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By Michelle Beavington, Association of Workers' Compensation Boards of Canada, and Pat A. Quintana, State Compensation Insurance Fund (California)
(Editor's note: This is a two-part article. To view part one, which examines examine health care and worker's compensation in Canada, click here.)
Health Care Reform in the United States
 Since the 1984 Canada Health Act was adopted, the United States – at both the federal and state level – has grappled with health care reform. President Clinton, in his February 17, 1993, State of the Union address, declared that: “All our efforts to strengthen the economy will fail unless we take steps this year … bold steps … to reform our health care system.”
Later that year, the Taskforce on Health Care Reform produced a 1300-page proposal, which failed passage in Congress in early 1994. However, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was a step in the long road toward U.S. health care reform.
Most agree that health care should be provided to the disabled, children, low-income families. In 1965, Medicaid was created to give low-income individuals access to medical care. Medicaid is a joint federal/state program funded by the federal government and state governments and administered at the state level, while monitored at the federal level. Medicare, on the other hand, is fully federally funded and targets the elderly and severely disabled.
Another national program, the State Children Health Insurance Policy (SCHIP), assists families that do not qualify for Medicaid. In 2005, six million children were insured through SCHIP. In 2006, several states considered modifying their SCHIP and Medicaid plans. Arkansas and Oklahoma now use Medicaid monies as subsidies for health insurance for certain small business employees. Kansas, Kentucky, West Virginia, and Idaho also altered their plans to enable more people to be covered under Medicaid. Wisconsin has used SCHIP to reach certain uninsured adults.
For families not covered under SCHIP or Medicaid, some states have extended traditional health insurance coverage to dependent adult children. Colorado, Delaware, Utah, and New Jersey have achieved some success in this effort.
On the other hand, Maryland's Fair Share Health Care program required employers to spend at least eight percent of their payroll on employee health care coverage or face a state imposed fee. This was blocked by the courts, but Maryland is exploring other ways to extend health coverage to more citizens. In January 2007, Minnesota introduced similar legislation.
By 2009, Maine's citizens will have voluntary access. Vermont has enabled voluntary access for the uninsured through affordable, private health insurance. Massachusetts passed legislation in 2006 which requires all citizens to obtain health insurance or lose their personal tax exemptions. In Pennsylvania, Governor Rendell introduced a plan in 2007 to subsidize private health care for uninsured residents.
In California, Governor Schwarzenegger announced a plan in January 2007 that he claims will protect the private insurance market while providing health insurance for California's 37 million residents, 6.6 million of which are uninsured. The plan calls for expanding public programs to cover children of low family incomes. It also requires hospitals to pay a fee of 4 percent and physicians to pay 2 percent of their gross revenue to a state fund.
Additionally, employers with ten or more employees must offer workers health insurance or pay four percent of their payroll into the fund. Health insurance companies must insure all applicants and spend at least 85 percent of premiums on health care.
The California legislature has introduced alternative plans. Two bills in the state senate would require employers to provide workers with health insurance or pay into a state fund. Another proposal, which is voluntary, would give individuals tax breaks for purchasing insurance, as well as provide hospitals and physicians a tax credit for utilizing electronic medical records and telemedicine. Yet another plan calls for a “single payer” state system.
The business community leans toward the Governor's proposal. In 2007, Safeway, Pepsi-Co, General Mills and PG&E joined insurance providers Aetna, Blue Shield, CIGNA, and PacifiCare in a coalition called Together for Health Care. They have powerful allies, including the California Teacher's Association, AARP, and the California Medical Association. In Washington D.C., the group is supported by Senator Bennet of Utah, Congressman Baird of Washington, and Senator Wyden of Oregon.
Senator Bennet summed up his support by stating: “Americans want access to quality, affordable health care. For years we have tried a piecemeal approach to reform, but it is clear that has not worked. Now is the time for real solutions.”
Conclusion
Health care reform will continue to be an issue for both Canadians and Americans for the foreseeable future. Though Canada has a very comprehensive program, it continues to strive toward providing quality health care for its citizens. American politicians, business leaders and labor leaders are jointly seeking a vehicle to administer and deliver affordable quality health care for all. As both nations continue to debate this issue, there are likely to be some overlaps in the workers' compensation arena.
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