 98504
(206) 753-6780
(FAX) (206) 753-1488
12 November 91
�Group Health Clinic
For Port Angeles Is
'Touch And Go'
By Martha Ireland
Group Health Corporation
(GHC) is studying the feasibility
of extending its medical care service to eastern Clallam and Jefferson Counties.
"From a financial point, it's
touch and go whether the present
Group Health population and
general population can support a
clinic," Dr. Phil Nudelman, president of GHC, told an eight-member delegation from the North
Olympic Peninsula during a meeting in Port Ludlow, March 20.
"We have an interest in the
Jefferson/Clallam area largely
because we have members and
enrollees who have asked us to,"
he said, "but we have an obligation to our other half-million
members to be solvent."
To assure that the proposed
clinic would not lose money,
"something else is going to have
to be added," he said, "maybe an
alliance with thestate—if thcstate
will be creative."
He offered to have two GHC
Continued on page 33.
Peninsula Business Journal
Group Health
Continued from page 1.
representatives sit down with two people
from the state to "see what kind of collaboration can take place and see if thatchanges
our perception."
"It's got to make, sense," Nudelman said.
"If it doesn't make sense financially, it
doesn't make sense for Group Health."
In areas it serves, GHC contracts with
the state Basic Health program and is one of
several medical care options for state
employees. Once they are members, state
employees can continue with Group Heallh
even if they transfer to posts outside the
GHC service area.
"I'm a Group Health member and I love
it,"said Man Jo Olson, Departmentof Social
and Heallh Services (DSHS) administrator
in Port Angeles. She is one of 60 state
employees in the area who are GHC
members and have petitioned to bring in
Group Health.
Doctors in "two of the three larger
communities" in the area are interested in
working for or with GHC to serve its
members, reponed Dr. Gary Feldbau, GHC
Chief of Staff. "A Group Health physician
presence may not be welcomed," he said.
"An opportunity does exist to deliver service through existing physicians, but that
might adversely affect your problem."
Crisis Or No
Roger Lemstrom, supervisor of the Port
Angeles DSHS office organized the NOP
delegation which urged GHC to help alleviate "a medical access crisis" by bringing
more primary care physicians to the area.
Group Health's eight representatives at
the meeting, and four people from the
Olympia DSHS office, were unsure that a
crisis exists. The peninsula's healthy physician-to-populaiion ratio led them to suggest that more doctors are not needed, but
rather that more of the doctors who are
already here should open their doors to
Medicaid patients.
"A significant number of our primary
care physicians are not seeing assistance
clients," admitted Dr. Thomas Locke, Clal-
April
lam County Heallh Officer. 'Their practices are near capacity so it's unlikely they
will.Weareapproaching capacity and need
to expand in some way," he concluded.
"A large percentage of our physicians
are specialists," added Clallam County
Commissioner Doroihy Duncan.
There is no problem with referrals to
specialists,Lemstrom indicated,but"Ican't
find a doctor who will see me," is a complaint his office hears twice daily, and
hospital emergency room (ER) costs are
rising as people use the ERs for basic care.
"At our office, we determine who's eligible for medical coupons," said Olson,
"butproviders are pulling lids on the number
of Medicaid people they will see." Neither
the Port Angeles DSHS office nor the
Olympia hotline know of any doctors in the
area who will take new Medicaid patients
at this time, she reported.
Economic Block
"It's primarily an economic block" that
causes doctors to refuse assistance patients,
Locke said, "people are looking at the
economic health of their practices."
Educating doctors not to think in terms
of "fee for service" could open their doors
to Medicaid clients, suggested Gaylan
Gaither of the DSHS agency which administers medical assistance. He oversees
a program under which doctors take assistance patients on a "capitation basis."
The program failed when tried earlier
in Clallam County because local physicians did not grasp the concept, he said.
Capitation means that a medical practice enrolls 100 or more Medicaid patients
and is paid a fiat amount—say S20—per
person per month wheiher they see a doctor
or not. Only a few of lhe 100 need care
during any given month, so the money
received for the whole group—$2,000 in
this example—profitably covers theircare.
