Information Trading How Information Influences the Health Policy Process (1997) / Chapter Skim
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3 The Use of Information and Misinformation in a State Health Reform Initiative
3 The Use of Information and Misinformation in a State Health Reform Initiative
Pages 49-70
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From page 49... ...
This paper explores significant factors involvecl in the failure of Missouri's health reform debate in 1993 and 1994, focusing on the use of information and misinformation in policy clecisionmaking and legislative action. STATE I~EGISI~ATION In most states, inclucling Missouri, the legislative process and the systems supporting the development of legislation differ from 49
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From page 50... ...
WHY MISSOURI? Missouri is an excellent laboratory that can be used to obtain an unclerstancling of the development anc3 implications of state health reform initiatives.
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From page 51... ...
As early as 1987, the St. Louis Business Health Coalition hac3 assembled a report on local hospital performance using data from Medicare cost reports (Katz, 1996~.
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Louis Business Health Coalition had access to most elected officials and business leaclers. Other important developments incluclec3 the growth of the Missouri Consoliciatec3 Health Care Plan that promoted movement of public employees into managed care plans, with public employee enrollment in managed care plans growing from less than 10 percent to 75 percent in just a few years.
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From page 53... ...
Despite these evolutionary events, in 1994, nearly 600,000 Missouri citizens remained uninsured, an ever-growing Meclicaic3 program accounted for 25 percent of the state's budget, and health care costs continued to grow. THE SHOWME HEALTH REFORM INITIATIVE Governor Carnahan was inaugurated in January 1993.
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From page 54... ...
The recommendations of the work groups were based on materials that were specifically requested for the ShowMe Health Reform Initiative, the existing literature, and most importantly, the knowleclge of the members of the working groups. In general, the members of the work groups were extremely knowledgeable and
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From page 55... ...
The Insurance Commission reviewoc3 the documents prepared by the ShowMe Health Reform Initiative. There was frequent conversation between staff anc3 members of the two groups.
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From page 56... ...
The bill also established the Health Guarantee Corporation, a private corporation established to allow providers anc3 insurers to coordinate their efforts to develop plans to improve community health status, accomplish public health objectives, anc3 develop risk adjustment mechanisms for the ISN premiums and ways to address universal coverage. INFORMATION AND EDUCATION Multiple steps were taken to educate Missourians about H.B.
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From page 57... ...
Targeted fact sheets regarding the comprehensive legislation were prepared and distributed to all affected individuals, including physicians ho~nitals nurses other health care providers emnlovers and · ~ citizens. -, -- - -A - rim -- a -- -- r -- ~- The ShowMe Health Reform Initiative commissioned a study by Lewin-VH} (Lewin-VHI, Inc., 1993)
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From page 58... ...
Educating State Legislators At the beginning of the legislative session, the bill managers were faced with the need to educate 197 members of the legislature, to actress the issues needled for passage of the bill, and to manage any misinformation created by opponents of the bill. The General Assembly's limited experience with comprehensive health care reform bills was an important issue.
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From page 59... ...
Eventually, some support was found by narrowing the bill to a series of insurance reforms (an end to banning coverage for preexisting conclitions, portability, and modified community ratings) combined with some public health initiatives.
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1622 reduced the role of insurance agents in selling and marketing health insurance products. The insurance industry used the threatened loss of income to activate agents, but they did not attack the provisions affecting their potential loss of income.
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From page 61... ...
Reasons for Success of Special Interest Groups The success of special interest groups was determined by the factors that differentiate legislative activity at the state level from that at the federal level. Incluclec3 among these factors are legislators who are actively involved in another career (including officials involvec3 in the insurance industry, limited resources for legislative staff, limited access to policy institutes and think tanks, limited availability to academic expertise, readily available national data
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From page 62... ...
CASE EXAMPLES The Uninsured In the debate surrounding universal coverage for Missouri's uninsured citizens, questions about the cost of extending coverage to the uninsured and the accuracy of the data concerning this group overtook the dialogue. Despite data demonstrating the advantages to all Missourians of extending health insurance coverage, many concerns remained.
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From page 63... ...
incluclec3 allegations that a significant number of the uninsured voluntarily withdrew from the market, despite being able to participate; that most uninsured lacked coverage for only a brief period; that the uninsured received coverage anyway; and that universal coverage was too expensive. During Missouri' s health care reform debate, the small complement of legislative research staff, the absence of major academic policy consultation, and the limited availability of Missouri think tanks led to a heavy reliance on departmental (Department of Health, Department of Insurance, etc.)
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From page 64... ...
When combined with the highly effective marginalization of acivocates who workoc3 for universal coverage, the debate on universal coverage was effectively halted. Community Rating Health insurance reform was debated throughout the legislative session and was one of the final pieces of legislation to be clefeatec3.
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From page 65... ...
Integrated Service Networks Consolidation of hospitals into vertically integrated systems was an emerging trend during the health reform clebate. Hospitals, group practices anc3 other ambulatory services were beginning to integrate horizontally as well.
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From page 66... ...
The managed competition aspects of the bill and the lack of a single-payer mechanism created ambivalence among these advocates. They attenclec3 all of the public and legislative hearings and were actively promoting comprehensive reform.
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From page 67... ...
Health Reform Efforts of Other States Other states' efforts were interpreted by advocates in a variety of ways. As stated previously, although community rating was seriously consiclerec3 cluring the health reform debate, the experience of New York State was used alternately to promote the advantages of community rating anc3 simultaneously to describe the outrageous rate increases anc3 reductions in coverage likely with community rating reforms.
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From page 68... ...
Efforts After the Debate Since the 1994 legislative session, the Missouri Department of Health has formed a new Bureau of Health Services Research, which has successfully obtained a grant from the Robert Wood Johnson State Health Reform Initiatives Program, and has continued the public-private dialogue regarding the state's health care system. Five health-relatec3 agencies at the state cabinet level have formed an interagency health policy group focusing on the development of health care quality indicators, consistent patient satisfaction measures, and the development of consistent public purchasing policies.
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From page 69... ...
1994. HealthCare Reform: The 1993-1994 Evolution.
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From page 70... ...
1993. Alternative Health Reform Initiatives: A Report for the Cost Control Committee of the Missouri ShowMe Health Reform Initiative.
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