Health insurers lay out a path to universal care

Group calls for public-private partnership

WASHINGTON - Leaders of the nation's largest health insurance industry lobbying group yesterday announced a series of proposals they said would help achieve universal coverage, control costs, and improve the quality of care.

"The heart of our proposal is a public-private partnership that builds on the employer-based coverage that 170 million Americans rely on today," said James Roosevelt, Jr., the president and chief executive of Tufts Health Plan. "We have laid out a workable, realistic path to universal coverage. . . . We want to make sure no one falls through the cracks of our healthcare system because of age, health status, or income."

America's Health Insurance Plans, the organization that represents insurance companies covering some 200 million Americans, unveiled the plan at the National Press Club. The proposals - stated so generally that the group's president, Karen Ignagni, said they would be impossible to price - included recommendations for insuring everyone, containing costs, improving quality, and reducing administrative hassles for doctors.

Insurers oppose the creation of a Medicare-style public insurance option, which both President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus have proposed, which they believe will force private companies to compete with the government on an uneven playing field. The insurers also do not support an employer mandate.

The ideas hinge on a proposal the lobbying group put forward last month: Insurers would agree to stop denying coverage to people because of preexisting conditions as long as all individuals were required by law to buy insurance. That would prevent people from buying insurance only when they need it and force younger and healthier people to share the cost of care for older and sicker people.

The insurers also proposed that regulations be revised so that basic high-deductible health insurance plans with a streamlined set of benefits would be available in all 50 states. The "essential benefits" plan would include coverage for wellness and disease management as well as chronic and acute care.

To help make coverage affordable to middle-class people, particularly the self-employed and those who work for small businesses, the government would give refundable tax credits on a sliding scale, according to income. Medicaid should cover everybody under the poverty level, the insurers said, and the State Children's Health Insurance Program should cover all children up to 300 percent of the poverty level.

To help control health costs, the insurers said, Congress should set a goal of reducing the growth of healthcare costs by as much as 30 percent over five years, for a savings of $500 billion, through steps including eliminating unnecessary treatments and paying doctors for better care, not more care.

The insurers' plan also calls for improving the quality of care by devoting more expertise and money to preventive and wellness care; investing in more research to determine the best treatment protocols and providing this information to doctors; and standardizing technology that is used to record and transmit patient information.

Health Care for America Now, a coalition of mostly left-leaning organizations, including the liberal group MoveOn, immediately issued a statement criticizing the insurers, saying their plan would still allow insurance companies to charge older and sicker people huge premiums and would do nothing to cap executive salaries.

But a spokesman for US Senator Edward M. Kennedy, whose staff has been meeting with the insurers and others to develop a reform initiatives, responded positively, saying, "The insurance industry has advanced serious proposals that deserve serious analysis and consideration."