Health Care for Everyone

Today, Jack Markell announced his comprehensive plan to cover all Delawareans as Governor. He unveiled the plan at St. Francis hospital in Wilmington this afternoon. Read more about it by clicking “continue reading…” to see the plan in its entirety.

Affordable, Quality Health Care for All Delawareans:

A Bold Vision for Change

Delaware families should not have to wonder whether they can afford to visit the doctor if their kids become sick or injured. Our businesses should not have to worry about losing their company health plan because one employee becomes seriously ill. And Delaware’s taxpayers should be assured that the money they spend on health care is buying the best possible value.

Unfortunately, Delaware still has a long way to go before achieving this ideal. Too many Delaware families and businesses are caught in a vicious cycle of rising health care costs and loss of coverage. The spiraling costs of health care threaten the profitability of companies, which have responded by shifting more and more health care costs to their employees. And the rise in health care costs has caused health insurance carriers to raise premiums, which has priced some employers and consumers out of the market, adding to the ranks of the uninsured. As fewer employees receive health care coverage through their employers, and as fewer consumers can afford paying for health coverage on their own, the number of those without health coverage rises. And as the number of uninsured people increases, the health care system that treats the uninsured absorbs higher levels of uncompensated costs, which ultimately are paid by taxpayers or through increased costs and premiums paid by those who still have health coverage.

Without action, the vicious cycle of rising costs and less affordable coverage will continue to threaten the competitiveness of Delaware businesses and the financial stability of our families. And most importantly, it will keep thousands of Delawareans from enjoying the benefits of good health — which is too important to wait on. It is time to act now.

The Need for Affordable, Quality Coverage for All Delawareans

Why does Delaware need a bold plan of action when it comes to health care? It comes down to this:

1. Health care costs are threatening to overwhelm families, businesses, and state government.

2. Affordable, quality health care is beyond the reach of many Delawareans, with over 100,000 having no coverage at all, and many more worried that a job change or sudden illness could mean losing coverage or being faced with catastrophic medical bills. These are hard-working people. Over 80 percent of uninsured Delawareans are in working families.1 People who work hard and do their fair share should not be left wondering whether they’ll be able to pay their bills if an illness or accident strikes.

3. We are spending too much at the back end and not enough on front-end coverage and preventive care. Delaware should invest the $91 million currently spent in our state on uncompensated care into a system of affordable, quality health care for everybody in the state.

The Rising Cost of Health Care

Hard-working Delawareans need to look no further than their own pocketbooks to know that health care costs are rising. Personal health care spending increased 9.8 percent a year in Delaware between 1980 and 2004 – faster than the national rate of 8.6 percent a year. 2 Personal health care spending accounted for 9.7 percent of our annual gross state product in 2004, up from 6.8 percent in 1980. And nationally, we spend $2 trillion on health care, or roughly $6,700 per person. 3 Although no longer increasing at double-digit annual rates as they did in the late 1990’s and early 2000’s, health insurance premiums still increased by 6.6 percent nationally in 2005. Some employers – who are also feeling the burden of increasingly high health care costs — have tried to contain their health care costs by shifting some of those costs to workers. This trend has contributed to a rise in consumer out-of-pocket health care spending of 5.8 percent in 2005.4 More consumers are paying higher deductibles and higher insurance payments, and are receiving less comprehensive coverage of treatments and drugs.

The Lack of Secure, Affordable Health Care Coverage

As in most states, thousands of Delawareans lacks secure, affordable, high-quality health coverage. According to the Delaware Health Care Commission, an estimated 105,000 Delawareans have no health care coverage.5 And although our percentage of uninsured is a little lower than the national average, it is growing rapidly. Between 2005 and 2006, Delaware’s uninsured population grew by over 10 percent, from 95,000 to 105,000 people.6 And between 2000 and 2005, Delaware experienced the fourth highest increase of uninsured residents in the country.7 It’s easy to get bogged down in dollar figures and statistics when one discusses health care and its impact on Delaware’s families. The numbers are important. But we must also remember that those without health coverage live in uncertainty and fear, knowing that a minor, treatable illness could become a major problem. For them, an accident or a serious disease not only threatens their physical health, but their financial health as well.

