Healthcare Council Policy Review
October Edition 2008
Pharmacy Opens First In-store Clinic
Massachusetts took a bold move this month with the state’s first MinuteClinic. In two rooms seemingly copied from a doctors’ office and implanted into a CVS, nurse practitioners tending to their patients. The clinic’s opening, the first of 28 planned this year in Massachusetts, follows months of controversy surrounding in-store retail clinics in the state in the midst of a shortage of primary-care doctors. The clinic is open nights and weekends and offer a flashy, digital menu of treatments for a variety of minor illness. Treatment for a cold sore will run you $59 while for $10 more, they can help you with your case of mononucleosis. You can also stop by for a $30 flu vaccine. Prices vary depending on a person’s insurance plan and anything more serious requires the emergency room or a family physician.
MinuteClinic began pushing its way into the Massachusetts market more than a year ago, but was met with fierce opposition from doctors and others, including the mayor, who worry that the clinics could fragment healthcare and compromise quality. The clinic’s chief nursing officer says that they aren’t there to disrupt health care; they’re just there to enhance it. MinuteClinic shares patient records with all clinics, both in Massachusetts and in other states. They also make an effort to provide a patient’s primary physician with a record of the visit. If the patient doesn’t have a physician, nurses are supposed to help find one. Since MinuteClinic got started in CVS, Walgreens Pharmacy has submitted plans for 15 of its own clinics.
Pharmacy Opens State’s First In-store Clinic
Candidates’ Healthcare Plans Come Up Short
According to two articles published in a leading policy journal, neither of the presidential candidates has proposed workable fixes to the nation’s most significant healthcare problems. Senator McCain’s reform plan wouldn’t reduce the ranks of the uninsured while Senator Obama’s plan wouldn’t stem rapidly rising healthcare costs.
McCain’s plan will foster competition among health insurers, but it won’t reduce the number of people without medical coverage. The Arizona senator wants to eliminate $200 billion in tax deductions on health insurance premiums paid by employers and employees. Uninsured families would get a $5,000 tax credit to buy insurance ($2,500 for an individual). McCain would also allow consumers to purchase health plans across state lines. Eliminating the tax credit will induce employers to stop offering coverage to as many as 20 million workers who currently have employer-based health insurance, the authors estimate. At the same time, tax credits and insurance-market innovations will allow an estimated 21 million people who are uninsured to purchase coverage. Innovations include the sale of so-called bare-bones insurance plans that offer reduced benefits at a lower cost. The net gain in people covered by insurance will be about 1 million people. However, that will disappear because tax credits aren’t set to rise along with the cost of health care premiums, making insurance unaffordable. By their calculations, upward of forty million Americans would be uninsured with that number likely to grow over time. Meanwhile, millions of people who newly purchase insurance under McCain’s plan will find themselves with less than comprehensive coverage. By creating a national marketplace for insurance, competition will likely flourish, but state laws that guarantee a measure of consumer protection will be superceded.
The second half of the articles argues that Obama’s plan, which favors much tighter regulation of health insurance won’t do nearly enough to bring down health care costs, a primary reason why millions of Americans are uninsured or unable to pay medical bills. The Illinois senator would retain the existing system of employer-based insurance coverage while creating a new government-sponsored option known as the National Health Plan. He’d also set up a new “Health Insurance Exchange,” essentially, a one-stop-shopping setup for health insurance. All exchange participants, including private insurers and the National Health Plan, would have to follow the same rules, providing a minimum set of benefits, offering policies to all comers at uniform rates and meeting certain minimum quality standards. Meanwhile, every employer would be required to offer insurance to workers or pay into a fund. Small businesses would be excluded. All children would be guaranteed health coverage, and subsidies would be available to low- income families. All of these measures “extend the control of government over health insurance, imposing new requirements that will drive up the cost of insurance unless the savings from other policies materialize. None of the policies Obama has proposed to reduce health care costs have been proven to yield significant savings as yet. If health care is promised to more Americans but not made more affordable, and if the government says it will help people shoulder the expense, federal subsidies will grow rapidly and become unsustainable over time.
Candidates’ Health Plans Come Up Short
Feds Call for Eliminating Illinois Law Regulating Hospitals’ Construction
Two federal agencies are calling for the elimination of an Illinois law regulating hospital construction and expansions, saying it shortchanges consumers by weakening competition that would help control healthcare costs. The agencies suggest states let the free market decide what gets built, which some states have done by repealing or scaling back similar laws. The board has been controversial for many years and has been accused of favoring projects pushed by influential lobbyists and thwarting potential competition and innovation should hospitals want to build specialized facilities. Proponents claim that hospitals are allowed to build unregulated tend to expand in affluent areas to tap wealthy patients with health insurance.
Some believe that the requirements have unfairly scuttled many new hospitals proposed for the suburbs. Plainfield had plans for Naperville’s Edward Hospital to build a new $246 million facility that the state rejected. Edward’s proposal has been back-and forth in various forms before the facilities planning board since 2003 and was most recently denied in August. Lake County officials are bracing themselves for the rejection of the area’s first new hospital in 30 years. The facility would have been a 140-bed, $100 million hospital in Lindenhurst.
The state’s certificate-of-need application process has been criticized for being bureaucratic and expensive. Senator Susan Garrett said that the process is unfair but that lawmakers probably won’t get rid of the health facilities planning board or eliminate the CON process entirely. During a time when the economy is going through a downturn, she said it’s unlikely they would remove their oversight of the massive health expenditures. She also stated that although the free market idea is good in theory, there isn’t any evidence that states without such laws have seen lower health-care costs or an increase in access. Senator Bill Brady believes that the fact that half the states have done away with certificate-of-needs laws offers a valid argument against the process. Florida, Georgia and Alaska have requested and received similar analysis and used it to scale back their CON laws. The recent convictions of a facility planning board member and a former political fundraiser for accepting kickbacks from a construction company should give lawmakers pause, Brady added. Most states adopted certificate –of-needs laws to cap or limit runaway healthcare spending and market over-saturation.
Feds Call for Eliminating Illinois Law Regulating Hospitals’ Construction
Feds: Illinois Hospital Regulation Keeps Health Costs High
Hospital Approval Law under Fire: U.S. Antitrust Agencies Decry Illinois Process
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