The proposal builds on the current employer-based system and calls for employers not currently purchasing coverage to join the system.
Titled “Universal Coverage, Universal Responsibility,” Blue Shield proposes universal coverage through:
- Asking employers to offer coverage or contribute an equivalent amount of money toward an essential benefit package for each employee
- Enrollment of every eligible Californian in Medi-Cali or Healthy Families
- Requiring Californians who can afford healthcare coverage to purchase it and providing subsidies based on need for those who can not afford insurance
- Guaranteed coverage regardless of health status
- The creation of an essential benefits package guaranteeing preventive care, physician services, hospital care and prescription drugs
- Expand preventive care to achieve savings through earlier treatment for the formerly uninsured, reduced emergency room usage and administrative efficiencies from more secure financing
The plan calls for additional individual and business costs to be supplemented, as needed, with a broad-based tax or fee.
Blue Shield CEO Bruce Bodaken understands the proposal poses new issues for Blue Shield and the health plan industry.
“Like all insurers, Blue Shield has benefited from a system that allows us to decline coverage to individuals with health problems. Under the existing rules, it’s a competitive necessity,” explains Bodaken. “A comprehensive solution that requires universal participation will eliminate barriers to coverage, which helps consumers, but forces changes to the economic model that has produced profits for many health plans.”