Do you think that all Dutchess County residents should have access to affordable, quality health care in a Dutchess Health Access Plan-- similar to San Francisco's Health Access Plan now being implemented there?

Among others, these local leaders of faith agree on this:

-- Rabbi Paul Golomb, Dutchess Interfaith Council President
-- Rev. Philip Carr-Harris, current Dutchess Interfaith Council Executive
Director
-- Rev. Gail Burger, former Dutchess Interfaith Council Executive Director
-- Michael Ignatowski, Hudson Valley Network of Spiritual Progressives
Cofounder
-- Brian Riddell, Dutchess Outreach Executive Director

The fact is that a Health Access Plan for Dutchess (like San Francisco)
might be possible-- if our County Legislature passed a resolution asking
the state for a home rule request on this, and it was granted (see much detail below on the San Francisco model).

"According to [San Francisco County Supervisor Tom] Ammiano, SFHAP could
save taxpayers $8-24 million annually by requiring employers to share the
costs of healthcare."
[NewRules.org/equity/sfhealthcare.html]

It's been pointed out that such a plan would save money by rediverting
money spent on very expensive care for the uninsured in clinics and
hospitals to preventive care-- and by making sure that profitable large
employers are paying for their employees' health care as well (so the rest
of us taxpayers aren't unfairly subsidizing this).

Note-- the specifics of a plan for our county don't necessarily have to be completely identical to the San Francisco model-- but it's a viable one that provides a good starting point for us to do something real here in Dutchess like this.

Fact: St. Francis Hospital spokesman Larry Hughes stated on his radio show
on WHVW 950 AM this summer that the hospital spent $14 million over the
last two years alone on care for uninsured patients.

Fact: "Uninsured patients treated at Saint Francis Hospital climbed
dramatically from 16 percent in 2000 to 33 percent in 2004. The cost
escalated too, up 20.6 percent to $12.9 million from 2004 to 2005 alone.
That amounted to 9 percent of the Poughkeepsie hospital's budget."
[from "Soaring Health Costs Leave Many in a Bind" by Dan Shapley
Poughkeepsie Journal 3/23/06
poughkeepsiejournal.com/apps/pbcs.dll/article?AID=/20060323/NEWS01/603230332/0/NEWS01&theme=NIF]

Fact: "New York has 2.9 million uninsured residents, who last year cost
hospitals $1.7 billion in so-called uncompensated care...$908,000 in 2002
at Northern Dutchess Hospital, $4.1 million at St. Francis Hospital, and
$1.7 million at Vassar Brothers Hospital."
[from "New York's Uninsured Need Not Be" by Mary Beth Pfeiffer (9/03
Poughkeepsie Journal):
cdfny.org/News/clips/PoughkeepsieJournalUninsured\%20need\%20not\%20be.pdf]

This excerpt below from a November 1st report from Westchester County Executive Andrew Spano points out how taxpayers in counties like ours now are forced to shell out millions for health care for workers of profitable companies paid poverty wages...
[westchestergov.com/currentnews/2006pr/medicaidsurvey.htm]

"An extensive survey by Westchester County of its employed Medicaid recipients has revealed that many of them are not provided adequate health insurance by their employers and therefore turn to the government for health care -- at an estimated cost to Westchester taxpayers of between $11.5 million and $34.5 million...

It is estimated that it costs about $4,000 a year to provide Medicaid to an adult who is neither disabled nor elderly and $12,000 for a family of four where the main wage earner is covered. Based on these numbers, the county estimates that the total cost to county taxpayers for providing Medicaid to the county's working poor is between $11.5 million and $34.5 million, depending on size of family (this range represents the county?s 16 percent share of the program. The remainder of the costs is picked up by the state and federal governments)...