If doctors lake too few enrollees—say
25—"it doesn't work," Gaither said, "one
bad case can wipe them out for the entire
year." The ideal is to have a group of physicians sign up for the plan, but the state
offers alternatives for individual doctors.
Those interested in the capitation plan can
contact Gaither at (206) 586-5339.
�Health care crisis symptom of more serious illness
BY JOHN A. BENNETT
on to the consumer. Organizations like
The crisis in medical care in this
Housekeeping, Consumer's Union
Reader commentary Goodthe medical specialty organizations
country is one of many symptoms of the
and
disease that has progressed in our society
could place an advisory warning, or "seal
during this century. At the same time that look forward, and imagine how a truly of approval" on new or established
we hear that the U.S. medical system free market medical care system could products.
provides the best care in the world, we exist with, and benefit from, the scientific
Individuals would discuss drugs with
wonder how long we can continue lo pay progress that has occurred in this century.
for it. Many individuals are unable to pay
As a Libertarian, I have been in- their physicians, pharmacists and even
for insurance, let alone the cost of serious fluenced by the writings of Murray Roth- with each other in order to make decisions
illness. The slates and federal gQyernment bard and ' Milton Priedman, both free- based on their personal needs and situaare also:-Jfj^i^'-the;(m^i^|j^phg tliwrv|j|ldec6n0ffii«»:
'j^^***®^- tionsi^ai^^ttha^^jiave the decision made
in Wa^hipglgp. f^ised on the "public
socialist programs increasingly difficult."
In ^ d e r tO'allow the free market, to good."' With the elimination of regulaWhat should be done about-all of this? function; we have to eliminate, the tions and restrictions, the Drug EnforceSuggestions have been made that we restraints that we have placed on it over ment Agency would not be necessary.
move to a nationalized health care sys- the years. This is radical stuff, but bear
tem- Other plans involve increasing con- with me. We need to eliminate the Food
The functions of the boards of phartrol over the professions by the govern- and Drug Administration, the Drug En- macy: and licensure and disciplinary
ment, requiring employers to provide in- forcement Agency, the Department of boards would be assumed by the professurance, government-controlled rationing, Health and Human Services, the Public sionals. Personal and group reputations
and — of course — increasing taxes to Health Service and its surgeon general, would be at stake, and the press and
pay for extra programs and bureaucracy. the Department of Health and boards of private watchdog organizations would
It has been concluded that the free market pharmacy, medical licensure and discipli- oversee the professions. Graduation from
has failed us, and that we need the nary boards in every state. I have already professional school and passing of apgovernment to save us and protect us in lost the hard-core socialists by now, so I propriate board exams would allow one to
will continue with the need to eliminate enter the profession of choice.
the future.
Medicare and Medicaid.
There would be a natural competition
I object! The government is the
problem, not the solution. The free market
These changes will not occur in a between professions, so that if one profeshas not been allowed to function since the vacuum, but would be part of a major sion was too restrictive or too lenient,
turn of the century. The older members of change in government in general to allow public opinion would apply pressure to
our society were but children when the individual choice, and empower the the individual practitioners of that profesgovernment began to interfere in the free government to protect us from violence, sion, and new professions would naturally
market, placing handcuffs on the "in- theft, fraud and breach of contract. It evolve to replace them. Midwives,
visible hands" described by Adam Smith. would not protect us from ourselves or naturopaths, chiropractors, D.O.s, M.D.s,
It is difficult for us to visualize what our our bad decisions, so we would look to nurses, Christian Scientists and any other
system would be like in the absence of the free market as individuals for that group would naturally want lo protect
their collective reputations by policing
government intervention in medical care. protection if we wanted it.
each other. We don't need the governThe free market didn't fail; it was
Private organizations would replace ment to do it.
crushed.
these departments, agencies, boards and
If we try to think back to the way that it programs, and individual choice would
Drugs would be available in a pharwas with the free market, medical care replace the rules and regulations. The macy or any retail outlet. If a person was
system, we have to look to the 1890s and FDA would no longer prevent the intro- ill and needed a drug, then a physician
• 1900s, an era that preceded present medi- duction of new drugs, and the cost would be consulted for a diagnosis and
cal technology. Rather, I will attempt to savings of development would be passed recommended treatment, including
1
recommended follow-up. The person
would then take that advice and obtain the
recommended drugs, without prescription
or restriction. If the lady next door was
knowledgeable, one could choose to ask
for her advice or help.
