Evaluation Criteria for Health Care Reform Proposals
Submitted by LWVC Health Care Committee and approved
by LWVC Legislation Committee
In this legislative session, we are fortunate to see an active interest
in finding a solution to the severe crisis affecting health care in California.
Several proposals have been brought forward and are under discussion by
stakeholders and legislators alike. The LWVC welcomes the wide interest
in reform that is being demonstrated and recognizes the role we can play
in bringing clarity and leadership to the discussion.
The League of Women Voters of California has long held a position in support of single payer universal health care reform as embodied in Senator Sheila Kuehl’s bill, SB 840. This approach is commonly described as “the gold standard” by those engaged in the policy discussion.
Single payer provides universal, affordable and comprehensive coverage on a continuous basis to all. It ensures maximum choice of provider and exemplifies shared responsibility that is equitable, accessible and requires contributions from individuals and employers that are related to ability to pay. Because it includes robust methods to control costs, it is sustainable over time. It makes significant contributions to improving the quality of our health care system, and because it is patient centered, it will bring measurable improvements to health outcomes.
As the LWVC contributes to the current dynamic discussion, we recognize that an opportunity may exist to improve the situation in the short term by supporting proposals that move us forward toward achieving the ultimate solution of single payer. It is critical that any actions taken in this regard are true to the elements of single payer that make it the best solution, and will not impair our ability to achieve our ultimate goal. We also must not accept compromises that do not protect the most vulnerable among us from further deterioration in their access to affordable and quality care.
In order to inform LWVC decision making as we evaluate various proposals, we have identified the following elements of various proposals as positive or negative in terms of the above comments.
Our judgment is informed by our understanding of the principles put forth in the LWVUS Health Care position adopted in 1993.
Elements the LWVC can support:
- Universal access
- Comprehensive coverage
- Expanded risk pools
- Expanded public programs
- Purchasing pools that offer affordable, comprehensive benefits to all residents who choose to participate
- Proposals that ensure affordable comprehensive coverage for the working poor
- Limits on administrative costs of insurers (required medical loss ratio)
- Community rating and guaranteed issue
- Proposals that would improve access to preventive and primary care, disease management, and evidenced-based practice
- Initiatives to support Information Technology development and implementation
Elements the LWVC will not support:
- Individual or employee mandates
- Proposals that promote limited coverage in order to provide affordability-such as high deductible plans and Health Savings Accounts
- Proposals that encourage individual coverage rather than expanding risk pools
- Proposals without effective and assured cost controls
- Proposals that do not ensure the same basic level of care for all
- Employer mandate that does not require employer contributions equivalent to the current average employer contribution
- Employer mandate that does not apply to most employers
- Proposals that shift funds from safety net hospitals before the number of uninsured has been reduced to an equivalent extent
- Insurance regulation that does not include:
- Community rating
- Guaranteed issue
- Minimum medical loss ratio
- Standardized comprehensive benefit packages
- Rate regulation
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