Based on the total survey results, the following companies were the ten largest employers of individuals receiving Medicaid benefits (and the number of employees involved):

A&P Supermarket (55)
Stop & Shop Supermarket (55)
McDonald's (48)
Mile Square Transportation Inc. (37)
Best Care Inc. (36)
Shop Rite Supermarket (33)
Pathmark (31)
Royal Coach Bus Lines Inc. (31)
Dunkin' Donuts (29)
Personalized Home Care Service (27)"

On that note-- this from the New Rules Project/Institute for Local Self-Reliance...
[newrules.org/retail/econimpact.html#7]

"Hidden Cost of Wal-Mart Jobs - by UC Berkeley's Institute for Industrial Relations, August 2004

California taxpayers are spending $86 million a year providing healthcare and other public assistance to the state's 44,000 Wal-Mart employees, according to this study. The average Wal-Mart worker requires $730 in taxpayer-funded healthcare and $1,222 in other forms of assistance, such as food stamps and subsidized housing. Even compared to other retailers, Wal-Mart imposes an especially large burden on taxpayers. Wal-Mart workers earn 31 percent less than the average for workers at large retail companies and require 39 percent more in public assistance. The study estimates that if competing supermarkets and other large retailers adopt Wal-Mart's wage and benefit levels, it will cost California's taxpayers an additional $410 million a year in public assistance.

Everyday Low Wages: The Hidden Price We All Pay for Wal-Mart - by the Democratic Staff of the House Committee on Education and the Workforce, Feb.2004

Although this study uses different methodology than the one above, it arrives at the same conclusion: Wal-Mart's low wages and meager benefits are costing taxpayers. The average Wal-Mart employee requires $2,100 per year in public assistance, including Section 8 housing vouchers, reduced-cost lunches for dependent children, health care programs, and tax credits for the working poor."

On a personal note, honestly, this issue is rather personal for me-- May 29th this year marked the seventh anniversary of the death of my stepfather, Bob ("Piggy") Malstrom from heart attack at 59-- way too young.

Though he worked most of his adult life (twenty years for IBM), he didn't
have health insurance at the end, and was too proud to go to anyone for
help, though he knew something was wrong with his health; the CPR I gave
him in his last dying minutes failed (recall--
petitiononline.com/forpiggy/petition.html).

It's not just Bob Malstrom though...

Fact: In 2002 the National Academy of Sciences' Institute of Medicine found
in their "Care without Coverage: Too Little, Too Late" study that 18,314
Americans die each year because they lack preventative services, a timely
diagnosis or appropriate care. This includes about 1,400 people with high
blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV.
Odds are the number of deaths is even higher.
[see books.nap.edu/books/0309083435/html/161.html#pagetop]

Fact: That's over a thousand New Yorkers dying each year because they don't
have access to health insurance.

Fact: A 2001 Dyson Foundation/Marist Institute survey found uninsured in
one of every four households here in the Hudson Valley. Basic insurance
costs for individuals range anywhere from $350 and above per month, while a
family plan is over $1000 per month and is too prohibitive for most residents.
[DysonFoundation.org/resources/resources_show.htm?doc_id=212586]

Fact: 80 percent of those without health insurance have jobs or live in
working families, according to the Cover the Uninsured Week, a national
coalition that includes both the U.S. Chamber of Commerce and A.F.L.-C.I.O.
[CovertheUninsuredWeek.org]

Fact: Three years ago an ABC News/Washington Post survey of over 1000
Americans found that 80 percent of us say it's more important to provide
health care coverage for all Americans-- even if it means raising taxes--
than to hold down taxes but leave some people uncovered.
[abcnews.go.com/sections/living/US/healthcare031020_poll.html]

Fact: "The overwhelming majority [of Americans]-- 75 percent, according to
an October 2005 Harris Poll-- want what people in other wealthy countries
have: the peace of mind of universal health insurance."
[commondreams.org/views06/0818-27.htm]

Fact: 89\% of Americans believe our system of health care is broken.
[americansforhealthcare.org/media/pressreleases.cfm?pr_id=119]

Of course I still support health care reform at the national and/or state levels to cover everyone with health insurance-- but how many more years do we have to wait for this?

Recall-- hundreds of us from across the county came out to the big Poughkeepsie Journal National Issues Forum at DCC earlier this spring to deliberate on health care-- and how the overwhelming, vast majority of those there were decidedly for universal health care-- that's our local mandate right there; failing to act on this is just plain irresponsible.

Letters to county legislators can make this a reality-- at
countylegislators@co.dutchess.ny.us and countylegislature@co.dutchess.ny.us.

You never know what might happen if enough of us pull together on this-- tens of thousands of Dutchess County residents need a Dutchess Health Access Plan like the one being implemented in San Francisco; let's not let them down.

