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Pennsylvania Joins Universal Coverage Race

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Pennsylvania Gov. Edward Rendell has unveiled a health care coverage proposal that builds on plans adopted in Massachusetts and announced in California.

Rendell, a Democrat, proposes that Pennsylvania phase in a plan making health insurance available to all adults. He estimates the plan would extend coverage to around 767,000 uninsured adult Pennsylvanians.

Pennsylvanians pay around $1.4 billion a year to cover the uninsured or underinsured, he estimated.

Rendell calls for the state to work with private health insurers to set up a “Cover All Pennsylvanians” program that would provide subsidized and discounted health coverage for small business and to individual adults, regardless of income.

Businesses could participate in CAP if they had not offered health care to their employees in the previous 6 months, if they have fewer than 50 employees and if their employees earn less than the state average, currently around $39,000.

Employers would pay about $130 per employee per month, while employees could buy into the plan on a sliding scale ranging from $10 to $70 a month.

The plan would also enable any uninsured adult to buy coverage individually at an estimated cost of $280 a month if they have incomes greater than 3 times the federal poverty level.

Businesses that fail to insure employees would have to pay a “fair share assessment,” Rendell says. Businesses with fewer than 50 employees would be exempt from that assessment in the first year.

Pennsylvania also would impose an adjusted community rating system that would prohibit insurers from using insured characteristics such as health status and gender in setting rates, Rendell says.

Full-time, 4-year college and graduate students would also be required to have insurance coverage.

Rendell’s plan includes 3 ideas not featured in the California and Massachusetts plans:

–A new regulation requiring hospitals to use electronic health record systems.

–A program to decrease dependence on emergency rooms by providing incentives for doctors and other health care providers who offer services in the evening and on weekends.

–A regulatory change that would permit nurses, advanced nurse practitioners, midwives and other licensed health care providers to provide more care with less direct physician supervision.

Rendell said the state spends $7.6 billion each year on avoidable health costs, including treatments that could be cut if proper medical attention were available in the early stages of an illness.

He will spell out details of his plans as part of his budget proposal to the legislature in February. If enacted, the CAP plan would go into effect in January 2008, he said.

–Trevor Thomas contributed to this story.


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