MINUTES OF THE
DUKES COUNTY HEALTH COUNCIL
Regular Meeting of February 22, 2001
I certify, that to the best of my ability to record and recall, these are the Minutes of the Regular Meeting of the Dukes County Health Council held on
February 22, 2001.
Meeting called to order at 8:07 a.m.
Members Present: *Ex Officio
Cynthia Mitchell, Chairman Les Holcomb
Arthur Wortzel Patty Begley
Kathleen Rose Sarah Isenberg
Sarah Kuh * Dennis Hoak
Jacque Cage Bob Sawyer
Murray Frank Lorna Andrade
Kathy Logue Ned Robinson-Lynch
Tad Crawford Maureen Kelly
Peter Strock Jane Cleare
Eric Butler Cathy Brennan
Tom Dresser Sandra Lothrop*
Katherine Colon Sharon Clauss-Zanger
Kevin Burchill
Also Present: Marsha Smolev Alan Hirshberg Nancy Kasen (JSI)
Teresa Rodrigues Chris Zadeh Nancy Turnbull (JSI)
Len Stewart Liz DiCarlo Pat Fairchild (JSI)
Maia Faillard Robin Rolin
Absent:
Matt Poole Marguerite Bergstrom*
Elizabeth Norcross Karen Kukolich
Carol Borer* Chris Knowles
Michele Lazerow Fred Rundlet
Else Membrezo Bud Macy
Cynthia Mitchell opened the meeting by announcing that the next meeting of the DCHC is scheduled for March 22, 2001. Arthur Wortzel Moved to Accept the Minutes of February 22, 2001. Kathy Logue Seconded the Motion. The Minutes were amended to note Kevin Burchill and Patty Begley’s absences. The Minutes were then Approved with Kathy Logue, Patty Begley, Kevin Burchill and Robert Sawyer abstaining.
Tad Crawford distributed and reviewed the Treasurer’s Report. He noted that a challenge for the Health Council is to meet salary commitments for Teresa Rodrigues and Chris Zadeh. Tad Crawford also mentioned that the Council will be seeking additional funds from the County for Phase III.
Nancy Turnbull announced that Blue Cross established a new $55 million foundation for Healthcare Access.
The Final Report for Phase II was distributed for review. Nancy Turnbull said the purpose of using an actuary was to see if there’s the potential to close the affordability gap and to allow the DCHC to make assumptions about underlying projections. Nancy Turnbull stated that she believes there is the potential to bridge the affordability gap in some scenarios. The premium rates discussed are not actual rates. They are there for study purposes. One target population to be discussed includes people currently employed but not insured, the commercial population.
Different benefit designs were reviewed in the handout. As for wellness benefits, the actuaries felt that wellness is too volatile an issue to be included at this point.
Three benefit plans are shown in the handout. Nancy Turnbull reviewed the handout section by section. A significant way to achieve lower premiums is through sliding fee scales. The differences between Medicare and Medicaid fee scales was discussed.
Chairman Mitchell asked for a definition of point of service. Ms. Turnbull explained that with point of service, a patient can go anywhere he wants. He has freedom of choice, so there need to be financial incentives for him to want to stay in the network. Dr. Hoak reviewed physician’s charges for office visits, and how Medicare pays. Nancy Turnbull said charges bear little relationship to what physicians get paid. She added that right now, Medicare offers physicians the best fee schedules for most doctors for whom she consults. Jacque Cage asked about means testing. Nancy Turnbull replied that if people want subsidies, they should expect to be means tested. Discussion continued about sections of the handout. Nancy Turnbull reminded the Council that the mix of people
joining is most critical. The bigger the group, the lower the administration costs. Kevin Burchill stated that while the MV Hospital Is not a participant in the free care pool, it uses the same guidelines.
Another assumption mentioned is the Plan’s 15% administrative cost. A key challenge, Nancy Turnbull stressed, is to attract a representative cross section of uninsured. Otherwise, the Plan would end up with adverse selection.
The different scenarios were reviewed:
Scenario one had the highest provider payment and highest benefit package fee schedule.
Hi benefits, Medicaid fee schedule for benefits
Lower benefits, Catastrophic plan, Medicare fee schedule
Lowest benefits, Medicaid
The Plans are not age based, but are representative samples. To get young people to want to join, would be a challenge. It would be important to make sure employers already in plans, don’t change to this one to pay less.
Robert Sawyer asked if acceptability of such a Plan on the Island has been looked at. Nancy Turnbull said there can be a smaller population in the Plan if it contracts with a company. For self-sufficiency, a large plan is needed.
The question remains, are employers really unwilling to pay anything towards insurance or would they contribute if they thought it was affordable?
Nancy Turnbull stated that 45% of the Island population has incomes under the 200% poverty level. She believes the affordability gap can be closed for this group.
Coverage for children was mentioned, how to maintain coverage, should a child’s parent leave the Plan.
The next steps were discussed, including meeting with focus groups. Chairman Mitchell mentioned the need for education about the Plan. Les Holcomb mentioned the need for a Children’s Health Trust, a way to pay for children so they’re covered no matter what happens to the economics of the family. Kathy Logue brought up the problem of trying to include seasonal employees. Sarah Kuh mentioned how to include undocumented workers. Nancy Turnbull said there could be eligibility requirements. Dr. Hoak mentioned the possibility of subsidizing physicians to care for some patients. Tad Crawford questioned why people would join, what are the incentives?
The meeting adjourned at 10:15 (?) a.m.
Respectfully submitted,
Marsha Smolev
Executive Assistant
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