Medical insurance would continue to
be available and, without governmental
restrictions, would be less expensive. The
individual would tend to use insurance
with a deductible,' and so would'search•
out cost effective'medical "care. Private
watchdog organizationswould observe
and certify insurance companies, as they
do now. The courts and government
would become involved only in the case
of fraud or breach of contract.
Over the years, people have paid in to
Medicare and Social Security, and the
government has to fulfill the implied contract that it has with all of us. The system
is bankrupt, and can continue to function
only with continued taxation. The federal
government does have significant assets,
however, which could be sold to allow the
establishment of personal annuities
through private insurance to fulfill the social promises made to us, without placing
the burden of overwhelming taxation
upon our children and their children.
Obviously the free market has not
failed to provide medical care — it has
not been allowed to do so. Either we insist
that the government get out of our lives
now, or it will continue to m;ike our
decisions for us, stifle our progress, and
cause/us to be even more dependent on it
than we are now. It's frightening, but we
must retake control of our own lives.
:
• John A. Bennett - ix ci Sequim
physician and member uf the Washinglun
State Board of Osteopathic Medicine nnd
Surgery in Olympia.
�PENINSULA WOMEN'S CLINIC
923 Georgiana Street
Port Angeles, WA 98362-3911
457-8840 1-800-628-1296
Practice Limited to
Gynecology and Obstetrics
Robert H. Palmer, Jr., M.D.
Charles T. Haley, M.D.
Carole S. Kalahar, A.R.N.P.
t - " 1 . ;
November 15,
:
1991
Roger W. Lemstrom, M.P.A.
Social Services Supervisor
DSHS-PA
1016 E. F i r s t S t r e e t B5-1
P o r t A n g e l e s , WA
98362-4099
Dear Mr. Lemstrom:
I r e c e i v e d your l e t t e r d a t e d 10-28-91 d e s c r i b i n g a m e e t i n g on
November 21 f r o m 9 a.m. t o noon a t t h e DSHS o f f i c e r e g a r d i n g a c c e s s
t o c a r e . I am q u i t e i n t e r e s t e d i n t h i s i s s u e and w o u l d l i k e t o be
p a r t o f the
s o l u t i o n , h o w e v e r , I p e r f o r m s u r g e r y on Tuesday and
T h u r s d a y m o r n i n g s and have o f f i c e h o u r s t h e r e s t o f t h e week
between 9 and 5.
Evening
meetings
are c e r t a i n l y easierf o r
physicians
t o attend although
committee
meetings
and o t h e r
community r e s p o n s i b i l i t i e s can make even t h o s e d i f f i c u l t .
I know
t h a t you c a n n o t s c h e d u l e your m e e t i n g a r o u n d me and I w i l l be
u n a b l e t o a t t e n d t h i s m e e t i n g , h o w e v e r , I c o u l d p e r h a p s a t t e n d an
e v e n i n g s e s s i o n were one a v a i l a b l e .
As s p e c i a l i s t s , we t y p i c a l l y see p a t i e n t s on r e f e r r a l f r o m o t h e r
physicians.
These p a t i e n t s a r e g e n e r a l l y seen by p r i m a r y c a r e
p h y s i c i a n s who a t t e m p t e d t o work up t h e i r b a s i c p r o b l e m and when
t h e y r e a c h an i m p a s s e , r e f e r t o u s . Our C l i n i c has n e v e r ceased
t o t a k e any GYN p a t i e n t on r e f e r r a l r e g a r d l e s s o f i n s u r a n c e s t a t u s .
We d i d t a k e an 18 month h i a t u s ( J a n u a r y 1 , 1990 - June 3 0 , 1 9 9 1 )
i n n o t a c c e p t i n g O b s t e t r i c a l p a t i e n t s who were i n s u r e d w i t h DSHS
f o r p e r s o n a l and economic r e a s o n s w h i c h have now been r e s o l v e d .
