Pennsylvania: Attempts to Enact Comprehensive Health Reforms Face Obstacles
In 2007, Pennsylvania Governor Ed Rendell introduced his health care reform plan. Called Prescription for Pennsylvania, the plan consisted of a comprehensive coverage expansion for adults age 19 to 64, combined with programs to improve health care quality, contain health care costs, and promote healthy behaviors.[i] The first initiative under Rendell’s comprehensive health care reform, announced even before introduction of the full plan, was passage of a law to provide affordable health care coverage to all Pennsylvania children. The state obtained federal approval in 2007 to subsidize children with family incomes up to 300 percent FPL.
Various components of Rendell’s broad health reform plan encountered significant opposition from the legislature. During 2007 and 2008, the legislature offered components of the health reform plan as separate pieces of legislation. Although most components passed the Democratic-controlled House, many of the reforms failed in the Republican-controlled Senate. However, the legislature passed several laws related to scope of practice for physician assistants, certified registered nurse practitioners, clinical nurse specialists, nurse midwives, and dental hygienists, all aimed at addressing serious workforce shortages. In addition, the legislature passed a bill that, for the first time, mandates hospital evidence-based infection control plans, statewide infection surveillance, and reporting of health care-associated infections.[ii]
One of the bills that the Senate passed and the House amended is the proposed Pennsylvania Access to Basic Care (PA ABC); the bill is now awaiting action before the Senate Banking and Insurance Committee (SB 1137). PA ABC would provide health care access for the uninsured, help small businesses provide health care for employees, and move those enrolled in the state’s current program for low-income, uninsured adults (adultBasic) into PA ABC. Pennsylvania has an estimated 900,000 uninsured residents, more than half of whom would be eligible for PA ABC.
Another bill passed by the House and now before the Senate (HB 2098) would allow private insurance companies to refuse to pay for serious, preventable adverse events.[iii] Still another bill, HB 2005, passed the House and would limit rating factors used for small group and individual coverage; it would require adjusted community rating and standardized benefit packages and give the Insurance Commissioner greater power to review rates. Another bill passed by the House would allow parents to continue coverage on their policy for single children up to age 30.
Governor Rendell was able to implement two measures in 2008 by using his power of executive order. One measure created the Pennsylvania Health Information Exchange, which will provide the information technology architecture needed to support compatible statewide electronic health records and electronic subscribing by sharing data collected in hospitals and health providers’ offices.
The second executive order created the Chronic Care Management, Reimbursement and Cost Reduction Commission, which issued a strategic plan to transform how Pennsylvania provides and pays for health care for people with chronic conditions. The Governor’s Office of Health Care Reform began implementing the strategic plan with a roll-out in southeastern Pennsylvania for more than 200,000 patients. Roll-out in south-central and southwestern Pennsylvania will take place in winter 2009.[iv]
Continue reading on: States Establish Frameworks for Health Reform
[i] State of the States, State Coverage Initiatives, AcademyHealth, January 2008.
[ii] Prescription for Pennsylvania, Legislation. www.rxforpa.com/legislation.html; Prescription for Pennsylvania, FAQs. www.rxforpa.com/faq.html.
[iii] Ibid.
[iv] Prescription for Pennsylvania, Executive Orders. http://www.rxforpa.com/orders.html.