Joel Tyner
Dutchess County Legislator, D. #11
Clinton/Rhinebeck
joeltyner@earthlink.net
RealMajorityProject.blogspot.com
(845) 876-2488

[for more info on San Francisco model see SFHP.org and below; also sfhp.org/about_us/whats_new/SF_HAP_faq.aspx?show=-1]

- - - - - - - - - - - - - - - - - - - -

More from the New Rules Project/Institute for Local Self-Reliance...
[newrules.org/equity/sfhealthcare.html]

San Francisco Universal Healthcare Initiative

"The San Francisco Board of Supervisors unanimously approved the San
Francisco Healthcare Access Program (SFHAP) in July 2006 with legislation
entitled the San Francisco Health Care Security ordinance. The program
would give the city's 82,000 uninsured adults access to healthcare
regardless of income, immigration status, or medical condition. The
majority of the uninsured cannot afford healthcare, yet earn too much money
to qualify for the state public health insurance program, Medi-Cal. SFHAP
is not insurance in that it is not portable--residents must be treated
within the city limits.

The plan would be paid for with tax dollars, local business contributions
and individual enrollment fees that are income-adjusted. The 15\% of local
businesses that do not currently provide healthcare to employees will be
required to pay an annual fee to go towards the program?a provision that
has put many from the business community on edge.

SFHAP is a merging of different plans by Mayor Gavin Newsom and Supervisor
Tom Ammiano. The mayor's Universal Healthcare Council released a report in
June with recommendations for the creation and implementation of
SFHAP. Shortly thereafter, Ammiano incorporated SFHAP into his Worker
Healthcare Security Ordinance. The plan has been enthusiastically received
by many-- when the first reading of the ordinance passed on July 18, it was
followed by a standing ovation...

The program is voluntary; it is hoped that 15,000 people will enroll when
phase one of the program debuts in 2007. If all 82,000 uninsured residents
were to enroll in SFHAP, it would cost approximately $200 million per
year. The city already pays $104 million annually to cover uninsured care
in emergency rooms and clinics. According to Ammiano, SFHAP could save
taxpayers $8-24 million annually by requiring employers to share the costs
of healthcare..."

- - - - - - - - - - - - - - - - - - - -

"Newsom Urges Health Care for the Uninsured: Proposal to Cover Health Costs
Would Be Subsidized by Taxpayers"
by Cecilia M. Vega
[excerpt below from San Francisco Chronicle 6/21/06]
sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/06/21/SFHEALTH.TMP

Mayor Gavin Newsom announced an ambitious proposal Tuesday that would make
San Francisco the first city in the country to provide taxpayer-subsidized
health care to all uninsured residents, covering services like doctor
visits, surgeries and prescription drugs.

San Francisco is home to an estimated 82,000 uninsured residents, who
typically go to public clinics and hospitals for treatment. The plan,
dubbed San Francisco Health Access Program, would offer people the primary
and preventative health care they lack and allow them to access hundreds of
doctors in public and private hospitals and clinics.

Efforts to provide universal access to health care in San Francisco have
been attempted before but have failed. But Newsom, who is facing
re-election in 2008 and has made the topic a cornerstone of his
administration, is optimistic that his plan will be implemented beginning
next year.

"This is not a pipe dream," Newsom said. "This city is going to be
the first city in America to achieve universal health care access."

The plan is not health insurance and therefore differs from other
proposals. Those who sign up would have access to care only in San
Francisco and, despite paying monthly premiums, would not be covered by the
plan if they sought treatment outside the city limits.

The estimated $200 million-a-year price tag, or $2,400 per person, would be
paid through a combination of sources, including tax dollars, local
business contributions and individual premiums.

In April, Massachusetts became the first state in the country to require
individuals to carry health insurance or face financial penalties. San
Francisco's plan would not be mandatory and assumes people without other
coverage will volunteer to chip in for the coverage.

"To treat chronic health issues, to treat ear infections and strep throat
so they don't get really bad and end up in the emergency room ...
ultimately that's what most people want," said Nathan Nayman, executive
director of the business lobby group Committee on Jobs and a member of a
task force created by Newsom to study and devise the health care plan.