B e g i n n i n g J u l y 1 , 1 9 9 1 , we began a c c e p t i n g o b s t e t r i c a l p a t i e n t s
c o v e r e d by DSHS on p h y s i c i a n r e f e r r a l .
Because o f a number o f
f a c t o r s , many p a t i e n t s a r e u n a b l e t o g e t a r e f e r r a l b u t s t i l l want
t o have c a r e by a b o a r d - c e r t i f i e d s p e c i a l i s t i n OB-GYN. F o r t h i s
p u r p o s e and a g a i n w i t h i n o u r g o a l s o f p r o v i d i n g s p e c i a l t y c a r e , we
a r e now a c c e p t i n g o b s t e t r i c a l p a t i e n t s w i t h DSHS c o v e r a g e w i t h o u t
referral.
We do r e q u i r e t h e s e p a t i e n t s , as we r e q u i r e a l l o f o u r
o b s t e t r i c a l p a t i e n t s , t o have a p r i m a r y c a r e p h y s i c i a n by t h e end
of t h e p r e g n a n c y so t h a t f o l l o w i n g t h e i r s i x week p o s t
partum
c h e c k , t h e y c a n be r e t u r n e d t o a p r i m a r y c a r e p r o v i d e r . We s i m p l y
do n o t p r o v i d e p r i m a r y c a r e and c a n n o t a t t e n d t o t h e b a s i c m e d i c a l
needs o f a p a t i e n t , i . e . c o l d s , f l u s , e t c . Each p a t i e n t w i l l need
t o u n d e r s t a n d t h a t l i m i t a t i o n and t h a t we a r e n o t t h e i r r e g u l a r
d o c t o r b u t a r e s i m p l y t a k i n g c a r e o f one c o n d i t i o n w i t h i n o u r
specialty training.
�Page 2
November 15,
1991
I would be pleased t o d i s c u s s t h i s w i t h you p e r s o n a l l y or i n a
meeting, and as I s a i d , am i n t e r e s t e d i n working on community
s o l u t i o n s t o t h i s problem.
Again, I am s o r r y t h a t I w i l l not be a b l e t o a t t e n d the scheduled
meeting but l o o k f o r w a r d to being of help i n o t h e r ways.
Sincerely,
2r&-
Robert H. Palmer, J r . , M.D.,
RHP/co
F.A.C.O.G.
�mmmm
January) ;8j ,1992-,;,...
- ".< v.'_/ '•• '"' *•
•
' •'
:
POR
ANGELES
CLINIC
433 EAST 8TH STREET
PORT ANGELES
WASHINGTON 98362
TELEPHONE
(206) 452-3373
FAMILY PRACTICE
Quentin Kinlner, M.D.
John L. Siemens, M.D.
E.A. Hoplner, Sr., M.D.
Richard J. Van Calcar, M.D.
Roger M. Oakes, M.D.
William R. Kintner, M.D.
Peter J. Erickson, M.D.
Mark S. Redlin, M.D.
DERMATOLOGY
Michael W. Piepkorn, M.D.
SURGERY
Robert M Allman. M.D.
INTERNAL MEDICINE
Robert S. Crist. M.D.
Mark D. Fischer. M.D
Arthur L. Tbrdmi. M.D.
RADIOLOGY CONSULTANTS
E. Rand Apgood, M.D.
Benjamin Pisciotta. M.D.
D. Bork, M.D.
Eric Schreiber, M.D.
ADMINISTRATOR
Leonard J. Borchers
Roger W. Lemstrom
Social Services Supervisor
Dept. of Social & Health Services
1016 East 1st St, B5-1
Port Angeles, WA 98362-4020
Dear Roger:
I appreciate the opportunity to attend the meeting yesterday, January
7, 1992, regarding healthcare access issues for DSHS clients. Although
we are aware that there continue to be access problems for certain types
of patients, it appears that pregnant women and children are well-covered
at the present time. I would like to offer a few additional comments
regarding a number of items which were discussed.
We believe the fundamental problem in this community is one of maldistribution of case loads. The current access problems are exacerbated
by the Port Angeles Clinic's decision to begin limiting new DSHS clients.
