Addendum to Spring Voter

LWVGD Health Care Chair Jo Ann Fields, M.D., introduced the panel discussion on health care access in Delaware by summarizing the major points of Delaware Senate Bill 6. The bill proposes a health insurance pool for small businesses, non-profit agencies and individuals.

Dr. Fields predicted that enactment of the bill would lower insurance premiums for these groups by 30-35% by budgeting $13 million to cover 300,000 people. Eligibility for individuals would be restricted to those earning less than $30,000/year. Governor Minner's proposed 2008 budget includes only $5 million to fund a health insurance pool. She felt that the weak point of the bill was that participation in the pool is not mandatory.

The bill has since been passed overwhelmingly by the state Senate but now has to go through the House which rejected it last year.

A second topic of the forum was the Children's Health Insurance Plan (CHIP) a federal program enacted in 1997 to help states assist those with incomes too high to qualify for Medicaid. The federal CHIP statute comes up for renewal this year with funding criteria and levels that could result in more uninsured children.

Finally, Dr. Fields cited Governor Minner's proposal to increase Delaware's cigarette tax by $.45 a pack to cover increasing costs of health care programs. The increased price per pack would still be less than that charged in surrounding states.

Vicenta Marquez, M.D., Head of Hope Medical Clinic, described the primary care services provided by her all-volunteer staffed clinic which treats uninsured adults not covered by Medicare or Medicaid. Opened in collaboration with the Modern Maturity Center, Hope Clinic has seen 1054 patients and provided over 5000 consultations. 99% of medications are given without charge. Patients include uninsured full-time workers, temporary workers in training, seasonal workers, those unable to afford insurance, newly divorced individuals no longer covered by the spouse's insurance, those who lose jobs but still earn $5.00 above the poverty line, new college graduates looking for jobs, and high school graduates not yet working.

Unfortunately, the Hope Clinic can only provide medical bridge care. Funding is provided primarily by the local donations. Foundation and government grants are not usually awarded to such small-scale operations. Medications are donated by local physicians and pharmaceutical representatives, but these supply sources are inconsistent. Volunteer practitioners are not covered by malpractice insurance. Dr. Marquez stressed that there is a need for a change in culture about how we view medical care, with an increasing emphasis being placed on education in preventive health care.

David Michalik, senior administrator of the Delaware Division of Medicaid and Medical Assistance, addressed reauthorization prospects of the federal CHIP legislation. Enacted in 1997, CHIP was supposed to cover children from low-income families whose incomes were higher than those qualifying for Medicaid. The legislation was intended to cover three million children nationwide and today covers four million. However, nine million children are currently in need of health insurance coverage.

Delaware's CHIP program covers 5,200 children (ages 0- 18), but 2,200 are not covered and that number is rising. Dental coverage has recently been added to Delaware's CHIP program. Under the 2007 federal reauthorization proposed by the Bush Administration, CHIP funds will remain at their current level. Without any expansion, however, 14 states will lose CHIP coverage due to insufficient funds. Congressional proposals for funding increases will still not cover all the nine million children in need of support. Some states have sought to expand the CHIP program to cover pregnant women, but these proposals have proven controversial because of adult coverage, and have not been supported by the Bush Administration. Delaware receives a fixed CHIP allotment of $11 million from the federal government for use over three years.

Joann Hasse, LWVDE Health Care Chair, commented that SB6 does not cover enough people but might keep some from falling through the cracks in insurance coverage. The bill also mandates that companies with state insurance contracts submit bids to participate in the pool. She expressed concern, however, that the $13 million appropriated in the bill would not be enough funding two years hence and questioned whether Delaware would be able to afford the increasing cost of insurance pool coverage. Ms. Hasse also referred to HB49, which would increase the cigarette tax to $1 a pack, making Delaware's tax equal to that of Maryland. She added that much of the funding provided by the tobacco settlement has gone to support the state's prescription drug program.

Ms. Hasse highlighted the Delaware Health Information Network, which allows for the exchange of information on lab results between hospitals, labs and physicians. Delaware is the first state to mandate standardized formats for reporting lab results, thereby facilitating the prompt exchange and transmitting of information.

Insurance Commissioner Matt Denn made an appearance at the close of the panel discussion to comment on Delaware's passage of legislation to extend children's coverage on their parent's health insurance from age 18 to 24 with only a minimal surcharge. He also addressed SB36, which would allow Delaware to regulate health insurance rates. Only 10 states currently allow insurance companies the discretion to charge any rates they wish, and Delaware is among them. SB36 passed the State Senate in 2006, but not the House. Commissioner Denn reiterated that SB6 (insurance pool legislation) will not provide affordable health insurance for everyone in the state, but can be expanded to include more people.

All the panelists, including the Commissioner, urged the public to express their concerns about health care coverage to their legislators in order to counter the clout of insurance company lobbyists at Legislative Hall. They specifically stressed the urgency of contacting House members to pass SB6.

Dr. Fields encouraged people to contact her with any ideas on how to lower the cost of health care. She can be reached at joannfields@verizon.net.