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Doctors' plan could include mandatory health coverage

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By JoANNE YOUNG / Lincoln Journal Star

Saturday, Sep 08, 2007 - 12:38:44 am CDT

OMAHA — Doctors in Nebraska are devising a plan they hope can help reduce unnecessary medical expenses and get medical care to every person in the state.

The proposal could require all Nebraskans who are not covered by Medicare to have a health insurance plan that includes preventive, mental health, dental and long-term care.

Insurance for low-income residents could be subsidized using Medicaid funds. And insurers could have to guarantee they would provide and renew policies, with no rejection for people who develop illnesses.

Story Photo
Dr. Rob Rhodes examines Dorothy Barneke at Clinic With a Heart in 2005. The free clinic services Lincoln residents who don't have access to quality health care due to a lack of health insurance. (LJS file)
Health reform
  • Health reform being considered by a task force of the Nebraska Medical Association could include: a requirement for all Nebraskans to have a health insurance plan, with subsidies for low-income residents; guarantees by insurers to provide and renew policies; taxes for employers and penalties for people who do not participate.
  • Drs. Richard O’Brien, Creighton Center for Health Policy and Ethics, and John Benson, professor of internal medicine at the University of Nebraska Medical Center, are co-chairs of the health care reform task force. Lincoln doctors on the task force are: Derrick Anderson, Krynn Buckley, David Dyke, Chuck Gregorius, Dale Michels, Dan Noble and Michelle Petersen.
  • Massachusetts passed comprehensive health reform last year that requires health insurance for all residents. People with the lowest income get free coverage. People with low and moderate income can buy health insurance on a sliding scale fee. Adults who do not qualify for free or subsidized health insurance or a waiver must pay a penalty. Employers - except for very small businesses - must offer their employees health insurance and pay a fair share of the cost, or else pay a penalty.

On Friday, a task force of 25 doctors — members of the Nebraska Medical Association — presented a preliminary report on its work to the association’s house of delegates, at its annual meeting in Omaha. The task force will continue to develop the plan in the months ahead.

The group’s goal is to come up with a plan that provides quality, affordable and accessible health care coverage for all Nebraskans while exploring whether medical practice guidelines can reduce unnecessary expense and create reasonable expectations on the part of patients.

Dr. Rowen Zetterman, the association’s president, told the doctors gathered that about 194,000 Nebraskans were uninsured in 2006. Estimates are that 75 people die each year because they don’t have insurance.

Nearly one-third of Latinos and Natives in Nebraska are uninsured.

The biggest group of uninsured Nebraskans are 19 to 34.

Dr. Richard O’Brien, with the Creighton Center for Health Policy and Ethics and co-chairman of the task force, said uninsured Nebraskans add $343 to each insured single person’s premium each year. They add $918 annually to each family policy.

Per-person health expenditures in Nebraska hit $6,339 last year.

The doctors believe there is more than enough money in Nebraska’s health system to pay for any health reform proposal.

Those sources could include: premiums from employers and individuals; existing state and federal Medicaid funds; a payroll tax for employers who do not provide health insurance; penalties for people who do not enroll in the plan; and potential taxes on tobacco and alcohol.

If health plans are required, the task force has considered ways for people to verify they have policies. They include requiring submission of evidence of insurance when filing state tax returns, paying property taxes, enrolling children in school, registering an automobile, obtaining a driver’s license or seeking health care.

At the task force meeting next week, the group will discuss: requiring malpractice claims to be reviewed by a panel of experts before any case could be brought to court, requiring hospitals to report medical errors and hospital-acquired infection rates and a public education program.

 O’Brien said the Nebraska Hospital Association has balked at any required reporting of medical errors and infection rates.

Details of the implementation, he said, would be subject to negotiation with hospitals, insurers, employers, legislators and other interested groups.

Dr. Ron Klutman of Columbus, a task force member, told the doctors that what Nebraska physicians are attempting to do could never be accomplished nationally, but it could happen locally.

“I think we have some chance here,” he said.

State Sen. Joel Johnson of Kearney, who is a retired surgeon, told delegates he had nothing but praise for what the task force has done so far.

“I don’t think we have to rush into this,” he said. “We can work at it.”

Johnson raised a caution flag, saying that any proposed legislation will require agreement  from other groups.

“Any legislation coming out of the Nebraska Medical Association by itself will go nowhere,” he said.

Reach JoAnne Young at 473-7228 or jyoung@journalstar.com.


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RN wrote on September 8, 2007 7:41 am:
" Guess them doctors want to be sure they get paid. Health care is a business in this country when it should be a service. "

 Scott Phelps wrote on September 8, 2007 8:46 am:
" Great idea--but shouldn't the plan also demand that those whom are covered be LEGAL RESIDENTS of the US & Nebraska? "

 Social Worker wrote on September 8, 2007 11:24 am:
" I think this plan would be great considering I work in a hospital and see just how much free medical care is given away. Besides most of what I see is people in crisis. (which costs the most) This plan may help provide some preventive care to stop the Emergency Department visits. I am curious to know who would all be involved in the funding of this and how it will effect the average middle class Nebraskan, but I still think either state coverage or MORE resources for those without insurance is needed, because no matter what the uninsured at one point or another will need to be seen and remember no hospital can turn them away so it will cost no matter which way you look at it. I would like to see something change especially if there is a way for people to help themselves. "

