Pennsylvania
Health Policy rankings
| Health policy rankings | Rank |
| Population | 12,212,934 |
| Number of insurance mandates | 38 |
| Death rate per 100,000 | 814.5 |
| Percent of adults overweight or obese | 59.20% |
| Percent of adults who have visited a dentist in the last 12 months | 69.90% |
| Number of births (2004) | 144,748 |
Ranking public policy | Rank |
| Overall health ownership rank | 16 |
| Government health care rank | 8 |
| Private health insurance rank | 19 |
| Medical tort rank | 36 |
Provider burden of regulation rank | 17 |
Sources
*Policy ranks are from the U.S. Index of Health Ownership, published by the Pacific Research Institute.
*Health indicators are from State Health Facts, a service of the Kaiser Family Foundation.
*Number of insurance mandates comes from Health Insurance Mandates in the States 2007 (PDF), a publication of the Council for Affordable Health Insurance.
State Policy Network member
State offices
Thursday, May 1, 2008PA Senate GOP offers alternative health care planBy Nathan BenefieldCategories: PennsylvaniaThe Pittsburgh Post-Gazette summarizes a hearing on health care affordability in Pennsylvania. Rick Dreyfuss of the Commonwealth Foundation was among those to testify (his testimony is here). The focus was on a number of market-based solutions, proposed by Senator Folmer, vs. Governor Rendell's proposed expansion of existing subsidies for government insurance programs.
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Thursday, March 27, 2008RendellCare lobbyist push community ratingBy Nathan BenefieldCategories: Insurance Regulation, PennsylvaniaThe legislation they are lobbying for imposes a modified "community rating" on all insurance providers. Community rating means that insurance companies can't charge different rates for different individuals. While this sounds good on the surface, what it means is that younger, healthier workers would pay higher premiums, while the old and sick may pay less. In addition, insurance companies wouldn't be able to charge smokers more (which seems odd given the anti-smoking campaign of RendellCare), nor would they be able to offer discounts for "healthy behavior" - i.e. wellness or fitness programs. Community ratings drive up the number of uninsured, and discourage younger, healthier customers from buying health insurance (even when health insurance is mandated, as in Massachusetts). Read more about community rating in the ALEC/CAHI State Legislator's Guide to Health Care. The RendellCare lobbyists claim that community rating would "help small businesses" and protect us from the big bad insurance companies. But small businesses oppose community rating, and many insurance companies favor it (including many of the big carriers), as they simply shift their cost to some people more while charging others less. Instead, here are some actual reforms that reduce the cost of health care for everyone - insured and uninsured, employer-provided and individual purchasers, young and old, sick and healthy, smokers and the physically fit.
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Monday, March 17, 2008Stateline: Socialized Medicine = Fiscally ConservativeBy Nathan BenefieldCategories: California, PennsylvaniaStateline.org has an interesting article on health care funding in the states. The headline reads "On health care, govs are tightening belts." Here are some examples of "belt-tightening": Governors in California, Illinois and Pennsylvania couldn’t get major universal coverage measures through their legislatures last year. They all vowed early this year to press the issue again. ...Apparently belt tightening means that a few states are delaying major spending increases, while the rest of the state continue to push massive expansions of government program and tax hikes. I think a lot of governors' need to learn the concept of a spending diet.
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Thursday, February 7, 2008Can Families USA Count?Its Cost-Shift Numbers Make One Wonder By Linda GormanCategories: PennsylvaniaThe magic number being used to gin up support for a Massachusetts-style more-government-is-better health care reform in Colorado is $950, as in the "cost of doing nothing" about health care reform is $950. Or, as the Denver Post put it "Coloradans who have insurance spend an extra $950 each year to cover the costs of those who show up at the hospital without insurance." How does the Denver Post know this? It doesn’t. It merely prints what people tell it, and the local "government is the solution" health care reform elites are all repeating, in unison, is the estimate of uncompensated care published in a 2005 report from Families USA. Apparently we are to believe that if Families USA says so, it must be true. The problem is that the Families USA estimating technique is quite complex and has the added problem of using sparse national data to interpolate the cost for each state. This can introduce big errors. Before promoting the results of such estimation one would expect that the people producing it would compare their estimates with independent ones. As a public service, a few comparisons are provided in the table below. Unsurprisingly, these sketchy results suggest that the Families USA systematically overestimates uncompensated care. The Families USA estimates are based on 1996 to 2003 data. Estimates from the independent authorities are for the years given. The Families USA estimates do not include "uncompensated care provided to insured people, who may be unable to pay," they are said to be only the cost of health care that is not paid out-of-pocket by the uninsured themselves. The independent estimates include bad debts where indicated. The independent estimates do not include uncompensated care provided by physicians unless indicated. As estimated by Hadley and Holahan, adding physician care would raise the total by roughly 15 percent.
