Legislating Healthcare Funding and its Effects on ARM

Many who make their living in healthcare and healthcare ARM say that single-payer healthcare is a political impossibility.  In an interview with insideARM.com, Michael DiMarco, CEO of medical collection agency The Outsource Group, said flatly, “I do not see a single payer system...as a likely evolution in the US. I do not propose to be an expert in this area, but it seems to me that the amount of cultural and political change needed to create an environment that is conducive to this type of change would be so great that it is hard for me to get my mind around it.”

On the state level, single-payer plans are also being trumped by universal healthcare mandates.  Recently, Massachusetts made national headlines when it pushed through a universal healthcare bill.  But the bill relied on private insurance and state government subsidies for those that couldn’t afford it, rather than on a single-payer system.

In fact, there are only a handful of single-payer bills currently being considered in state legislatures, according to Zackeria Bailey, a legislative analyst at StateScape, a legislative and regulatory research firm in Arlington, VA.  Bailey’s focus is healthcare legislation on the state level.  Universal healthcare is winning the day.  He says, “On the universal healthcare front, the Massachusetts bill is what we call an individual mandate bill.  It states that all citizens of the state must have health insurance, much like mandatory car insurance.”  If a citizen cannot pay for health insurance, then the state will help to pay for it, Bailey noted.  But that’s a far-cry from a single-payer system since the payer can be any one of hundreds of insurance companies; and, of course, the patient’s portion of bill.

 

The Massachusetts bill also highlights the massive differences in mandate bills being pushed in state legislatures across the country.  Bills come in several different flavors: the aforementioned individual mandates; employer mandates, which dictate that all employers, regardless of size, provide medical plans to their staffs; and, the most common type of mandate, Pay or Play.  Pay or Play legislation is a type of employer mandate, but since there are options available to employers, the bills are given a separate classification.  These laws attempt to use the state government’s power to compel employers to provide coverage for their employees.  The most straightforward of these bills are the ones that stipulate only companies that provide health insurance to their workers can be eligible for state government contract work.  Some create a tax penalty for those that do not comply.  And some target companies of a certain size, like the so-called “Wal-Mart bill” recently passed in Maryland that was struck down by a federal judge.

Regardless of the mandate, though, nearly all the current bills in state legislatures focus on providing access to private health insurance.  A few states are looking into public funding of healthcare.  According to the National Conference of State Legislatures, New Hampshire currently has a bill that would establish a committee to study single-payer healthcare.  California seems determined to expand on the universal healthcare initiatives of Massachusetts, Vermont, and Maine by providing more government involvement and taxpayer money in its universal healthcare plan.

But ultimately, all of the state programs rely heavily on the private health insurance-fueled hybrid system that Americans have grown used to in the past 50 years.  That means more of the same for the ARM industry: healthcare expenses not fully covered by insurance will fall on the consumer, who at a predictable rate will default.  The uninsured will continue to be billed for health expenses they cannot afford, leaving collectors with accounts they cannot collect.  And as the U.S. population grows, healthcare accounts receivable management will grow with it.