Cities Seek Health Care Reform

Health care reform is now emerging as the single most important domestic issue after economic recovery. Congress seems poised to move on the issue this summer as debate on both sides of the issue picks up.

There is a very strong case to be made for health care reform. Whether in the public or private sectors, whether as part of the insurance industry or the health care provider network, the facts are increasingly pointing to the emergence of a health care system that is no longer sustainable. 

Forty-six million or more Americans are without health insurance and millions more have inadequate health insurance. For many, an illness is financially unmanageable. In fact, the cost of health care is the single largest reason for individual bankruptcy filings in the U.S. today. The poor and persons of color especially have limited access to the kinds of health care needed to prevent illness, recover from an illness or address a chronic health care problem. All of this despite the fact that health care in the U.S. costs $2.2 trillion per year at a per capita rate that is nearly twice as much as that of other developed nations.

The impact on cities and towns across America has been substantial as well. As the nation’s fourth largest employer, cities and towns have a huge health care burden. Whether because of state or local laws or collective bargaining agreements, most cities and towns provide their employees with health care. 

A recent survey determined that 86 percent of all cities and towns provide health care for their employees and most provide coverage for employee families. NLC estimates that cities and towns spent $87 billion last year on health care for the employees and families, with the certainty that each year that number will increase substantially. Over the past 10 years, the cost of health care for cities and towns has risen nearly 120 percent.

So what is it that cities and towns want to come out of the health care reform process?

There are two major outcomes cities and towns seek. The first is for the federal government to put in place mechanisms that will help control the costs associated with health care; the second is to ensure universal access to health care.

Mechanisms to control costs identified by cities include market place reforms — establishment of a national exchange to which individuals and businesses may go to select insurance,  implementation of payment systems based on quality rather than quantity of service, better use of Web-based health care records and other information technologies and better alignment of needs and resources — addressing regional, racial economic and other disparities in the delivery of health care.

Among the mechanisms to ensure universal access that cities have identified are expanding Medicare, Medicaid and the State Children’s Health Insurance Program to reach a wider group of individuals and families with free or reduced cost health care; keeping in place cost effective and efficient private sector health insurance options; and health care access for low income earners and people of color.

The next two parts of the series, featured in upcoming issues of Nation's Cities Weekly, will focus on the federal response to the health care crisis and the prognosis for passage of health care reform, respectively.