What Next for Kentucky Health Care?

Contact:
Michal Smith-Mello
502-564-2851 or 800-853-2851

FRANKFORT, KY (November 16, 1999) — At a Capitol press conference here today, the Kentucky Long-Term Policy Research Center and the University of Kentucky Center for Health Services Management and Research released a joint report that recommends ways of responding to growing gaps in access to health care.

What Next for Kentucky Health Care? details the scope of current problems with access to health care, trends that are influencing rates of insurance, the effects of state and federal initiatives designed to expand access, and state and local models that offer transferable ideas for reducing the state’s uninsured population. The report also presents an analysis of a series of interviews conducted with selected Kentucky health care leaders and offers policy recommendations.

The report is being released in conjunction with the Center’s sixth annual conference, "Unraveling the Health Care Dilemma," which will be held November 18, 1999, in Bowling Green. New York Congresswoman Louise Slaughter, a native Kentuckian and a nationally recognized leader in the field of health care, will be the keynote speaker. The conference will feature state and national experts in health care policy, as well as the leaders of award-winning initiatives that have marshaled resources to close gaps in access to health care.

As the number of Americans who do not have health insurance continues to increase by a million more people a year, access to health care has once again assumed high priority on the public agenda. Kentuckians ranked the goal of an inclusive health care system as their highest priority on a recent University of Kentucky poll conducted for the Kentucky Long-Term Policy Research Center.

Though recent data show that uninsured rates may have declined somewhat in Kentucky, the steadily rising costs of health care and health insurance are adversely affecting insured rates. While more employers are offering health insurance, they are also shifting more of the cost to employees in the form of coinsurance (the employee share of insurance costs) and copayments. In turn, fewer employees are taking advantage of employer-sponsored health care. At the same time, employment is growing rapidly in occupations and industrial sectors where health insurance is least likely to be offered to employees.

Health care leaders interviewed for the report included payers (insurance industry representatives), providers, advocates on behalf of the public interest, and political leaders. Concerns about rising health care costs dominated these discussions. These leaders also pointed to, among other things, the need to address root causes of high health care costs, better educate health care consumers about costs, identify resources to finance health care, and focus on improving population health.

The report details selected state and local initiatives that have addressed gaps in access to health care principally through better organization of resources, dedicated funding streams, and creative expansions of Medicaid. Regulation of the private insurance market, the report observes, has not proven to be an effective means to expanding access to health care.

Over the long term, the report concludes that the cost of excluding more and more people from the health care system will likely outweigh the cost of expanding access. To expand inclusion in the current system of health care and improve the health status of Kentuckians, the report recommends a number of steps.

Provide the tools and organizations for informed decisionmaking. The report recommends creating an impartial body or investing an existent group with the authority to act in an advisory capacity and to collect and analyze health care data to inform policymaking.

Recognize the limitations of insurance reform. The report concludes that reform of the state’s individual and small group health insurance market has not significantly expanded access to health insurance for low-income Kentuckians; that comprehensive reform was not given sufficient time to prove its worth or its failure; and that more must be learned about the insurance market before further attempts are made to refine the state’s regulatory framework. In the meantime, the report recommends no further legislative action in regard to insurance reform.

Identify and expand resources dedicated to health care. Expanding access to health care will require additional funds that can be met through increased taxes, the reallocation of existing revenue, or the dedication of tobacco settlement dollars to health care, the report concludes. While polls continue to show that health care is a top priority among Kentuckians, the report recommends a deliberate effort to assess public opinion on expanding access to care and ways of meeting its cost. An essential counterpart to any expansion of health care, the report emphasizes, is prudent purchasing. Finally, the report concludes that resources should be dedicated to the work of identifying existing sources of care and creating accessible networks for the uninsured.

Enroll those who are currently Medicaid eligible and expand eligibility. In particular, the report underscores the importance of enrolling Medicaid-eligible children whose parents lost coverage when they left welfare rolls, and fashioning a more accessible, user friendly program that is relatively free of stigma.

Focus on population health. The report recommends an intensified focus on population-based health initiatives to improve the poor overall health status of Kentuckians through investment in the core public health roles of local health departments and the dedication of public and private resources to a concerted effort to change health behaviors. Over the long term, the authors conclude, improving population health may be the state’s best insurance against rising health care costs.

The report was prepared by Michal Smith-Mello, a Senior Policy Analyst with the Kentucky Long-Term Policy Research Center; Julia Field Costich, an Assistant Professor at the University of Kentucky Center for Health Services Management and Research; and F. Douglas Scutchfield, a physician who serves as Director of the Center for Health Services Management and Research and as a Professor of Health Services Research and Policy and of Preventive Medicine and Environmental Health.

For further information about the Center’s November 18, 1999, conference in Bowling Green or to receive copies of the report, What Next for Kentucky Health Care?, free of charge, interested citizens should contact the Kentucky Long-Term Policy Research Center by mail at 111 St. James Court, Frankfort, Kentucky 40601-8486; by phone at 502-564-2851 or 800-853-2851; by fax at 502-564-1412 or 800-383-1412; or by e-mail at ltprc@lrc.state.ky.us. The full text of the report can be downloaded from the Center’s Web site at: www.lrc.state.ky.us/ltprc.