 Ron Kriha wrote on September 8, 2007 11:28 am:
" Sure...another plan to increase the coffers of parasitic insurance companies. The medical community needs accept that what they charge for their services is totally out of line for the average person to pay. Thus, insurance companies, enter the mix and laugh all the way to the bank. "

 Disgusted wrote on September 8, 2007 1:17 pm:
" Ron Kriha is exactly right. Miss with my company insurance and they will up the premiums faster than lighting even though I worked there. The cost of medical & doctors is twice what I paid in my former state. One Dr. tried to make me pay a big bill and medicare said I DID NOT owe it. Apparently they tried to pull a fast one, because they quit billing me and medicare didn't pay either. Medicare isn't all bad, because there are doctors & hospitals that will clean your clock financially. I get a little tired of paying for my health care and all the uninsureds' too. Too many of these doctors have you coming every six months when you aren't or haven't even been sick, then increase the office call, just to walk in the door from $140.00 to the next six month to $160.00. This is what you get in a dinky town like Lincoln that refuses to grow so there is no competition. Its the clicks town and you pay or move out!! "

 JR wrote on September 8, 2007 1:43 pm:
" I think it is great this group is trying a positive approach as opposed to sitting back and whinning like some people on here. Too bad our poloiticians don't try harder to help Nebraskans instead of just trying to please their base. And here, you would think a strong "family values' state like Nebraska would be more concerned with helping the needy. HA "

 Liberal Republican wrote on September 8, 2007 4:50 pm:
" I agree, there must be major changes! But wouldn't this be like "mandatory" auto liability that results in a system where we must buy a policy against uninsured motorists? We know how well that system works! I'm for personal responsibility and to reduce medical costs to the point where a mid income person can afford the cost. If one has insurance, do they care what medical service costs? Wouldn't this idea be expanding the insurance pool to cover irresponsible people? It appears that much of the cost is caused by the "emergency" care system and poor life style choices. Thanks to Bush and the church folks, I'm almost a Democrat, so don't bash me too hard! As I said, the whole system needs changed! "

 CS wrote on September 8, 2007 5:31 pm:
" If your office call is 160.00 you should go to a different doctor. There is no one in Lincoln, of the 4-5 practices and insurance plans that I and my family have had used, that charged more than 30-50 for an office visit. "

 Eric wrote on September 8, 2007 6:34 pm:
" Require health insurance and the state better be ready to pay for it. They CANNOT require health insurance. Period. I can see a fight brewing over this. "

 Jacob King wrote on September 9, 2007 12:47 am:
" After reading this article I was left with the nagging question, “is there and ulterior motive here?" A group of doctors, whose interest may not be just the welfare of Nebraska’s citizens, proposed this plan. Is it possible that I am the only one who sees that maybe what is really motivating them is a desire to decrease the amount of free care given out to people in emergency rooms, because of lacking health coverage? This article talks about making sure that those who cannot afford commercial health insurance, are covered by Medicaid. Well here is something to consider. My wife and I both work minimum wage jobs, and attend school full time. Neither of us is eligible, let alone capable of buying health insurance through our employment. We were just told by H&HS that we could not qualify for Medicaid coverage. It was explained to us in a letter from an H&HS employee that in order to qualify for this we would have to make less than $584 per month for a family of four. Now, add to this the fact that in order for us to qualify for food stamp benefits, my wife and I must both work a minimum of 20 hours each, per week at minimum wage or higher. When you do the math that adds up to around $936 per month of income. If we do not maintain this then we loose the generous $225 per month in food stamps we get. So can someone please explain to me how mandating health care is going to help me? As things are, my wife and I can barely afford to take care of our family. On top of this, some group of doctors now wants to mandate that I have some form of health insurance, or that I be fined. It is clear that I am not eligible for Medicaid, so under this new plan, the best I can hope for is some sort of discount. I appreciate that some people want everyone to be covered, but I question their motives, and their plan of action. For this plan to work some serious evaluation of the Medicaid system, and its eligibility requirements must be done. I fear that without proper planning this idea may only serve to burden a group of people who already carry a heavy weight. "

 Christine wrote on September 9, 2007 10:17 am:
" This is the worst idea I have ever heard. First, who says the profits made off of the 11% of uninsured Nebraskans will be returned to other insurance payers? Health insurance are for-profit private sector businesses. Your bill will not decrease. I would also like to know how the numbers of $343 and $918 are reached. This is not affordable to a majority of people. I am not low-income, and I would not receive aid, but making only 15,000 a year and attending school full time makes it impossible. I would literally have to move (add to the brain drain?). Second, the type of insurance I could afford would most likely have an extremely high deductible. The office or hospital that I attend would still be SOL if I could not pay my deductible. Place more emphasis on tax-free, rollover health savings plans. The least likely insured group is also the most healthy, most likely to recover enough (which increases the likelihood they could collect on bills), and spends the least on healthcare. At age 21, I have not spend $6,000 in the last five years combined. I suspect if I get in a major accident, I will go into debt, but it is not comparable to what I would experience if I had to pay ALL the healthcare (how many insured Nebraskans have dental right now?). Saddle youth up with more debt... school, life, etc. You're just encouraging us to stay "children" longer. It is difficult being financially responsible as a young adult with the amount of debt we have, and attempting to add this? No way. Besides, it's not going to save any of you a dime. Worst idea ever. "

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