Individuals who earn $50,000 a year, or 500 percent of the national poverty
level, would pay $201.25 a month in premiums under the proposed San
Francisco Health Access Plan, Newsom said. Those who make between $19,600
and $40,000 a year would pay $35 a month. The figures are comparable to
what individuals pay for insurance under private providers, industry
experts said.

"This is about the people in the middle," Nayman said. The plan applies
only to those people whose incomes are too high to qualify for federally
subsidized health care under Medicaid...the proposal introduced Tuesday is
backed by a broad coalition of business groups, labor unions, health care
providers and members of the Board of Supervisors...

Newsom proposes a voluntary program and predicts that businesses opting to
join to provide their health care to their workers probably would spend
about $30 million. Meanwhile, the city would chip in $104 million annually
by redirecting funds that it already pays to cover the cost of treating
those uninsured who visit emergency rooms and clinics. The rest would come
from premium payments and other sources.

But today the Board of Supervisors is scheduled to discuss legislation
introduced by Supervisor Tom Ammiano that would require every business with
20 or more employees to contribute $1.60 an hour into health care savings
accounts that the city could use to in turn provide health care to the
uninsured...

Ammiano's measure could be merged with the mayor's plan, making the
employer contribution mandatory rather than voluntary...

Under Newsom's plan, all adult city residents would be eligible, regardless
of employment, immigration status or pre-existing medical conditions.
Children in San Francisco already have access to government subsidized
health care.

Newsom said the plan is not meant to take the place of private health
insurance. It would, however, offer a means of treating people without
insurance so they don't rely on hospital emergency rooms for care.

The plan would be administered by the San Francisco Health Plan, which
currently provides health insurance to more than 50,000 low-income city
residents and who receive care at city public health clinics,
city-supported private nonprofit health clinics and most city hospitals,
including city-owned San Francisco General Hospital.

Participants in the new program essentially would join the existing San
Francisco Health Plan. They would receive a medical card and could seek
treatment from more than 400 primary care providers in the network and at
nearly all private and public hospitals in the city.

Everything from emergency room stays, physical therapy and psychiatric care
to radiology, allergy tests and prosthetics would be covered. Dental care
and fertility and cosmetic procedures would not.

"San Francisco," Newsom said, "is moving forward to fulfill its moral
obligation."

- - - - - - - - - - - - - - - - - - - -

From laborcenter.berkeley.edu/healthpolicy/sf_security_ordinance.pdf...

The San Francisco Health Care Security Ordinance

What does it do?

The San Francisco Health Care Security Ordinance creates a Health Access
Program(HAP) that will offer comprehensive healthcare services to uninsured
San Franciscans and their employers at a reasonable cost. The program will
emphasize preventive care that keeps people out of emergency rooms by
providing regular checkups, performing screenings and managing chronic
conditions such as asthma, diabetes and high blood pressure. The ordinance
also sets a "minimum health spending requirement" for medium-sized and
large businesses. This helps level the playing field for the majority of
businesses that already pay for their workers' coverage and discourages
companies from dumping even more of their workers into the
taxpayer-financed public health system. By establishing an affordable
Health Access Program for the uninsured, the ordinance helps better
guarantee access to care for all San Franciscans. By requiring medium-sized
and large businesses to pay their fair share, the Health Care Security
Ordinance will help reduce the taxpayers' burden to shoulder the costs of
caring for uninsured workers.

The Health Access Program-- what is it?

The Health Access Program will replace San Francisco's current system for
taking care of the uninsured. Employers and individuals will be able to
enroll in the program for an affordable monthly fee. The cost of the
program will be subsidized for low- and moderate-income individuals and
small- and medium-sized businesses. The Health Access Program will assign
individuals to a primary care doctor, nurse or medical assistant at one of
the City's public or nonprofit clinics, deliver acute care and specialty
services through a network-- including San Francisco General Hospital and
the city's nonprofit hospitals-- and cover prescription drugs and home
health care. By expanding access to health care, rather than creating an
insurance program, the City can maximize the funds it receives from state
and federal programs, including Medicare. However, the structure of the
plan will not cover services residents receive outside of San Francisco.

What services will participants get that they don't get now?