This problem does not just affect people who are unemployed. Almost three quarters (74 percent) of Delaware’s uninsured belong to families with at least one full-time worker.8 Many uninsured Delawareans are not offered benefits through their jobs or cannot afford employer-sponsored or individual health coverage. This is despite the fact that Delaware’s businesses are slightly more likely to offer health coverage than the national average (61% vs. 56%).9

We’re Not Getting What We Pay For

You might think that with all these trillions of dollars going to pay for health care, compensated or uncompensated, at least Delaware and the rest of America would have a healthier population. Unfortunately, higher health care spending does not inevitably lead to healthier people. The U.S. spends more money on health care both per person ($6,711) and as a percentage of GDP (16 percent) than all other countries,10 but Americans score worse than other industrialized nations on important health outcomes like infant mortality and life expectancy.11 Why are we paying more for our health care but getting less in return? Part of the reason for this is that we pay for health care very inefficiently. When we pay for uncompensated care for the uninsured in hospitals or emergency rooms, it is the equivalent of paying for a new engine instead of an oil change.

Uninsured Delawareans are less likely to seek necessary medical care when they need it, leading to the development of more severe and expensive illnesses, overuse of emergency rooms, decreased productivity, and even premature death. Even those with coverage may delay treatment of minor issues in the hopes of avoiding costlier doctor visits and crowded health facilities. And there are other spill-over effects. For example, emergency rooms that are overcrowded due to increasing numbers of uninsured patients may mean that ambulances get turned away and have to spend precious minutes traveling to a different hospital. Also, untreated infections may put everybody at risk, whether or not they have coverage. In addition, the hospital emergency department is the most expensive and least efficient way to deliver care – especially if access to primary care could have prevented the illness in the first place.

The lack of affordable, quality health coverage for all Delawareans has a profound impact on those with coverage and on the state’s economy as a whole.12 Hospitals and other health care providers treat some patients even if they lack health coverage. In Delaware, the cost of health care for the uninsured that was not paid for out-of-pocket by the uninsured themselves amounted to over $91 million in 2005.13 Some of these costs are paid for by the State and Federal governments (that is, by taxpayers), but much of this “uncompensated care” is absorbed by providers such as hospitals and these costs are shifted to privately-insured individuals in the form of higher bills – which ultimately translates to higher premiums. In addition to the tax dollars going to cover uncompensated health care, the private coverage “cost shift” added an estimated $724 to Delaware family health insurance policies in 2005.14 By 2010, this “hidden” cost of caring for the uninsured will cost every Delaware family an additional $1,083 in insurance costs every year.15 Insuring Delawareans up-front could save Delaware families hundreds of dollars a year, while keeping more people out of the hospital.

Having all Delawareans covered is also in our state’s economic interest. Nationally, the lack of health insurance costs our economy up to $130 billion per year due to lost productivity.16 Delawareans may be afraid to move to a job that suits them better – and where they would be more productive – if it does not offer health insurance. Because it is so much harder to obtain insurance in the individual market than through an employer, the lack of secure, affordable, and portable coverage can stifle entrepreneurship. Finally, those Delaware employers who do offer coverage are forced to compete with those that do not. On average, Delaware businesses with fewer than 50 employees pay for 87 percent of their employees’ health care costs.17 Delaware deserves a conversation about whether it’s time to level the competitive playing field among businesses.

Finally, we are not paying enough attention to chronic disease prevention and management – and we should, because preventable chronic diseases like diabetes, heart disease and asthma account for over 75 percent of national health care spending. Quality, affordable health care coverage – along with strong public health measures to promote healthy lifestyles — will help us move towards a more affordable health care system.

A Bold Vision for Delaware

Delaware certainly is not alone in grappling with these concerns. Every state has been challenged by these issues of rising health care costs and insufficient coverage, just as many businesses have. Clearly, the status quo is unacceptable, but what alternatives do we have? As it turns out, there are some options. None will be easy, but other states have taken bold steps to address their health coverage problems head-on. With the number of uninsured Delawareans rising and health care costs posing an ever increasing burden on our residents and businesses, Delaware is long overdue for some bold and innovative leadership.

Access to Health Care for All: Guiding Principles

In order to control costs and increase coverage, health care reform in Delaware ought to meet five basic principles:

1. Everyone ultimately should have access to affordable, quality coverage in Delaware. It’s the right thing to do, and it’s a long term investment in our people, our businesses, and our future.

