Universal Healthcare
A Summary of Our Provide-or-Pay Universal Health Insurance Proposal*
We propose a method of providing health insurance we call "provide-or-pay." Under this plan everyone who lives or works in a community or region that adopts this plan will have affordable and comprehensive health insurance. The plan is designed so that currently held insurance policies, including those negotiated by unions, will not be disrupted. Those who already have individual or group insurance and those already enrolled in BadgerCare/Medicaid, SeniorCare, Medicare or other state/federal plans, will not be affected by our proposal.
Our proposal is designed to be self-supporting. Employers will either provide insurance for their own employees or pay their local government to provide a plan for their employees. Everyone who lives and works within the local government boundaries will be required to have health insurance.
A. Who is involved?
- All employers in the local government community that adopts this plan are required to either provide health insurance for all their employees or pay a payroll-based service fee or tax to the local government. (The fee rates will be determined after a study by a health insurance actuary.)
- All residents and employees in the local government community that passes this plan must have health insurance. The city plan will be available to all, regardless of health condition or pre-existing conditions. That makes it attractive to insurance companies, which don't like voluntary sign-up plans that only attract the sick.
B. What are the health service benefits of the plan?
- There is no specific benefits package required of employers. However, if an employer’s plan does not meet the benefit standards in the local government plan then it is not considered comprehensive insurance. If the employer's plan has premiums or cost-sharing charges to the employee of more than a specified percentage of an individual’s or family’s income, then it is not affordable. (For example, the Maryland plan requires that premiums be no higher than 3 % of an individual’s, and 6% of a family’s, income.) Employees who do not have comprehensive or affordable health insurance, as defined above, can opt out and join the local plan.
- Local plan benefits are comprehensive and would include, but not be limited to: preventive care services, coverage for children, immunizations, maternity care, out-patient and in-patient care, mental health (at parity with physical health), substance abuse treatment, chronic disease management and prescription drugs.
C. What are the costs to employers and to individuals?
- Both the service fee or tax on employers and the premiums charged to individuals will be set by the health-care insurance actuary hired by each local government. (We don’t know the percentage or premium without that actuarial study, but the proposed plan for the state of Maryland set the fee at 4.5% of payroll for most businesses and 8% for very large businesses.)
- Employees and individuals who are insured under the government plan will have some cost-sharing responsibilities for this health insurance, varying with the income of the person insured. We would expect there to be no cost sharing for families with incomes below 200 percent of the Federal Poverty Level (FPL). For families above 200 percent of the FPL, the premium will be based on a sliding scale. There may also be deductibles and co-pays on some services.
D. When is an individual eligible for the local government plan?
- Uninsured adults and children will be enrolled in the local government plan if their employer, spouse’s employer, or parent’s employer does not offer them comprehensive and affordable coverage as defined earlier.
- If the individual does not have an employer, he or she needs to get the city coverage or buy private, individual insurance. These individuals might include retirees who do not yet get Medicare, people unable to work, and self-employed people. Individuals with incomes above 350% of the FPL will pay full price for the local government plan, but that still will usually be less than they are currently paying for individual policies. Those individuals below the 350% FPL level will pay on a sliding scale.
E. Who administers the plan?
- The local plan would be administered by either an insurance company or a quasi-public entity hired by the local government.
F. How is the plan funded?
- The plan is designed to be self-supporting. The service fee or tax on employers will fund the program, along with premiums paid by individuals.
G. Final Plan
- The specifics of a provide-or-pay plan for a particular community cannot be determined until an actuarial study is made of that community and the benefits its people want to include. This study would consider such matters as: average age of citizens, types of businesses in the community, general health of residents, expected number of people who will be part of the insured pool, etc. Based on other states that have already considered provide-or-pay plans, we believe the final costs will be reasonable to businesses and individuals alike. At last, it will be possible for all citizens to have affordable, comprehensive health insurance.
* For more information, please see the Maryland plan for an example of their proposed provide-or-pay plan.