The HAP will place an increased emphasis on preventing illness by providing
an integrated package of primary care, hospitalization services, specialty
care and prescription drugs. These services will be more highly
coordinated, easier for participants to navigate, and will allow enrollees
to have a "medical home"-- a place they can go for primary care. One of
the
goals of the program is for patients to be able to get primary care early
in their illness, rather than emergency care later on. That said, the HAP
is not an insurance program but rather an integrated package of health care
services available only inside San Francisco County.

How do people enroll in the HAP?

The uninsured will be able to be enrolled in one of two ways:

1) individual enrollees could pay a premium, set according to an
income-based sliding scale;

2) employers could enroll their employees as a group, by paying their
premiums.

The Department of Public Health will develop the rules and regulations
governing enrollment-- including rules to discourage employers who
currently provide health insurance from dumping their employees into the
Health Access Plan.

How much does it cost?

The Department of Public Health has estimated that the program would cost
about $201 per enrollee if it were implemented today. If all of San
Francisco's 82,000 uninsured residents were to enroll in the HAP, the total
cost would be about $200 million. To finance the program, the City will
contribute $104 million that it currently spends onthe uninsured; the
remaining costs will be borne by individual enrollees and businesses that
enroll their employees. If fully enrolled, premiums and co-payments (mostly
from higher income individuals) would make up about $60 million of the
total, and business premiums would raise another $30 to 40 million. The
program is expected to reap another $10 million through increased federal
cost-sharing.

The minimum health spending requirement-- what is it?

The Health Care Security Ordinance will require medium-sized and large
employers in San Francisco to spend a minimum amount per employee per hour
on health care for their workers. Large companies (100 or more workers)
will be required to spend a minimum of $1.60 an hour per employee on health
care services. For a full-time employee, this is equivalent to 75 percent
of the average amount that the 10 largest counties in California (other
than San Francisco) spend on individual health coverage for their
employees. This rate will go up 5 percent in 2007, 5 percent in 2008, and 5
percent in 2009. From 2010 on, the rate will be indexed once again to 75
percent of the 10-county rate. Medium-sized companies (20 to 99 workers)
will be required to spend a minimum of $1.06 an hour per employee on health
care services. For a full-time employee, this is equivalent to 50 percent
of the average amount that the 10 largest counties in California (other
than San Francisco) spend on individual health coverage for their
employees. This rate will go up 5 percent in 2007, 5 percent in 2008, and 5
percent in 2009. From 2010 on, the rate will be indexed once again to 75
percent of the 10-county rate. Small companies (fewer than 20 workers) are
exempt. Non-profit organizations with fewer than 50 employees are also
exempt, as are non-profit job-training programs.

Which employees does it cover?

Companies will have to meet the spending requirement for all workers,
except for managerial, supervisory, and confidential employees who earn
over $72,450 per year. Employees who are eligible for Medicare and/or
CHAMPUS/TRICARE (veterans' benefits) are also exempt (so that they continue
to receive those benefits). Employers will pay on hours worked by part-time
as well as full-time workers, up to a cap of 172 hours per month. This
avoids any incentives to cut employees' hours in order to avoid the
requirement. To be a covered employee, an individual must work a certain
number of hours per week. This threshold is set so that businesses can more
easily anticipate for whom they need to make contributions, and so that
there is no incentive to adjust workers' schedules in order to evade the
ordinance. This requirement is phased in: during 2007, a worker must work
12 hours per week; during 2008, a worker must work 10 hours; from 2009 on,
a worker must work 8 hours. Workers who verify that they receive health
services through another employer (either as an employee, or as a spouse,
domestic partner, or child of another person) and who sign a voluntary
waiver will also be exempted. This opt-out can be revoked by the worker at
any time.

What are employers required to spend money on?

Health care expenditures are defined as "any amount paid by a covered
employer to a covered employee or to another party on behalf of its covered
employee for the purpose of providing health care services for its
employees." This includes, among many other options:

1) insurance;
2) contributions to a public program for the uninsured (i.e., the Health
Access Program);
3) health savings accounts;
4) direct reimbursement to employees for health expenses.

The Health Care Security Ordinance gives employers a choice as to how to
spend this money-- it does not require employers to buy health insurance or
to pay money to the Health Access Program. These are just two options for
meeting the spending requirement.

Why are the minimum health care spending requirement and Health Access
Program so closely linked together?