We believe that the high percentage of DSHS clients that we presently
serve, puts us at a competitive disadvantage in the marketplace. We
believe that longterm, lasting solutions must address this fact. We are
encouarged by DSHS willingness to provide data to the local community,
which will indicate the exact nature and extent of the problem. It may
be helpful to encourage a greater participation by other community
physicians. I think that the idea of a referral system which could be
established to allocate new DSHS clients to various providers throughout
the community in an equitable fashion might also be workable. Any such
system, of course, would depend upon the level of commitment made by
individual physicians to accept new patients.
I personally am encouraged by DSHS willingness to investigate and
implement managed care systems. It is possible that the Port Angeles
Clinic would be willing to enter into significant discussions concerning
such an approach for our existing DSHS patients. We would have very
limited interest in any approach which would link our success or failure
to the participation or actions of any other providers in the community.
In other words, if DSHS would be willing to enter into a relationship
for some of its clients and not require that the entire community population enter into the program, there is ample room for some very
productive discussions to occur.
The idea which was presented suggesting a medical case manager to assist
the client and providers also has merit. As I know you are aware, many
clients have multiple needs and a case management approach can be very
effective in coordinating and achieving proper utilization of resources.
We will be very willing to consider a pilot project in this area.
�Finally, as I have stated previously, we continue to remain opposed to the idea
of a specialized low income clinic within the community. As a last resort, it may
prove necessary. However, a universal access and delivery system which is truly
"seamless" should not and cannot differentiate service delivery on the basis of
economic status.
One additional way in which the State and DSHS could effectively encourage
greater participation by physicians, would be to create incentives within their own
healthcare benefits package which encourages State employees to utilize providers
who are making a significant effort to meet the needs of DSHS clients. Some
type of a preferred provider network comprised of physicians meeting or exceeding
local market standards for DSHS participation levels would provide a direct and
significant benefit to providers. I suspect that there may be legal and/or administrative problems which would undoubtedly make such a system difficult to
implement, but is a rather simple and straightforward concept which may merit
consideration, given the State's rather bleak financial forecast.
Again, thank you for your efforts to provide leadership in this troublesome area.
I am encouraged by the range of possibilities which have been presented. The Port
Angeles Clinic remains willing to work with you concerning potential solutions.
.en Borchers
Administrator
cc:
Jeff Graham, M.D.
Roger M. Oakes, M.D.
Ed A. Hopfner, M.D.
LB/la
��Medicaid
m-^**
services
r Social anJ Heaiv»
^ " • f l oT iw in
C, ' s i t u a t i o n has
financial f S
the su
u
l , o r l
h
An
y c a r s
l r o m
b she couiu i»—
$6.50 an hour.
$6 50
a
c
welfare P y ' [icia\s say.
f
aduUs wim
^ r e f c e U ^ ^
Lcmsuom. social
.-cenUy
w
h
e
^
.,
b e n c
n t s , so she
H
n
R o g e r
^
years, after,. lhe
„
v i r
^rt\i
"Onder Fire,.- a j
book ^"tten °yHl
l
" tecrecy
North
T h
rivahnfr \
f
a
i
* £ North
e 446-oaRC booK.
�pouring of the ashes.
. .....^ t ui t c u
nuii being nearly too "tec-hee,"
as the naive tccn giggling through
her first love. But functioning as
pure symbol, she pulled it off,
teetering between sappy and sympathetic. Finally, it was a happy
ending when she waxed serious to
deliver a poignant "They Were
You." So we forgave everything;
believed, at last, that she was real.
The flat-out show stealers were
Dave Bendell as the Old Actor
with his fractured Shakespeare,
his tattered bombast and sagging
underwear, and newcomer Jeff
Howard as The Man Who Dies,
and never does. Jeff had the audience howling, doubled over at
his delight and contortions —
winks, leers, sniffs, wiggles, knee
jerks and collapses. Flipping cotton Indian braids as the first
caricature, and raising a crooked
eyebrow and sneering lip under a
flopping pirate hat, he maintained
an evil pact with the audience as
they cheered him on.
