Nebraska’s physician association plans to have a bill introduced in the next legislative session that would require people to have health insurance.

The proposal likely would include three other provisions designed to make health coverage affordable to all, stabilize costs and ensure portability.

Dr. Les Spry of Lincoln, incoming president of the Nebraska Medical Association, said the package would slowly wean state residents from employer-based health coverage, but other parts of the plan would protect lower group rates and other benefits of employer-based insurance.

Slightly more than half of all Nebraskans are insured through company or union plans. One in eight, or 237,000 Nebraskans, were uninsured for all of 2007.

Mandated health coverage might work like the state requirement for car insurance. The program would require a system to verify proof of insurance.

The state’s physician association has been promoting a 14-point health care reform package modeled on a Massachusetts plan, a state-subsidized program requiring every resident older than 18 to have health insurance, with penalties for those who go without.

Spry said recently the group is deciding which of those 14 points to include in its initial effort.

“Within our organization, there are those who would like to see all 14,” he said. “I don’t know that that’s possible.”

Dr. John Benson Jr., professor at the University of Nebraska Medical Center, is one of those pushing for adoption of the full plan.

“My goal is to not piece this out,” he said recently. “I see incrementalism as part of the problem since 1965 (the year Medicare was created).”

Benson said it was an issue of paying more to implement health reform now or paying even more later because of runaway costs.

The association is putting the final touches on its proposal as yet another Nebraska health care costs study is adding to the growing impetus for change.

Families USA said Thursday that health care premiums for family coverage in Nebraska rose by 69 percent during 2000-07. Meanwhile, median earnings for state employees rose 21 percent.

For family health coverage provided through the work place in Nebraska, annual health insurance premiums in the 2000-07 period rose from $6,760 to $11,434, an increase of $4,674, or 69.1 percent.

Between 2000 and 2007, the median earnings of Nebraska’s workers increased from $21,255 to $25,802, an increase of $4,547, or 21.4 percent.

“Skyrocketing health care costs were a problem in Nebraska before the current economic downturn, and slow wage growth or job losses now only make matters worse,” said Ron Pollack, director of Families USA.

The latest statistics dovetail with those the medical association uses to underline a need for reform. Overall, their numbers show that while costs are rising, access is falling and the quality of care delivered isn’t great.

* Costs. Each person in Nebraska will spend an average of about $7,200 on health care this year, for a total bill of $13 billion. It cost an average of $13,000 in premiums for family health coverage in 2008.

* Access. The cost of providing care to the 237,000 uninsured Nebraskans is passed on as higher premiums to those who are privately insured. In 2005, those costs added $918 to each Nebraska policy for family coverage.

* Quality. Studies show just 55 percent of indicated care is delivered to adults. The remainder is wrong, unnecessary, expensive or risky care. An estimated 1,500 Nebraskans each year die due to lack of timely and appropriate care, and 650 to 700 deaths occur annually due to hospital infections or medical errors.

Nationally, presidential candidates John McCain and Barack Obama have offered competing health reform plans.

McCain’s would restructure insurance using tax incentives and promises liability reform. Like the state association’s plan, it would separate employers from the provision of health care.

Obama’s would tie health care more firmly to employers, requiring all but the smallest businesses to offer health insurance or pay a fine.

Critics have raised doubts that McCain’s plan would do much to expand access to care or that Obama’s would be affordable.

The record national debt, bank industry bailouts, a slowing economy and campaign tax promises threaten to make a casualty of either option in the near term.

In Nebraska, finances also could derail the association’s reforms.

Spry said that in conversations with Gov. Dave Heineman, he’s indicated that if the program costs money, he’s not interested.

Program start-up costs, Spry said, would be expensive.

On the other hand, he said, surveys show a majority of Nebraskans think health care is broken or too expensive.

To make it more affordable, he said, more of the 237,000 uninsured Nebraskans, who often receive inefficient care from hospital emergency rooms, need to buy into the program.

Three provisions likely to form the cornerstone of a mandated insurance program, he said, would help level costs, making health coverage more affordable for younger people in the state.

* Everybody living in a community — yet to be defined — would pay similar insurance premiums, regardless of existing medical conditions. Some variation in premiums would be allowed for lifestyle choices.

*  The ability to renew health insurance would be guaranteed.

* The portability of health insurance would be guaranteed.

Any type of reform, Spry said, would also have to make better use of public health to prevent disease, “or this would be way too expensive.”

The association plan, he said, “has the potential to save a lot of money.” It would redirect the provision of health care.

“Our state would be a leader compared with other states.

Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.