Common Sense Proposals for a Healthy Kentucky
We face steep challenges to reforming our complex system for financing and delivering quality health care for all Kentuckians. The problems often seem intractable. Our nation has 45 million people living without health insurance coverage, a disproportionate number of whom live in our own state.
Hundreds of thousands of Kentuckians depend on Medicaid to provide health care for needy children, the disabled, and seniors in nursing homes. Yet the costs of the Medicaid program continue to skyrocket toward unsustainable levels, taking up an ever-increasing proportion of an already strapped state budget. Rampant fraud within the Medicaid programs leaves even fewer of these scarce dollars available to take care of patients.
Across our state, many of our fellow citizens live and work in poor health, often with undiagnosed conditions such as diabetes which may one day completely disable them, or cause an untimely death. This problem is worse in rural areas with less access to physicians and the latest medical technology.
These problems are daunting but they can be solved through common sense policies. There is no silver bullet for the problems of the ill and uninsured. What is required is progress on all fronts to increase insurance coverage where possible, prevent illness before it happens, improve access to treatment, and curtail the fraud which consumes too many valuable health care dollars.
To accomplish these objectives, Jody Richards will pursue the following policies:
* Expand the Kentucky Children's Health Insurance Program to insure more children and young adults with a dedicated portion of new tax revenues;
* Increase access to affordable long-term care insurance policies so that seniors in need of nursing home care are not forced to bankrupt themselves and rely upon Medicaid;
* Improve the quality of health care in rural areas by expanding access to top-notch physicians and other health care professionals, and the latest health care technology;
* Enhance early detection and treatment of diabetes and other chronic illnesses through coordinated outreach and data collection;
* Reducing fraud on the health care system by allowing citizens who observe fraud to initiate Whistle Blower lawsuits with government protection.
Health insurance for more Kentuckians
Right now there is a gaping hole in our system of health insurance. Medicare is provided for our seniors, and the Medicaid safety net covers children of the neediest families and the disabled. The rest of our citizens rely on their employers to provide health insurance which is often barely affordable.
The self-employed, the temporarily unemployed, and employees with no access to an affordable policy are all at risk of going without coverage. As the ranks of the uninsured grow, we see more avoidable health care problems being addressed in the emergency room after they have gotten out of hand - at greater cost to us all.
A solution to this problem gaining increasing attention in Washington is universal coverage, perhaps through a single payor system. A solution of this magnitude can only be accomplished at the federal level. Unfortunately, universal coverage been unsuccessfully tried several times at the federal level - most recently in 1994. Therefore, while we are hopeful for a comprehensive federal health care reform, we cannot wait on Washington to act. We must do what we can to shrink the ranks of the uninsured through common sense interventions at the state level.
To address the crisis, Jody Richards will immediately begin to expand the Kentucky Children's Health Insurance program (K-CHIP) to include more uninsured children and young adults under the Medicaid program. Health insurance is very expensive, so coverage must be expanded incrementally as new revenues become available. Fortunately, our economy is growing fast enough to generate some new revenue each year.
Jody Richards' first budget as Governor will devote at least 10% of new revenues to defray the costs of expanded coverage. The maximum income level to qualify for Medicaid coverage (based on family income as a percentage of the federal poverty line) will be raised as more funds become available. Over time, working families making 200% to 300% of the poverty line will be able to get no-cost coverage for their children. In each new budget, we will use new revenue to help plug the remaining holes in our system until none remain.
Long-term care insurance
Millions of Americans depend on nursing home care in their older years. Most stay only for a relatively short time, but at $70,000 or more per year in costs, it does not take long to reduce retirement savings to zero. Most middle class Americans assume that if they one day require nursing home care, they will need to impoverish themselves prior to becoming eligible for Medicaid. The result is that more and more Medicaid dollars are needed for nursing care for seniors who are left with nothing to pass on to their children.
One solution to this expensive and often tragic problem is to encourage more people to invest in long-term care insurance which will cover the costs of a future nursing home stay. Unfortunately, it has been difficult to convince middle-class Americans to purchase long-term care due to lack of information about the product, concern over rising premiums, and uncertainty as to whether the face value of coverage will be enough to pay for care which may not be required for decades.
In order to encourage Kentuckians to buy long-term care and reduce pressure on Medicaid, Jody Richards will do the following to make long-term care insurance attractive, accessible and affordable.
* Require the Cabinet for Health Services and the Department of Insurance to coordinate training for insurance agents who sell policies and outreach for potential purchasers, so that both the sellers and purchasers of long-term care insurance are well-informed about the options available to consumers.
* Permit middle-class families to protect a dollar of assets for each dollar of long-term health insurance coverage they purchase, up to an appropriate cap.For example, a person who purchased $100,000 in coverage would be permitted to go onto Medicaid when his or her assets have been depleted to $100,000 (instead of zero). This measure would preserve some of the life savings for persons who would otherwise need to be bankrupted before receiving Medicaid. Equally important, it benefits Medicaid by allowing private insurance to cover a greater share of future nursing home costs.
