Gov. Rendell's plan would widen health insurance, target medical costs

Gov. Ed Rendell is putting the final touches on a health care reform plan that could make health insurance available to about 1 million Pennsylvanians who lack coverage.

The plan also is expected to include measures to reduce infections that patients acquire in hospitals and suggest other ways to cut costs or improve quality.

For weeks, the governor has been dropping hints about the proposal, which he plans to announce in January.

Under development for months, the plan will be the latest in a series of health care initiatives that Mr. Rendell has supported.

To provide affordable coverage to uninsured Pennsylvanians, most of them adults, Mr. Rendell wants to develop a program similar to an expansion he proposed for the Children's Health Insurance Program. That expansion, known as Cover All Kids, subsidizes health insurance for children from low-income families and makes coverage available to other children for fees based on family income.

Mr. Rendell has suggested that health care costs could be lowered in part by reducing the expensive, even life-threatening infections that patients acquire in hospitals.

Last month, a ground-breaking report from the Pennsylvania Health Care Cost Containment Council found that mortality rates and hospital charges were five to six times higher for patients with the infections than for those without infections.

Mr. Rendell said he also favors other initiatives aimed at cutting costs or improving access to care, including the lifting of certain restrictions on nurse practitioners.

He said parts of his proposal will require legislative or regulatory approval, and predicted that it will provoke objections from health care interest groups.

Major health groups have had little comment so far, saying they are awaiting details.

Amy Kelchner, a spokeswoman for the Governor's Office of Health Care Reform, said late last week that the plan still was being finalized.

With help from a $900,000 federal planning grant, officials have sought to craft a plan to provide "access to affordable, quality health care coverage for every citizen in Pennsylvania," according to a document outlining the project.

Dozens of health care experts, business representatives, consumer advocates and others provided input by serving on four committees that focused on cost containment, quality, public-funded health care and issues related to small employers.

Improving health care coverage has been a growing priority for governors in many states, said Diane Rowland, executive vice president of the Kaiser Family Foundation.

While states have attempted small-scale reform projects for years, Ms. Rowland said, a universal health care plan developed in Massachusetts may have spurred states to consider broader efforts.

The Massachusetts program, signed into law earlier this year, requires residents to obtain health insurance or face penalties. Subsidized coverage is provided for low-income residents.

Federal efforts to increase coverage for children through state CHIP programs also may have highlighted the needs of uninsured adults, Ms. Rowland said. Of the 46 million Americans who are uninsured, about 9 million are children.

In Pennsylvania, about 900,000 people lacked health insurance in 2004, and many were adults who worked full time, according to a survey by the state Insurance Department.

About 133,000 children lacked coverage, the state study found, but all but 23,000 were eligible for coverage through CHIP or Medicaid. Cover All Kids provided an option for children not covered under other programs.

Nurse practitioners in Pennsylvania work in a variety of specialty and general practice health care settings. Current guidelines require them to prescribe drugs and perform other duties in collaboration with physicians.

Nurse practitioners say the guidelines limit their ability to provide certain services and that they can have trouble getting paid through some insurance plans.

In those cases, "we either wind up eating the bill or the patient pays," said Dr. Mona Counts, a nurse practitioner for the Primary Care Center of Mount Morris in Greene County.

Chuck Moran, a spokesman for the Pennsylvania Medical Society, said it was unclear whether giving greater independence to nurse practitioners would reduce health care costs.

Dr. Douglas Roblin, a researcher for Kaiser Permanente's Center for Health Research, said studies have suggested that use of nurse practitioners or physician assistants can result in savings in delivering primary health care.

Dr. Robert Kane, a physician and professor at the University of Minnesota's School of Public Health, said nurse practitioners were especially suited to manage chronic diseases once they have been diagnosed.

Besides Cover All Kids, Mr. Rendell's other health care reform efforts have included plans to help doctors pay for malpractice insurance through the state's MCARE program.

In long-term care, the Rendell administration has expanded a program to help low-income people receive services in their homes that could help them avoid nursing home care. The administration also has helped leverage additional federal funds for nursing homes.

In addition, Mr. Rendell has supported initiatives to expand eligibility for seniors under the state's prescription drug programs, PACE and PACENET, and to reduce the waiting list for adultBasic, a health care program for low-income adults not covered by Medicaid or other programs.

While applauding those efforts, Jessica Seabury, executive director of the Consumer Health Coalition, noted that thousands of people remain on the waiting list for adultBasic. She also said more outreach is needed to enroll young people through Cover All Kids.

Consumer advocates noted that the state has raised co-pays and reduced coverage for some health care services provided to groups of low-income people.