As another check on the Families USA numbers, the 2005 report states that the number of uninsured in the USA in 2005 would be 47,564,000, or 16.1% of the population. The pooled Census estimates for the uninsured from 2004-2006 were 45,102,000 or 15.1% of the population ±0.1%. In short, Families USA was high again.
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Wednesday, February 6, 2008Rendell Continues Push for "Cover All Pennsylvanians"By Nathan BenefieldCategories: California, Massachusetts, PennsylvaniaIn his budget address, Pennsylvania Governor Ed Rendell, continued his push for "Cover All Pennsylvanians" despite bad news on three state health care proposals fundamentally similar to RendellCare:
A few weeks ago, the Commonwealth Foundation put out some quick facts about the few Pennsylvanians that would be covered by "Cover All Pennsylvanians." Based on the new Governor's budget, we have had to revise that estimate (PDF version).
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Monday, January 7, 2008State Policy Drives Number of UninsuredBy Nathan BenefieldCategories: PennsylvaniaA Wall Street Journal article by Tarren Bragdon asks a question:
Why does New York spend more on Medicaid -- a health-care program for the poor -- than every other state but still have a larger portion of its population walking around without health insurance than states that spend far less?His comparison, interestingly, is Pennsylvania: Last year, New York spent $48 billion on Medicaid. That amounts to about $2,100 for every man, woman and child. Yet 13.5% of the state's population lacks health insurance. Pennsylvania, meanwhile, spent closer to $1,300 on Medicaid for every state resident and ended up with an uninsured rate of 10.5%.This should raise eyebrows for Pennsylvania lawmakers, since Governor Rendell proposes to lower the number of uninsured by spending more on Medicaid. But the reasons for New York's uninsurance problem is regulation and mandates. Again this should provide a lesson to lawmakers, many of whom support additional mandates and passing community rating laws in PA and elsewhere.
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Wednesday, December 26, 2007A Year of Health Care InactionGovernment health care expansion kept at bay in many areas By Marc KilmerCategories: California, Pennsylvania, SCHIPThere are a couple reports from the New York Times that should give us at least a little bit of Christmas cheer. This article discusses how politicians in Pennsylvania, California, and Illinois failed to enact widespread health care "reform" this year. And this article notes that SCHIP will not be expanded any time soon at the federal level. These developments are something of a surprise given the seemingly widespread desire among politicians of both parties to increase government involvement in citizens' health care decisions. Of course, 2008 is a new year and these battles will continue to rage. But some bad ideas were stopped, even if this is only temporary in some cases. In our line of work, that's a pretty good year.
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Wednesday, December 26, 2007So Much for State ExperimentsNYT cites "roadblocks" to state coverage plans By John LaPlanteCategories: California, PennsylvaniaThe goal of implementing government-controlled health care has moved from Washington DC to the states. But the NYT yesterday reported that such efforts are hitting roadblocks. What a Christmas present! Lest you conjure up images of Scrooge, let's be clear: health is good. Treatment to promote health is good. But entrusting personal health to government is like leaving milk and cookies for Santa Claus and waking up to find that not only did he eat what you left for him, but he's also drained the bank account, stole the car, and drank all the whiskey in the house.
That's the good news. How did this come about?
Business isn't always the friend of freedom, what with rent seeking and all. Given the directions of the plans in those three states, however, it's probably just as well that "business lobbies" succeeded. After all, consensus is risky:
There are at least three things wrong with this assessment: coverage is not health care; consensus is not always good, and bad templates are worse than no templates.