* Encourage insurers to develop policies attractive to lower income consumers who are unlikely to have significant assets to defray nursing home expenses prior to going onto Medicaid.
* Strengthen Department of Insurance review of long-term care insurance rates, and require the Commissioner to assess the impact of medical inflation on the future value of the policies.
Rural health care
Kentucky is blessed to have both vibrant urban centers and a rich rural heritage which lives on in our many small towns and rural counties. Unfortunately, those who live outside urban areas are less likely to have access to the best health care. As a state with almost half its population living in areas classified as rural, Kentucky cannot afford to tolerate rural health disparities.
With 21st century technology and telecommunications, there is no good reason why our rural residents cannot enjoy health care on par with their urban counterparts. However, there are still area of the state which have a paucity of highly trained health care professionals, a scarcity of nearby hospitals and health clinics, and a lack of access to sufficient capital to invest in the modern health care technology.
In 1990, the General Assembly wisely established the Center of Excellence in Rural Health in Hazard, which has made great strides toward addressing the shortage of health care professionals and access to health care by needy rural families. Jody Richards will build on these efforts in a systematic fashion which includes the following components:
* Support measures encourage health care professionals to practice in rural areas, including loan forgiveness and other incentives.
* Support revolving loan funds to finance primary health care and other heaoth care facilities in rural areas.
* Create rural health networks to facilitate multi-county cooperation in purchasing and accessing expensive health care technology and facilities and taking advantage of economies of scale.
* Modernize Medicaid and develop e-health standards on a statewide basis to help meet the health care need of rural residents and the technology needs of rural health practitioners.
* Support the development of community-based primary care systems to provide a safety net for the uninsured, particularly as regards oral and mental health.
* Expand into rural areas programs directed toward tobacco-cessation, drug and alcohol abuse, and obesity.
Combatting chronic health problems like diabetes
Kentucky ranks high in scenic beauty and the quality of its citizens. Unfortunately, we also rank in the top 20 for poor health, including the percentage of adults suffering from diabetes.
More than 300,000 have diabetes, and one-third of these cases are undiagnosed. The reasons for this epidemic are many, including obseity and lack of physical activity. But regardless of the cause, the costs are clear: diabetes is the fifth leading cause of death in Kentucky. And for those diabetics who live with the diseases, medical expenses are 240% higher than they would be without the condition. The direct and indirect costs of diabetes to the nation as a whole are $132 billion.
We know that early detection, early treatment, and disease management are the most effective ways to save lives and to reduce the social and economic costs of diabetes.
That is why Jody Richards will initiate a Kentucky Diabetes Disease Initiative consisting of research, prevention, outreach, early detection and follow-up for persons affected by diabetes. The key to the initiative is to identify at-risk individuals and target populations using a statewide internet-based database and then getting them the most appropriate treatment as quickly as possible.
The initiative would be implemented in partnership with our university health programs, local health departments, and community-based physicians. During the 2007 Legislation Session, the General Assembly passed legislation establishing a similar initiative directed toward cardiovascular disease. Jody Richards believes a similar model can help our state take great strides toward addressing diabetes as well.
Stopping health care fraud and abuse
Each year, health care billing fraud costs our nation hundreds of millions of dollars. At the state level, this means that the taxpayers are paying for millions of dollars of services billed to Medicaid which are overbilled or never provided. Kentucky simply cannot afford to pay scarce Medicaid dollars to thieves. These dollars should be spent taking care of needy children, seniors in nursing homes, and the disabled.
For years, the federal government has used Whistle Blower suits brought by citizens to recover millions in fraudulent billings. Now, almost 20 states including Indiana have followed suit in providing this effective tool to over-strapped law enforcement authorities. Jody Richards believes it is time for Kentucky to enlist the aid of responsible citizens in putting a stop to this theft from the taxpayers by enacting a False Claims Act which does the following:
* Authorize a private citizen who is a witness to Medicaid fraud to file a court action against the perpetrator.
* Allow the Attorney General or Medicaid Inspector General to intervene and take over meritorious lawsuits;
* vide for damages equal to three times the amount of the fraud and recovery of attorneys fees from the perpetrator of the fraud.
* llow the court to award up to 15% of the financial recovery to the citizen who initiated the court case as an incentive to come forward, with the remainder going back into to the health care system.
Jody Richards will put our state on the right path to a healthy Kentucky through a combination of common sense policies which attack the problems from many different angles. The solutions to our health care problems will not be easy or simple. Addressing the many challenges we face will require funding, dedication, and creative thinking. As shown above, Kentucky can begin to address its health care problems by incrementally enhancing health care coverage as funds permit; encouraging the purchase of long-term care insurance; improving rural health, combatting diabetes, and cutting down on Medicaid fraud.