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Praise, pans for ACP-ASIM universal coverage plan. (Goal Set for 2009).

WASHINGTON -- A plan that lays out a prescriptive timeline for Congress to achieve "steps" toward universal health care coverage within 7 years received kudos for its constructiveness but slim odds for its adoption.

The plan, developed by the American College of Physicians-American Society of Internal Medicine, is not an attempt to replace the existing health care system, ACP-ASIM President Sara Walker said. Instead, ACP-ASIM suggests keeping the strongest aspects of the current system and expanding programs that are already in place, she said at a press briefing where the plan was unveiled.

If the plan went forward without a hitch, Congress would adopt a resolution this year to make health insurance coverage available to all citizens within 7 years. An advisory commission also would be created to report annually on measures to expand health insurance coverage.

In 2003 Congress would enact legislation making affordable coverage available to people with incomes up to 200% of the federal poverty level. The bill would create national income eligibility for Medicaid--up to 100% of the poverty level. In ACP-ASIM's estimation, these steps would make coverage available to more than one-third of the uninsured population.

The State Children's Health Insurance Program would be converted to a federal-state entitlement program, and the federal contribution to Medicaid would be augmented to cover costs of expanded enrollment. In addition, a premium subsidy program for people with incomes from 100% to 200% of the poverty level would be applied to Medicaid or SCHIP "buy-ins" or toward the purchase of individual or employer coverage. Jan. 1, 2005, would be the proposed deadline to enact these programs.

By December 2004 Congress would enact a bill expanding the premium subsidy program to uninsured individuals with incomes above 200% of poverty. The legislation would authorize the creation of purchasing groups and establish basic benefit requirements and market reforms for health plans. These new coverage options would go into effect Jan. 1, 2007.

Go forward another year, and Congress would have enacted legislation to authorize states to request a waiver to opt out of the national framework for coverage. The waiver requests would begin on Jan. 1, 2007.

States meeting federal guidelines would be able to use federal funding for state programs.

In the final step of the proposal, the National Commission on Expanded Access would submit a recommendation to Congress on mechanisms to discourage individuals from voluntarily opting out of insurance coverage. Programs that provide coverage to people who would otherwise opt out and financial incentives to obtain coverage would go into effect on Jan. 1, 2009.

Robert Doherty, ACP-ASIM's senior vice president for governmental affairs and public policy, acknowledged that not all of the plan components may be adopted.

"We'll try to get a commitment to support some of the [proposals] and get our [ACP-ASIM] chapters in discussions around the country," he told reporters when the plan was unveiled at the annual meeting of ACP-ASIM in Philadelphia.

The plan got mixed reviews from members of Congress, however, when it was introduced on Capitol Hill several weeks later.

While applauding ACP-ASIM for approaching the issue in a constructive manner, Rep. Jim McCrery (R-La.), who sits on the House Ways and Means Committee, said that the plan "would lead us to where we're already headed, with the government taking over our health care system."

Alan Weil of the Urban Institute in Washington lauded the incremental steps of the reform plan and the concept of combining complete subsidies for the poor and partial subsidies for people in higher income brackets.

Subsidies, however, are a difficult concept to address in health care reform, he added. "There are big ideological disagreements on what is the government's role and what is the private sector's role in subsidies."

Implementing this type of plan isn't going to be cheap, either, Mr. Weil said.

The college has yet to conduct a financial analysis of the proposal, Mr. Doherty said. "Certain elements haven't been worked out, and that would affect the cost."
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Title Annotation:American College of Physicians-American Society of Internal Medicine
Author:Silverman, Jennifer
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jun 1, 2002
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