Now doesn't "regardless of an applicant's health status" sound rather caring? Of course, community rating, as this is otherwise known, has proven to raise insurance rates across the board--hardly what you want if promoting insurance coverage is your goal. Oh wait, price doesn't matter! Health insurance will be required! How's that working out in Massachusetts, by the way? The fly in the punchbowl? It's barely seen in the account presented by the Times:
There's a lot of congratulatory talk in the state about the work of Gov. Schwarzenegger and Speaker Núñez. But then again, there's also an unusual coalition of people who see problems with the plan:
Not affordable? Maybe that guaranteed issue provision has something to do with it. So will the increased demands on health care services--which, contrary to expectations, don't always translate into better health outcomes. The Time article then mentions developments in a few other states:
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Thursday, December 13, 2007Buying Insurance Across State LinesBy Merrill MatthewsCategories: California, Insurance Regulation, PennsylvaniaThe health-insurance market can be divided into three segments. The first consists of mostly large employers, with self-funded plans, and are regulated by the federal Employee Retirement Income Security Act (ERISA) and thus not subject to state regulation. The two remaining segments of the health-insurance market are heavily regulated by states: those that serve small-group plans (typically covering two to 50 people), and individuals who pay for their own insurance. The Health Care Choice Act, proposed by Rep. John Shadegg (R-Ariz.) would allow residents in one state to buy health insurance that is available in and regulated by another state. It would only apply to the individual market. Because regulations vary from state to state, the cost of health insurance for these last two segments of the insurance market vary widely. Some states ensure that residents have access to a wide range of affordable policies. Others -- New Jersey, New York, Massachusetts, for instance -- have all but destroyed their individual health-insurance markets with over-regulation. One of the most expensive state-level regulations is "guaranteed issue," which requires insurers to sell insurance to anyone willing to buy it, regardless of their health, or other factors that may make it much more expensive to cover them. New Jersey, for example, enacted guaranteed issue in 1994. At the time, a family policy could be purchased in the state for as little as $463 a month or as much as $1,076, depending on which of the 14 participating insurers a family chose. Now there are just 10 insurance companies offering plans in the state and the cost has soared to $1,726 per month on the low end and $14,062 on the high end. In New Jersey then, residents who buy their own insurance have to pay at least $20,000 a year for the cheapest family policy. Meanwhile, in neighboring Pennsylvania similar health-insurance policies cost a third of what they cost in New Jersey. What Mr. Shadegg wants to do is to let New Jersey residents buy what's now for sale in Pennsylvania. Mandates are another reason the cost of health insurance varies from state to state. States impose those mandates on what an insurance plan must cover -- such as chiropractic care or mental-health services. The Council for Affordable Health Insurance, which tracks mandates, estimates that there are more than 1,900 state mandates nationwide. These mandates can increase the cost of health insurance by as much as 50%, which can then force residents in many states to decide between "Cadillac coverage" -- insurance that covers nearly everything and costs a mini fortune -- or no coverage at all. Typically, state mandates are justified by the belief that they make health insurance more comprehensive. But consider this: Idaho has just 14 state mandates, the fewest in the nation, while Minnesota, with 63, has the most. Yet, the people of Idaho aren't dying in the streets for lack of mandates. Critics of the Health Care Choice Act claim that it would limit the ability of states to protect their residents. The assertion is that cross-state health-insurance purchases are a risky experiment. In truth, millions of people already have access to health insurance across state lines. Employees of large companies with plans covered by ERISA are one example. But there are others. Some small businesses cover employees working across state lines. And, because people are mobile, some people buy individual insurance in one state and then end up moving to another. In many cases, they can take their health-insurance policies with them. A person living in Pennsylvania with an individual policy now could retain that policy even if he moved to New Jersey. Premiums would likely increase, but they would be cheaper than if he had started out with a New Jersey policy. If states are worried about losing regulatory control over health insurance, they might try making their regulations competitive with other states. Health insurers would likely respond by returning and offering a wide range of affordable policies. As it stands, many states are "protecting" their residents right into the uninsured camp. The Health Care Choice Act won't solve every problem. But it would increase competition and consumer choices currently denied to residents in many states.
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Wednesday, December 12, 2007A Health-Insurance SolutionBy Nathan BenefieldCategories: PennsylvaniaMerrill Matthews of CAHI (and frequent contributor to this blog) has an editorial featured in today's Wall Street Journal on John Shadegg's Congressional proposal to allow individuals to purchase health insurance from any state. He uses a comparison of health insurance costs in New Jersey compared with Pennsylvania - which works for New Jersey residents. Coming from Pennsylvania, I have used a comparison to Ohio for similar effect.
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