2. No one should lose current coverage due to any reform efforts. But everyone should be able to obtain decent health care coverage at a price he or she can afford in partnership with employers and state government.

3. We must ensure that all children have coverage.

4. To make health coverage more affordable to employers, consumers, and the government, health care coverage must emphasize proven preventive care.

5. To keep health care costs sustainable in the long run, all Delawareans should take individual responsibility for their own health, and the state should work to help people make healthier choices. Everybody can take simple steps to achieve a healthier lifestyle, like turning off the television and going for a walk.

The good news is that Delaware does not have to start from scratch in reforming its health care system. We can learn from other states that have made significant progress in health care reform. While these reforms may not be perfect, the question we must ask ourselves is whether we will continue to accept the status quo or whether we will work towards a better health care system for our state.

A Partnership to Cover All Delawareans

Here is how I would propose to reform Delaware’s health care system as Governor. None of these steps will be easy, but simply tinkering around the edges, or worse – doing nothing – are not responsible or effective options either.

First, we will focus on enrolling Delawareans who are already eligible for health coverage programs. An estimated 24 percent of uninsured Delawareans – more than 25,000 people – already are eligible for coverage through Medicaid or the Delaware Healthy Children Program.18 For example, almost 13,400 uninsured Delaware children are eligible for Medicaid or the Delaware Healthy Children Program.19 My friend Mark Warner was able to make Virginia a national leader in insuring eligible children in low income households by aggressively reaching out to uninsured families making it easier to sign up, and we can do the same thing here in Delaware. To ensure that these individuals are enrolled and receive health coverage, Delaware will improve its Medicaid and Delaware Healthy Children Program outreach by:

* Providing premium assistance to help low-income workers who are eligible for public programs enroll in coverage offered by their employers. Compared to enrolling these individuals directly in Medicaid, this approach can save the state money: for example, Rhode Island’s premium assistance program, RIte Share, has saved an estimated $4.7 million since the program began, or $1 million in savings for every 1,000 people enrolled in the program.20

* Allowing Delaware hospitals to directly enroll eligible newborns and their siblings in Medicaid or the Delaware Healthy Children Program. Nearly half of all births in Delaware are financed by Medicaid (approximately 5,000 births a year), and this requirement could help ensure coverage of thousands more children a year.21

* Allowing schools and preschools obtaining state funding to screen children for Medicaid or Delaware Healthy Children Program eligibility and enroll them if applicable.

* Reducing the red tape that needy families must contend with to apply for Medicaid or the Delaware Healthy Children Program, for example by allowing presumptive eligibility, which would cover medical care for kids when they need it, not months later when their application is complete.22

* Implementing “Express Lane Eligibility”, which would facilitate health insurance enrollment for children who are already eligible for other types of public programs, such as food stamps or the free and reduced school lunch program.23

* The estimated state cost of covering adults in this manner would be up to $20 million a year, while the state costs of enrolling uninsured but eligible children would be up to $13 million.

Second, we will provide all Delaware families with the opportunity to purchase affordable coverage for their children. I will make the state’s health insurance program for children in low-income families – the Delaware Healthy Children Program – available to all children with sliding scale premiums based on family income. Currently, families of four with incomes under roughly $40,000 are eligible for Delaware Healthy Children Program health coverage. This proposed change would provide the opportunity for coverage for nearly 9,300 additional uninsured children in Delaware.24 The estimated state cost to cover these additional children would be up to $8 million annually.

Third, I will establish a Diamond State Health Marketplace for comprehensive, affordable, and portable health insurance. This Marketplace will serve as a private health insurance one-stop shop and will be available to all small businesses, sole proprietors, uninsured individuals, and families. All Delawareans who like their current health coverage will have the option to keep it; but for those who are not satisfied, or those with no coverage at all, the Marketplace will be a source to purchase affordable coverage. Since the Marketplace will serve as a one-stop-shop for health plans, it will also reduce administrative hassles for small businesses, sole proprietors, and individuals searching for health coverage. Furthermore, the Marketplace would provide an option for purchasing coverage on a pre-tax basis for workers in the nearly 40% of businesses that currently do not offer coverage to their workers.