Crucial to maintaining the
spell of fantasy, Justin Barrett
was a flawless mime as The Mute,
with impassive chalk-white face. .
With sensitive hands and highly
trained body language, he created
;very scene -'change" — the
kVall, the Rain, the Fire, the
jeasons.
The good.neighbors on either
ide of the wall were Bill Anabel
s the stocky and sarcastic fatherf-the-boy, and Lew Barlolomew, confused and handringing keeper-of-the-girl. The .
>ntrast between the two worked,
cir dance routines clipped and
rfected, their voices sure and
;y. Shawn Dawson was tender
young Matt — his voice, like
rson's, not showcased until the
: two duos: "Round and
und" and "They Were You."
tut the red badge of profeslal courage and performance,
my money, goes to the two
icians (that's all, folks) who
d the theater with enough fine
id for a full orchestra. Sitting
t
Continued from A l
doctors that accept Medicaid. They
said there were no openings from
Port Townsend to Clallam Bay.
Situations like that occur every
day, Lemstrom said, as his social
workers find it harder and harder to
convince a doctor to take a patient.
Often, they are sent all over Western
Washington to find a doctor, and
the state buys the gas, he said.
More often, patients go to the
Olympic Memorial and Jefferson
General hospital emergency rooms,
which costs the state twice what an
office visit would cost.
Medicaid paid Olympic Memorial
$21,000 for emergency room doctors in the first half of this year,
hospitalfinanceofficer Chuck Karst
said. That paid 20 percent of the
emergency room doctors' bills, he
said, and did not include the equal
amount of hospital overhead, which
is footed by the hospital district
taxpayers.
If the.state,Legislature,paid doctors more for Medicaid, the state
would .save money on emergency
rooms and sending, people around
the state to find doctor^,'.many
physicians and officials say.
However, some officials say a few
doctors are partly to blame. •
" I believe there is bias .against
poor people," said Dr. Tom Locke,
Clallam County public health officer. "There are physicians who
would rather not take care of poor
people."
Some doctors think that if they
accept Medicaid they will Ijave
drunk, dirty patients who disrupt
the waiting room.
"We don't agree with that point
of view," said Dr. Roger Oakes of
the Port Angeles Clinic, which
Lemstrom and Locke said carries
the bulk of the welfare patients in
Clallam County. "By and large that
group of patients is not any more
difficult than any other," Oakes,
said.
While he agreed that it would help
if some doctors on the Peninsula,
especially obstetricians, would open
their doors to Medicaid patients,
Oakes said the state must pay doc-
tors more. • .
>
.. ••:
The clinic stopped taking new
Medicaid patients because of the
money, he said. " I t has gotten to
the point where it is affecting our
business."
The 40 cents on the dollar does
not even cover a doctor's operating
costs, Oakes said, adding if a doctor
accepted all welfare patients, he
would be out of business.
The head of the Washington State
Medical Association agreed.
"The problem with Medicaid is
the under payment," said Dr. Jim
Kildoff, a urologist in Bremerton
and association president.
While the association's credo is to
not turn anyone away because of
how they pay, doctors have financial obligations as well, and can be
altruistic only to a point.
"You do have an obligation to
your own family, your children," he
said.
The final solution, he and others
said, is a revamping of the state
health care system, with universal
health insurance for everyone.
However, he said, that will be a long
time coming.
"This noise'is like standing n
to a jet plane," said Barbara Off
mann. "And we're more than oi
half mile away."'
• i ...
Others complained about a den:
white cloud that was released wh<
the plant was .running. There w.
even speculation that thc-'cloi
caused leaves to turn brown. Whi
said the claim was unfounded.
Other gripes included fuel odo,
and frustration that there wasn
more publicity about the company'
plans, Benson Road residents said.
Fields Shotwell manager Miki
Davidson acknowledged tht
neighborhood's concerns.
"They're well-founded, and
they're taken care of," Davidson
said. "Anybody that asks us questions has been fairly impressed with
our answers."
The burn plant is designed to
clean fuel-tainted soil by pouring it
into a large, rotating oven capable
of being heated to temperatures as
high as 750 degrees, Davidson said.
