Overview of

Overview of “Prescription for Pennsylvania”

Governor Ed Rendell of Pennsylvania has just recently introduced his program to reform the health care of the State. This proposed program of health insurance in Pennsylvania, still needing to be approved by the legislature, is entitled Prescription for Pennsylvania, and it will certainly bring some real changes in the health care in PA. His overall goal is to bring health care to everyone in the State, including some 767,000 who do not have it now. Here are some of the overall ways in which his program will benefit the residents of Pennsylvania.

1.  Affordable Insurance For All

A new program which is part of this "Prescription" is called CAP, which means "Covering All Pennsylvanians." By this, the Governor intends to be able to bring affordable health insurance to everyone in the State, especially to those who make less than the State's average income of $39,000. Two target areas that this program is looking to provide insurance for, are:

Employed individuals who do not have health insuranceSmall businesses owners who do not have health insurance

2.  Employed Individuals Who Do Not Have Health Insurance

Governor Rendell's own goal for those who are employed but have no insurance, but limited to those who make at least 300% of the poverty level of income, is to be able to provide health care coverage for around $280 per month. Apparently this is the actual cost of providing this policy that his counsel has determined. There are presently several insurance carriers offering health insurance for this amount or less in Pennsylvania.

3.  Small Business Owners Who Do Not Have Health Insurance

By providing health insurance for small businesses, CAP will help employees and employers meet their health needs.  It will also encourage business growth in Pennsylvania. If the business chooses to join the CAP program, the employee would be responsible for between $10 and $70 each month while the employer will pay about $130 for each employee.

4.  Program Will Reduce Medical Costs To Make It More Affordable

Several areas in the new program are targeted in an effort to curb overgrown and unnecessary medical costs. These targeted areas will help reduce billions of dollars spent each year and help to reduce the overall cost, making it affordable for nearly all. Here are some of the features that have been specifically highlighted:

A. Reduce Medical Costs By Enlarging Services. The annual cost of providing health care runs into billions of dollars. The Governor is looking to reduce this figure by cutting out unnecessary expenditures in order to lower costs of health insurance in Pennsylvania. If medical facilities hours of operations could be expanded to include evening hours and weekends, then Rendell foresee a diminishing need of using emergency rooms for everyday medical needs. Additionally, he believes that by bringing everyone into the health insurance program, overall costs of healthcare in Pennsylvania will be reduced. B.  Monitor The Various Services Performed - Examine the possibility of reducing the length of hospital stays in order to prevent things like hospital infections and costs of extra days. Another aspect will be hospital stays that could have been prevented by better personal self-care or better physician services in the first place.  These often occur among people who have diabetes, asthma, and other various medical conditions. This also includes evaluating some procedures and tests that may be unnecessary. C. Other Changes That Will Benefit Many - Other additional changes in the health insurance program include:

Allowing Nurses To Perform More Services:

Rendell proposes the utilization of medical attendants like nurses and possibly dental technicians in a greater capacity as they are trained to do more than they generally are permitted to do. One proposed change is the provision of prescriptions during the birthing process. Mid-wives and nurse practitioners already deliver as much as 10% of newborn population in PA, and this would be the natural progression of their services into this arena.

Additionally, nurses in a nurse-controlled medical facility may not be permitted to treat infected toenails, remove moles, or stitch wounds. In fact, many nurses regularly perform these types of treatments in a doctor-controlled facility. By allowing them to perform these medical functions on a statewide basis and not by facility type, health care costs will be reduced as doctors will instead perform functions that are more geared to their specialized training.

Adapting nurse care in such areas as these would certainly enable health insurance costs to be reduced as nurses do not charge fees as high as doctor do for their services.

Reducing Costs Through Rebates:

For insurers that provide health insurance plans to small businesses, they may need to provide rebates if an employer's medical costs for their group plan uses less than 75% of the collected premiums.  Then, the insurer would provide a rebate to each of the employees. This would help keep costs down for employers - at least for those years in which expenses are lower than anticipated.  It is questionable how the insurers will fund claims for the groups whose claims exceed 200% or even 500% of their premiums. If done on an overall loss ratio basis, it would benefit employers.

All of these changes will soon positively impact health insurance in Pennsylvania. Many people will surely be given better healthcare. The Prescription for Pennsylvania may really be a wonderful plan. Only time will tell.