Compromising on health reform

National health reformers are looking to Pennsylvania for inspiration.

The debate over how to reform the U.S. health care system has some experts looking anew at the strengths and weaknesses of state and regional programs, including one in Pennsylvania. WHYY reports on one idea that would create a network of regional or state-level health insurance cooperatives.

Listen: [audio:090622tecoverage.mp3]

Experts say the cooperatives would be heavily supported with tax payer money, similar to Pennsylvania’s AdultBasic program. But there’d be no direct government control.

Valerie Arkoosh is president-elect of the National Physicians Alliance. She says a cooperative would have difficulty competing with well-established insurance companies.

Arkoosh: And it’s not clear that it would be big enough to spread the risk adequately, if for instance a number of very sick signed up for it, you’d need a counterbalance of a number of healthy patients in the plan.

The Physicians Alliance prefers a new government-run plan that would be available to people nationwide, and have more buying power in the marketplace. But others say a government-run plan may have very limited options, like Pennsylvania’s AdultBasic program which does not offer behavioral health or prescription drug benefits.

Robert Field leads health policy studies at Philadelphia’s University of the Sciences. He says taking Pennsylvania’s AdultBasic idea nationwide would create big regulatory challenges. AdultBasic is limited to low-income residents.

Field: The national plan would have to cover everyone that didn’t have access to insurance which would include some middle-class and even upper middle class people. The national plan would have to be much larger and that opens up a hornet’s nest, a whole range of new problems.

AdultBasic is administered by the Commonwealth. But experts say the health reform ideas with the greatest bi-partisan support are plans without direct government control.