The framework for the Marketplace will include the following elements:

* Choice of Plans: The Diamond State Marketplace would put choices of coverage back in the hands of individuals, instead of employers choosing a single health care plan for their workers. Delawareans purchasing coverage through the Diamond State Marketplace would be able to choose from a range of plans, from basic to comprehensive. Standards for health care plans offered through the Marketplace would be set by a Delaware Diamond Board. There would be a benchmark comprehensive plan that would cover primary, preventive, acute, and hospital care, with an emphasis on preventive care and disease management. Health care plans would vary in the level of benefits offered and out-of-pocket costs. The out-of-pocket costs for the benchmark plan would be capped to ensure affordability and designed to encourage smart preventive health practices and treatment. The Delaware Diamond Board, in addition to setting standards for the plans offered through the Marketplace, will obtain bids from private insurance companies for a variety of other health coverage options to be included in the Diamond State Marketplace.

* Pre-tax savings for employers and employees: Currently, employed individuals who have employer-based coverage are able to purchase that coverage on a pre-tax basis. However, those Delawareans who work for the nearly 40% of Delaware businesses that do not provide coverage are left to either be uninsured or buy coverage on their own, through the individual market, with after-tax dollars. My plan would require all businesses to set up Section 125 Cafeteria plans for their employees, whether or not they contribute to premiums, so that these individuals can purchase coverage on a pre-tax basis. Massachusetts has used this tool to help level the playing field between people who currently have employer-sponsored coverage and those who don’t. On average, obtaining coverage on a pre-tax basis through a Section 125 Cafeteria plan can result in tax savings that equal up to 40 percent off the cost of purchasing health coverage on an after tax basis.25

* Simplified Payment of Premiums. Premium payments to the Marketplace will be a shared responsibility between businesses, employees, and the State. Employers purchasing insurance for their employees would only have to send their premium payments to a single entity, the Diamond State Marketplace, which would distribute premium dollars among plans chosen by employees. Workers with multiple jobs would be able to pool contributions from each employer, and would be responsible for covering a minimum percentage of the benchmark plan premium amount, or a higher percentage if they chose a more expensive private plan. The state would subsidize premiums for low-income uninsured individuals on a sliding-scale basis. The estimated cost of subsidizing these premiums would be up to $60 million annually.

* Additional affordability measures: Competition between plans, negotiation by the state, and subsidies for low-income individuals and families would help to ensure affordability of coverage in the Diamond State Marketplace. For example, Massachusetts has already been able to use the negotiating power of the state to obtain more affordable premiums for plans offered through its Connector.26 The Diamond State Marketplace would provide Delaware with this same negotiating power.

Fourth, employers should contribute to the cost of coverage for their workers, or pay the public for the coverage we must pick up for them. Currently, only 61 percent of private sector firms in Delaware offer health insurance to their employees.27 But everyone in Delaware ought to pay their fair share. Businesses that provide health insurance are at a competitive disadvantage with those that do not help cover their employees – and the rest of us pay for this through taxes for uncompensated care and higher premiums. In fact, on average, Delaware businesses with fewer than 50 employees already pay for 87 percent of their workers’ premiums.28 To level the playing field, employers with 10 or more employees will be required to pay a fair share fee for each full-time-equivalent employee who is not covered through the employer or through another insurer. These business health care assessments will be collected and used to support health coverage offered through the Diamond State Health Marketplace. I would seek to phase in the imposition of this fair share fee by requiring it of large employers first – those with 100 full-time equivalent employees or more – before imposing it on smaller businesses.

Fifth, Delawareans who can afford coverage will be required to obtain a minimum level of health insurance. As with other states, a key problem with Delaware’s health care system is that those with insurance end up paying the cost of services for the 105,000 who are uninsured, so it’s essential that those who can afford to do so pay their fair share as well. Individuals who can afford insurance but do not purchase it in effect are taxing everybody who is insured. It will be difficult for Delaware to begin to drive down costs until more Delawareans have a minimum level of coverage.

Finally, to ensure access to and continuity of health care coverage, I will require insurers to guarantee coverage for individuals. Delawareans should not ever fear being unable to get health coverage or to hold on to coverage that they have. Unfortunately, health insurers in Delaware are allowed to deny coverage to individuals if they have been or are currently sick – just when they need coverage the most. To protect the ability of Delawareans to obtain health insurance, I will propose legislation that prohibits insurers from denying coverage to individuals based on health status. That legislation also will place limits on the amount premium costs can vary based on health condition and age. About 20 other states have guaranteed issue for individuals in some form, and Delawareans deserve the same protections as residents of other states. With an individual requirement to purchase coverage, insurance companies will be protected from having only the sickest individuals purchase coverage – so these two reforms must be instituted together.