Such high temperatures cause the
hydrocarbon molecules in gasoline
IIKHK'S TIIE.STOHK
WIIEHt VOUH *. BUY MOHK
0°°'
Continued from A l
The project was kept so secret
that North and Novak registered at
hotels under assumed names and
was referred to by publisher HarperCollins only as "Mr. Smith Goes to
Washington."
As he has throughout his
testimony to Congress and in court,
the former Marine officer insisted
he had full authority for the sale of
U.S. weapons to Iran and the diversion of the profits to the Contra
rebels in Nicaragua.
Reagan conceded he approved the
sale of weapons to Iran in the hope
of winning freedom for Americans
held by pro-Iranian radicals in
Lebanon. But he has denied knowing of the diversion to the Contras,
which violated a congressional ban
on U.S. aid to the rebels.
" I have no doubt that he was told
about the use of the residuals for the
Contras and that he approved it.
Enthusiastically," North wrote.
North concedes, however, that he
never spoke to Reagan about the
diversion and that it was possible the
president's top aides, sought to
shield him and the office of the
presidency from the scandal, i
North.said one Reagan confidant
who was clearly in on the diversion
was William Casey, the CIA director who died of cancer in 1987.
North said Casey tutored him in the
secrets of codes and off-shore bank
;
accounts when he sought Casey's
help to arrange private contributions for the Contras from wealthy
A m e r i c a n s and f o r e i g n
governments.
. There was no answer Saturday at
the office of Reagan's spokesman.
Despite efforts to keep the U.S.
involvement in the Contra resupply
network a secret, at some point well
over 100 people in various government agencies knew about it, North
said.
"Offering me up as a political
scapegoat was part , of the plan —
although Casey believed there would
be others," North wrote.
" North was convicted in 1988 of
destroying documents, accepting an
illegal gratuity and aiding the
obstruction of Congress.
1
TWICE
IS ft
N I C E ""V,
HM KASTMtOIVT
B
A
B
'Y
WOMENS WEAR
:
I
T
E
M
S
Carpet/Vinyl
Installation S Repairs
22 yrs. experience, state certified
Dave McNamara 683-7801
Gifts
&
China
Holiday enttnaining?
We have full line ,
of tablecloths &
plactmais by .
QUAKER LACE..
Spnial ordrrt loo.
114 East Front • 457-7484
�HEALTH CAKE TASK FORCE SORTING SHEET
CODEfti
TYPE OF MATERIAL:
General mail
^Letterhead
Letter Campaign
Casework
.Personal stories
.Offers to help
^Employment
.Policy
.Advocacy
_Re quests:
-speech
-meeting
Other
Explanation:
ADVISORY PANEL?
physician
large employers
small business
y*^other health provider
seniors
other consumers
Explanation:
PRIMARY INTEREST:
COST ISSUES
Drug Prices
Physician Fees
Hospital Fees
Unnecessary Procedures
Medical Equipment
Fraud and Abuse
COVERAGE
Working Families
Unemployed/Low Income
Benefits
Providers
PUBgiC
HEALTH/SPECIAL POPULATIONS
Prevention
AIDS
Women s Health
TmiriiiTiiyjttinTia
Rural
Urban
GOVERNMENT PROGRAMS
.Medicare
Medicaid
Veterans
DoD
ORGANIZATION
Insurance Premiums
Insurance Reform
X Insurance Pools
1 Boards and Oversight
INFRASTRUCTURE/WORKFORCE
Quality Assurance (Guidelines)
Administration, Reimbursement
& Patient Information Systems
Malpractice & Tort Reform
Manpower Issues (Training)
LONG-TERM CARE
MENTAL HEALTH
FINANCING
OTHER
Explanation:.
PLANT PRBFBHENCB: (Support = +; Oppose = - )
CP
SP
OP
Clinton Plan
Single Payer
Other Plan
MC
PP
CV
Managed Competition
Pay or Play
Credits, Vouchers,
Medical Savings Accts.
CA
BR
GE
Canadian
British
German
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[Letters to HRC from State Officials re: Health Care] [loose] [Folder 3] [3]
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Jason Solomon
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 37
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12092971" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12092971-20060885F-Seg3-037-002-2015
12092971