Health Insurance

1. Affordable Insurance For All

"Covering All Pennsylvanians" or CAP is part of this "Prescription." By this, Rendell intends provide affordable health insurance to everyone in Pennsylvania, especially to those who make less than the State's average income of $39,000. Two specific groups that this program is looking to provide health insurance for include:

small businesses without health insurance

employed but no insurance

2. Small Business Health Insurance

Providing health insurance for small businesses is designed to encourage business growth in Pennsylvania, and help employees to be able to meet their own health needs along with their employers. If the business chooses to join the CAP program, the employer will pay only about $130 for each employee, and the employee will need to pay anywhere between $10 and $70 each month.

3. Employed But No Insurance

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

In addition to this, the Governor also announced plans to provide financial help where it may be needed. Those who can get this help are those who bring home less than $60,000 a year.

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

Several areas in the new program are targeted to curb overgrown and unnecessary health care costs. These targeted areas will help reduce billions of dollars spent each year and will help reduce the overall cost, making a health insurance plan more affordable. Here are some of the features that have been specifically mentioned:

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:

Governor Rendell is proposing the use of medical attendants like nurses and possibly dental technicians in a wider capacity as they are trained to do more than they are generally permitted to do. For example, in a nurse-controlled medical facility, nurses may not be permitted to do things like stitching wounds, treating infected toenails, or removing moles, if these nurses were in a doctor-controlled facility, they would regularly perform these tasks. Costs will be reduced by allowing nurses to perform these medical treatments on a statewide basis, allowing doctors to perform functions that are targeted to their specialized training.

Another example is the distribution of prescriptions during the birthing process. Many mid-wives and nurse practitioners already deliver as many as 10% of the babies in PA, and it seems like it should merely be the natural progression of their services into this arena, as well.

Nurse care in such fields as has been mentioned here, and others, would reduce health insurance costs as nurses do not charge much as doctors do for their services.

Reducing Costs Through Rebates:

For small business plans, Rendell proposes a rebate if an employer's medical costs for their group plan uses less than 75% of the collected premiums. The insurer would then provide a rebate to each of the employees. For those years in which expenses are lower than expected, costs would be less for the employer and employee. It is uncertain how the insurers would fund claims for the groups whose claims exceed 200% or even 500% of their premiums. If this is done on an overall loss ratio basis, it would be of great benefit to employers.

With the many changes that will soon change health insurance in Pennsylvania in a positive way, it appears that many people will receive better healthcare. The Prescription for Pennsylvania may truly be a real good thingonly time will tell.