Some will object to requirements that employers contribute to coverage and individuals purchase coverage. But here’s the way I see it: research shows that without these requirements, states can at best hope to cover 20 percent of the uninsured – even with generous subsidies to individuals.29 Of course, that would be a good start – but it would not be the kind of bold reform that will truly bring all Delawareans the security of health coverage.

Through the reforms I have just described, we can provide all Delawareans with the opportunity to purchase more affordable health insurance coverage.

Remember, the cost of care for the uninsured in Delaware came to $91.2 million in 2005 and is predicted to reach an estimated $127.6 million by 2010.30 Taxpayers largely bear the cost of this care in one form or another, but all too often this money is spent to treat expensive illnesses that could have been prevented by better access to health care in the first place. But by investing about the same amount – up to $111 million – we can provide health insurance coverage to virtually very Delawarean and in the process, improve the delivery of health care throughout our state.

That’s the choice we face. We can continue with the status quo, which leaves more than 105,000 Delawareans without health insurance, costs us $91 million to pay for health care for those uninsured people, and only serves to drive up health care costs for those lucky enough to have it. Or we can work together to change our health care system for the better by spending this money more wisely to extend health insurance to all Delawareans, helping everybody to stay healthy, improving our productivity as a state, making our state more attractive for investment, and lowering health care costs for those who are already insured.

How to Pay for These Reforms

This effort to reform Delaware’s health care system recognizes that all Delawareans – individuals, families, employers, and the state government – have a responsibility to enroll in and pay for health care, and all of us will. The Federal government, not state taxpayers, is financing a large portion of reforms in states like Massachusetts and Vermont. Delaware should seek comparable funding from the Federal government. For example, the Federal government will match 50 percent of all Medicaid expenditures paid by the state of Delaware. As Governor, I will direct state health agencies to seek funding from the federal government to support these reforms, as other states are doing to support theirs.

And individuals and businesses will be paying into this health care system as well, through sliding scale fees and assessments. I also will ensure that state government does its part. Savings that are realized through reductions in uncompensated hospital and health care system costs will be dedicated to support these health care reforms. We can examine the potential for increasing taxes on activities that contribute to poor health, such as tobacco use. Even with the recent tax increase, Delaware still will have a lower tobacco tax than some nearby states, such as New Jersey ($2.58 per pack) and Pennsylvania ($1.35 per pack).31 We still rank 21st among states in our tobacco tax.32 An additional 50 cent increase in the tobacco tax would raise nearly $38 million in additional revenue, result in over $85 million in long-term health care savings, and save 1200 Delaware kids from an early smoking-related death.33

Other Health Care Reform Initiatives to Improve Patient Care, Health Care Quality, and Reduce System Costs

In addition to championing a steady transition of our health care market towards greater access and affordability, as Governor, I also would push for the following types of initiatives to improve the state of health care in Delaware and to reduce overall health care costs.

Focusing on Health Care Education and Prevention

Remarkably, less than five percent of our national health care budget is spent on prevention efforts.34 Preventable injuries and diseases are not only a health care problem, but an economic problem as well. As Governor, I will intensify efforts to encourage healthy behaviors through high-impact education, awareness, and outreach campaigns. We should strive to make Delaware one of the nation’s healthiest states, and the only way to do this is to emphasize and encourage healthy living. Some examples of areas of emphasis will include:

* Curbing Obesity. Obesity has reached epidemic levels nationally and in our state, impacting the lives of adults and children everywhere. We must work across all settings – work, schools, and community – to help Delawareans maintain a healthy weight. As Governor, I will be committed to building on and strengthening efforts to curb both childhood and adult obesity in Delaware, for example by using school facilities to provide safe indoor and outdoor space for physical activity during and after school, and encouraging schools to serve healthier meals in schools.

