Anna Sommers: Theater of Health Reform

Anna Sommers, Ph.D., is a Senior Research Analyst at The Hilltop Institute at the University of Maryland, Baltimore County (UMBC). Anna has over ten years of experience conducting health services research, with expertise in survey and quantitative analysis related to health insurance access and service use. She has conducted studies in the areas of maternal and child health, access to care, health services use and spending, eligibility for insurance programs, Medicaid quality measurement, and local initiatives to cover children in California and Florida.

As the Principal Investigator on the SHARE study, Anna leads a team of researchers in examining employer participation in New Mexico’s State Coverage Insurance program. We talked to Anna about programs that fill health service gaps, her own experience losing health insurance as a young adult, and the U.S.’s reluctance to adopt a public health model.

New Mexico’s State Coverage Insurance (SCI) program is a public/private partnership program. What is the state trying to accomplish?

The program began in July 2005 and it was intended to reach out to low-income uninsured employees of small businesses. New Mexico has many small businesses and this sector has been poorly served by the private market. The State Coverage Insurance program combines federal funds from SCHIP, state subsidies, and employer/employee contributions to create an affordable option for these employees and their families. The program also allows adults with no employer sponsorship to enroll.

What employers is New Mexico’s SCI program targeting?

New Mexico’s SCI program targets employers who want to enroll low-wage employees into a program at very low cost to employers. Businesses like restaurants, construction companies and daycare centers may have never before had an affordable option for health insurance coverage. Others may have only offered insurance to higher wage employees who can afford to pay the high premiums charged to small groups in the private market. Businesses can do this through what is called a carve-out, but this leaves low-wage workers without a coverage option.

How will the SCI program affect New Mexico’s high rate of uninsurance?

Our study is not evaluating the impact of the program on uninsurance rates. However, through surveys with participating individuals and employers, we will learn about the prior insurance status of individuals enrolled in SCI, and the prior experience participating employers have had offering health insurance coverage. Low-income adults who are not parents and do not have a disability cannot qualify for Medicaid. For these individuals, SCI is the only public insurance option in New Mexico, so we do expect an impact on this group. However, the program’s impact will be limited by available funding. In the fall of 2008, program enrollment was capped because of funding limits, despite its growing popularity.

To what extent do you think New Mexico’s SCI program will serve as a lesson for other states?

The greatest challenge SCI has faced is how to negotiate the tradeoff between accepting federal funds to subsidize the program and work within the restricted guidelines this federal contract permits. At the same time, the program relies on some private market features, such as using brokers. We can learn a lot from New Mexico’s experience about what steps federal policy makers may need to take in order for federal funding to offer continued support for such public/private partnerships.

Considering New Mexico’s unique demographics, is it a reasonable option for other states to consider?

Not every state can do what Massachusetts is doing, so it’s important to look at a variety of state reform models. Our study examines the challenges faced in recruiting small employers with low-wage workers to participate in a public program. These employers exist everywhere. In particular, we are asking what is an affordable contribution for these employers to make toward their employees’ health insurance coverage? Gathering better data on this question is important for engaging these small employers in a statewide public/private reform solution.

How did you first get involved in the field of health services research?

As a young adult right out of college working in the theater industry, I was denied health insurance in the individual market and was uninsured for three years. I had recently completed treatment for bone cancer. While uninsured, I was able to complete my follow-up care by receiving charity care from the hospital. But I also missed out on rehabilitation therapy, and even delayed treatment for emergency care. I experienced the stigma of negotiating for needed care using a credit card, knowing that I never could have paid for a catastrophic medical bill that way. So I understand the real consequences of being uninsured.

Paying out of pocket is not an option for everyone.

Certainly not. From my experience, I learned that being uninsured has very real consequences on the choices that providers make about what kind of treatment they prescribe. It also impacts daily life decisions, like the types of preventive care you seek. These lessons moved me toward a new career promoting health insurance coverage in this country so that we can ameliorate the very real suffering that occurs among the uninsured.

Where do you think health policy is headed?

I believe that in five years, we will come to some national consensus on a federal framework for achieving universal health coverage. Working out the nuts and bolts to make this work will be an enormous job for health services researchers, economists and policy makers. I hope that soon after that, we will turn our attention to recognizing the value of public health models. Other countries that have slowed the growth of their health care costs have relied far more heavily on primary care and on public health initiatives and programs.

How would you like to see public health incorporated into health policy?

We have to shift gears over the next 10 years and incorporate public health models into our delivery system and into our society again. We need to bring to bear non-medical paradigms for improving the health and well-being of our society. This would include bringing back physical education to schools and making communities more walkable. And to do that, we are really going to need our public health partners.