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Clinical Laboratories and Pathology Groups

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Health reform plan preserves patient choice and requires no new government funding

As Congress gets down to the nitty gritty details of healthcare reform, a unique bipartisan proposal presented by the Rolling Hills Group, a group of Tennessee healthcare experts and community leaders, is gaining support on both sides of the aisle.

This healthcare reform proposal, initially developed for a statewide program in Tennessee, has captured Congress’ attention because it meets top health care reform priorities—universal coverage, lower costs, improved care and safety, but doesn’t require any new funding sources.

The plan isn’t perfect, but it may wind up as a blueprint for national health care reform, noted Craig Becker, President of the Tennessee Hospital Association and a member of the group, who summarized the plan in a Modern Healthcare article.

Craig Becker - President of the Tennessee Hospital Association

Craig Becker
Tennessee Hospital Association

The Rolling Hills Group healthcare reform plan calls for a structured private insurance system subject to robust government oversight, without the need for a new government plan. It would change payment and care delivery systems to eliminate unnecessary procedures, coordinate care, and reduce the overall cost of health care.

Hospitals would be required to focus on efficiencies and ensuring high care quality. It would drive all providers and payers toward an evidenced-based, patient-centered care model. The Rolling Hills healthcare reform plan also calls for payment reforms, with regional federal health boards determining payments based on regional and local cost variations.

All individuals would be required to have credible, portable health coverage equal to the federal employee health plan by 2019. The mandate would be phased in over 10 years to avoid flooding the system with new patients. Becker wrote that the long phase-in period would permit pilots of changes in healthcare delivery and payments. That would allow modifications to be made before rolling them out nationally. It also allows time for the health delivery system to gear up to handle the increased patient load, a lesson learned when Massachusetts implemented universal healthcare without adequate resources in place to handle the extra patient load.

United States Healthcare Reform

Under the Rolling Hills plan, coverage would be provided through a pool of private insurers managed by a Federal Health Reserve (FHR) system, which would organize and negotiate a range of health plans for employers and individuals. Using the Federal Employees Health Benefits Plan structure, the FHR would facilitate regional selection and purchase of private plans by employers and individuals.

The FHR would establish an affordable risk pool for people with pre-existing conditions and provide subsidiaries to individuals and families who cannot afford to purchase insurance. Businesses that do not provide health coverage would be required to pay into a fund to provide tax credits to workers to help pay for insurance.

The U.S. Treasury would provide subsidies, or “direct transfer payments,” to insurers qualified for refundable tax credits, guaranteeing payment of premiums and coverage under a basic insurance benefit for lower-income, uninsured individuals and families.

Coverage would be financed by changes in the federal tax code to reduce the exemption for employee benefits, and elimination of disproportionate-share hospital payments, once charity care is no longer needed, Becker said.

A study by The Moran Co., a Washington, DC-based research and consulting firm, found that the tax code change would cover 99.8% of the $81.6 billion needed for subsidies. By the middle of 2016, revenue would total $100 billion. Becker noted that this would allow universal coverage to be phased in sooner.

“While Tennesseans are not naive enough to think this plan will be the one that eventually will be passed by Congress, it is a feasible way of accomplishing universal coverage while making it affordable and more patient-centered,” wrote Becker. “Tennessee also is hopeful it can be a potential pilot state for healthcare reform.”

Clinical lab managers and pathologists may recall that Tennessee obtained a federal waiver from the Clinton Administration and enacted a close model of the Hillarycare proposals for its Medicaid program in 1994. By 2005, excessive costs forced the Tennessee governor and legislature to drop tens of thousands of individuals from the Medicaid program, called TennCare. The Rolling Hills Group healthcare reform proposal incorporates the lessons learned from TennCare’s experience. – P. Kirk

Related Information:
The Rolling Hills Group Health Reform Proposal Executive Summary

Rolling Hills plan in Tennessee could be outline for health reform nationwide

Sun, moon, stars aligning. Rolling Hills plan in Tennessee could be outline for health reform nationwide.