* Promoting Healthy Living through Businesses. Given the amount of time we all spend at work, it is an obvious place to promote healthy living. Businesses across the country are beginning to recognize the potential rewards of investing in their workers’ health. For example, each dollar invested in worksite health promotion programs can save an average of $3.48 in reduced health care costs and $5.82 in reduced absenteeism costs.35

As State Treasurer and a member of the State Employee Benefits Committee, I certainly know this to be true. A few years ago, I championed a program called “Health Rewards,” which offered Delaware state government employees comprehensive physical assessments, detailed statistics about how their health compares with their peers across the country, and recommendations about how they can improve their health. This pilot program improved employee health and reduced the cost of their health care and received an Innovation Reward from the Council of State Governments in 2004. As Governor, I will continue to support efforts to improve worksite wellness.

Reducing Unnecessary Expenditures by Ensuring High-Quality, Coordinated, and Safe Patient Care

Delaware can do better when it comes to reducing avoidable hospitalizations and re-admissions. In fact, a recent analysis found that over $21 million could be saved in Delaware by improving the quality of health care to the level of the top performing state when it comes to reducing unnecessary hospitalizations and readmissions. 36 Not only will this save money – most importantly, it will also improve the quality of life for thousands of Delawareans.

One of the ways to avoid unnecessary hospital costs is to reduce the number of hospital-acquired infections and medical errors. Other states and studies have made reducing hospital-acquired infections a part of health reform initiatives. For example, Pennsylvania’s Health Care Cost Containment Council, one of the only organizations in the country to report on the number and cost of hospital-acquired infections, estimates that these infections cost an extra $2.9 billion in unnecessary hospitalizations and led to 2,500 deaths in 2005 alone. Although hospital-acquired infections are not reported in Delaware, reducing these infections could yield substantial savings. For example, a collaborative between Johns Hopkins University and all of the Intensive Care Units in Michigan to reduce certain types of infections saved an estimated 1,500 lives and $175 million during an 18-month span.37 I will direct Delaware’s health-related agencies to study and pursue such strategies as:

* Creating a Delaware Center for Patient Safety, similar to the New Jersey Quality Institute and the Maryland Patient Safety Center.38 This Center would serve as an essential resource to hospitals in the state by providing technical assistance and opportunities for collaboration among health care facilities to implement proven patient safety practices. For example, representatives from more than 50 Maryland hospitals that joined together in a Safety Culture Collaborative succeeded in reducing the rate of bloodstream infections in their hospitals by 36 percent in only eight months.

* Supporting efforts by hospitals and nursing homes to report infections acquired in their facilities, provide feedback to health care providers on their performance, and publish public reports to help patients make decisions on the best place to receive care.

* Establishing a pay-for-performance system in state-funded health programs that provides increased payments to facilities that improve patient safety outcomes.

* Continuing to implement electronic health records and e-prescribing. We also need to talk about having enough doctors, nurses, and other health are professionals to ensure that everybody has access to quality care. In the first months of my administration, I will work closely with physicians and other health care professionals to make sure we are addressing the capacity in our system.

Promoting Widespread Health Information Technology

Anybody who has ever had to take an extra medical test because their last lab results weren’t on record, or been to the emergency room, or even just switched doctors, can imagine how much more efficient health care would be if medical records could be quickly and securely transmitted between health care providers. Indeed, electronic medical records and other health information technology, such as electronic reminders about when to get a test, can improve the quality of care, reduce health care costs, and even save lives. The Delaware Health Information Network is a public-private partnership that aims to “save lives, reduce medical errors, and manage health care costs…to bring Delaware’s health care system into the twenty-first century.”39 As Governor, I will make the implementation of health information technology a priority, to improve health care quality now and for future generations of Delawareans.

Containing Pharmaceutical Costs

In 2004, Delaware spent $676 million on prescription drugs.40 While prescription drugs are an essential part of modern health care, too many patients are struggling to pay for prescription drugs, and pharmaceutical spending is eating up a larger and larger share of state and national health care budgets. States have used the following tools to reduce spending on prescription drugs, and Delaware can continue to learn from these examples and undertake similar efforts:

* Continuing to use the purchasing power of the state to negotiate lower drug prices: Pharmaceutical costs can be reduced by using the purchasing power of multiple agencies to lower drug costs, for example by combining the purchases of state employee health plans, Medicaid, and corrections departments. In addition, public-private partnerships should be explored such as pooling drug purchases with large employers and insurance companies.