Without making medium-sized and large businesses pay their fair share of
health costs, the Health Access Program would fail. Many businesses that
currently provide health coverage to their employees might drop that
coverage and force their employees onto the public health care system.
Conversely, without the HAP, medium-size businesses would have few
affordable options for meeting the health spending requirement. One way to
meet the minimum health care spending requirement will be to enroll
uninsured employees into the HAP. The financing model for the HAP assumes
that the payments required of businesses under the ordinance will be
sufficient to enroll that employer's eligible workers in the HAP. At $1.06
an hour, employers with between 20 and 99 workers would be paying $182 per
month for a full-time employee and $91 per month for a half-time employee
to enroll those workers in the Health Access Program.

Why place a minimum health care spending requirement on employers?

The minimum health care spending requirement will help maintain the current
base ofemployer-sponsored health insurance while also securing the
resources necessary for the City to offer the Health Access Program. The
minimum health care spending requirement will significantly diminish the
incentive for employers to drop their employees' existing health care
coverage and dump them into the HAP. The vast majority of San Francisco's
employers currently provide health care coverage for their employees. If
these employers were to drop that coverage in response to the HAP, the
City's health care system as well as its budget would be swamped. Creating
a floor for health care spending by medium-sized and large businesses will
help ensure that these businesses maintain employer-sponsored health care
coverage for their employees, while at the same time securing the
additional resources necessary to offer the Health Access Program from
those employers who aren't currently doing their fair share.

Isn't this unaffordable to smaller businesses?

No. Small businesses are exempted entirely. And among businesses that are
covered by the minimum health spending requirement, the vast majority
already pay for their workers' health care. In fact, 83 percent of all
workers at companies of 20 or more employees have employer-sponsored health
coverage. It is a small minority of businesses that don't provide coverage.
The Health Care Security Ordinance levels the playing field for those
businesses that are already doing the right thing, and reduces their
competitive disadvantage. Moreover, the ordinance will provide a
steeply-discounted program for medium-sizedbusinesses to enroll their
uninsured workers. For a full-time employee who works 40 hours, the $1.06
spending requirement amounts to just 50 percent of what other employers pay
for individual coverage. For part-time employees, it's even less-- because
this is an hourly spending requirement, an employer would pay just 25
percent for a half-time worker. This makes the program much more affordable
for restaurants and other businesses that rely heavily on part-time
workers. Finally, the spending requirement is phased in over several years,
allowing companies to plan ahead of time. For the first three years
(through 2009), the spending requirement will rise by a fixed 5 percent per
year. Each year thereafter, the rate will be pegged to the 10-county survey
amount. For businesses with 50 or more employees, the spending requirement
does not go into effect until July 1, 2007. For businesses with 20 to 49
employees, it doesn't go into effect until March 31, 2008.

If this is so affordable, won't businesses dump workers into the HAP?

In addition to the disincentives to dumping created by the minimum health
care spending requirement, the Department of Public Health will set
enrollment rules to restrict crowd out. If there is a problem, DPH will
have the flexibility to revise regulations accordingly.

Why not just require businesses to pay directly into the HAP?

Federal law (ERISA) prohibits state and local governments from doing this.
Moreover, it is good for employers to have a choice as to how they meet the
spending requirement. What option is best will vary for both workers and
businesses.

Health care costs are soaring-- doesn't this create huge liability for the
City in the future?

Health care inflation is currently leading some businesses to dump their
workers into the public health system-- so that taxpayers are increasingly
footing the bill for irresponsible employers. By creating a floor for
health spending, the Health Care Security Ordinance actually reduces the
City's exposure to this trend. The costs of the Health Access Program will
rise over time with inflation, as will premium rates. The program will
utilize best practices from around the country to contain costs while
providing quality care. The spending requirement is in turn indexed to
actual employer healthcare spending in California. As a result, employers
will continue paying their fair share for health care over time and the
City will be able to meet its ongoing obligations.

Has any one else done this?

Many different jurisdictions are experimenting with health care reform,
including the States of Massachusetts and Maryland, the Cities of New York,
Chicago and Los Angeles, as well as many others. The San Francisco
ordinance has the broadest reach of any local health care reform effort and
is being studied closely by other jurisdictions.