* Further exploring opportunities to better manage prescriptions. States can save millions of dollars by using technology to manage the use of prescriptions in state health programs. For example, Florida’s Medicaid program provides doctors with handheld devices that provide them with the real-time medication history of their patients. This tool has enabled physicians to make more informed prescribing decisions, resulting in fewer drug interactions, fewer prescriptions written, and a net two-year savings of $50 million. By ensuring that Delaware’s health care providers have the tools they need to better manage their patients’ prescriptions, our state can improve the quality of care, reduce prescription drug costs, and even help avert serious problems like prescription drug abuse.

* E-prescribing: Electronic prescribing has the promise to hold down drug costs by as much as $20 to $44 billion each year nationally by reducing prescribing errors and helping prevent duplicate prescriptions. In addition, e-prescribing could help avert up to 2 million incidents of patient harm from medication errors that occur each year in the United States.41 As Governor, I will support efforts by Delaware’s physician community to implement eprescribing, and will set a goal that all physicians will be using e-prescribing by 2010.

Enacting Common-Sense Medical Malpractice Reform

Medical malpractice lawsuits often arise out of a culture of fear and mistrust – and often end without addressing what should be a top priority – patient safety and quality of care. But new, creative solutions for health care reform – solutions that began at the Veteran’s Administration and are being implemented by hospitals around the country — are reducing the need for medical malpractice lawsuits and showing real savings in litigation costs.42 At one hospital in Minneapolis, medical malpractice lawsuits decreased by 50 percent after this program was implemented.

As Governor, I would support the implementation of these solutions – known broadly as medical error disclosure programs – in Delaware. These and other reform initiatives will contribute to our overall goals of improving health care coverage, reducing costs, eliminating health care disparities, and improving quality. In particular, efforts to control health care costs will be key to our success. The primary reason so many employers, families, and individuals struggle with health care is cost. Unless we do a better job of containing health care costs, such as by emphasizing preventive care, eliminating fraud, and reducing the costs of prescription drugs, all we will wind up doing through efforts to insure more Delawareans is shift the responsibility for high health care costs from one entity, usually businesses or individuals, to another, most likely state government.

Through these and other reform efforts to reduce health care costs while improving the quality of health care, we can, and we will, do better than that. None of these reforms will be easy to accomplish. But the costs of not trying to change the way our health care system operates will far exceed the costs of bold and innovative leadership. Shouldn’t we strive to do it right?

1 See Statehealthfacts.org, http://statehealthfacts.org/profileind.jsp?ind=135&cat=3&rgn=9
2 Office of the Actuary, Centers for Medicare and Medicaid Services, Health Expenditures by State Provider:
Summary Tables, May 2006, available at:
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/nhestatesummary2004.pdf.
3 Julie Appleby, “Health Care Spending Rose at Twice the Rate of Inflation in ‘05,” USA Today, January 9, 2007,
available at: http://www.usatoday.com/money/industries/health/2007-01-09-costs-usat_x.htm
4 Id.
5 Delaware Health Care Commission Annual Report and Strategic Plan, 2007, www.state.de.us/dhcc. Note that the
Commission’s estimates of the uninsured in Delaware are based on a 3-year average (2004-2006).
6 Delaware Health Care Commission Annual Report and Strategic Plan, 2007, www.state.de.us/dhcc. Note that the
Commission’s estimates of the uninsured in Delaware are based on a 3-year average (2004-2006).
Page 15 of 15
7 U.S. Congress Joint Economic Committee. Economic Brief, THE NUMBER OF AMERICANS WITHOUT HEALTH
INSURANCE ROSE FOR THE FIFTH YEAR IN A ROW IN 2005, August 2006.
http://jec.senate.gov/Documents/Reports/healthinsurance2006.pdf
8 Kaiser Family Foundation, www.statehealthfacts.org, 2003-04 data
9 See www.statehealthfacts.org
10 Kaiser Family Foundation, Health Care Spending in the United States and OECD Countries, January 2007,
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
11 Commonwealth Fund, Commission on a High-Performance Health System,
http://www.cmwf.org/publications/publications_show.htm?doc_id=401577
12 Kaiser Family Foundation, www.statehealthfacts.org, January 17, 2007.
13 Families USA, “Paying a Premium: The Added Cost of Care for the Uninsured” June 2005,
http://www.familiesusa.org/assets/pdfs/Paying_a_Premium_rev_July_13731e.pdf
14 Id.
15 Id.
16 Institute of Medicine: Hidden Costs, Value Lost: Uninsurance in America. 2003.
17 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical
Expenditure Panel Survey (MEPS) -Insurance Component. Table II.C.3 available at: Medical Expenditure Panel
survey (MEPS), July 2006.
18 Delaware Health Care Commission Annual Report and Strategic Plan, 2007, www.state.de.us/dhcc. The
Commission’s estimates of the uninsured are based on a 3-year average (2004-2006).
19 Id.
20 Annual Report On the Department of Human Services’ Implementation of Programs To Address Uninsurance
Among Rhode Islanders. Submitted to Permanent Committee on Health Care Oversight by Gary Alexander, Acting
Director, Rhode Island Department of Human Services. February 15, 2007. p. 26.
21 See www.statehealthfacts.org.
22 Delaware does not currently allow presumptive eligibility or self-declaration of income, two enrollment criteria
that could help enroll more eligible families. (Statehealthfacts.org)
23 The Children’s Partnership, About Express Lane Eligibility,
http://www.expresslaneinfo.org/AM/Template.cfm?Section=About_Express_Lane_Eligibility
24 Delaware Health Care Commission Annual Report and Strategic Plan, 2007, www.state.de.us/dhcc.
25 Commonwealth Health Insurance Connector Authority, Health Care Reform Answers for Massachusetts
Businesses, www.mass.gov/Qhic/docs/Business_Requirements_pr.doc.
26 Insurers slice rates on health premiums, Boston Globe, March 4, 2007,
http://www.boston.com/business/globe/articles/2007/03/04/insurers_slice_rates_on_health_premiums?mode=PF
27 Kaiser Family Foundation, www.statehealthfacts.org, January 17, 2007.
28 Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends. 2004 Medical
Expenditure Panel Survey (MEPS) -Insurance Component. Table II.C.3 available at: Medical Expenditure Panel
survey (MEPS), July 2006.
29 S. R. Collins, Universal Health Insurance: Why It Is Essential to Achieving a High Performance Health System
and Why Design Matters, Invited Testimony for the Committee on the Budget, United States Senate Hearing on
“Health Care and the Budget: The Healthy Americans Act and Other Options for Reform,” June 26, 2007.
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=506778
30 Families USA, Paying a Premium: The Added Cost of Care for the Uninsured,
http://www.familiesusa.org/assets/pdfs/Paying_a_Premium_rev_July_13731e.pdf
31 Gov. Minner’s proposed tax increase would bring Delaware’s tax to $1/pack, less than surrounding states.
Delawareonline.com, 1/19/07,
http://www.delawareonline.com/apps/pbcs.dll/article?AID=/20070119/NEWS/701190355/1006, and Campaign for
Tobacco Free Kids, 11/17/06, http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf
32 Campaign for Tobacco Free Kids, July 2007, http://tobaccofreekids.org/research/factsheets/pdf/0148.pdf.
33 Campaign for Tobacco Free Kids, July 2007, http://tobaccofreekids.org/research/factsheets/pdf/0148.pdf.
34 J Lambrew. A Wellness Trust to Prioritize Disease Prevention. April 2007.
http://www3.brookings.edu/views/papers/200704lambrew.pdf
35 Partnership for Prevention, www.prevent.org
36 Commonwealth Fund State Scorecard,
http://www.commonwealthfund.org/improvementcalcs/improvementcalcs_show.htm?doc_id=496192
37 http://www.mha.org/mha_app/pressreleases/2006/6-29-
06%20New%20Keystone%20Funding%20Announcement.pdf
38 For brief descriptions, see http://www.premierinc.com/quality-safety/toolsservices/
safety/topics/bundling/region-state.jsp
39 Commonwealth Fund, http://www.cmwf.org/publications/publications_show.htm?doc_id=469669&#delaware
40 Kaiser Family Foundation, www.statehealthfacts.org
41 Democratic Leadership Council, Restraining Prescription Drug Costs, 2006,
http://www.dlc.org/print.cfm?contentid=253949
42 Joint Commission on Accreditation of Healthcare Organizations. Journal of Quality and Patient Safety, 2006,
http://www.sorryworks.net/pdf/Sorry_Works_White_Paper.pdf.