Health & Wellness
Making Delaware the First State to Provide Universal Access to Primary and Preventative Care
John Carney is a firm believer that quality health care should be accessible to everyone. He also believes that physical activity and good nutrition are keys to avoiding chronic illnesses.
Now he wants to bring the objectives of healthier lifestyles and access to care together and really focus on prevention, routine screenings and health care visits. John would like to create a system that guarantees all Delawareans access to primary and preventive care. He wants to be able to say, "If you are a Delaware resident, you will have access to preventive services and primary care, regardless of your income or insurance status." That should be our goal, and he thinks it's within our grasp.
That's why he has proposed that the State of Delaware guarantee access to primary and preventive care for its residents by creating Delaware First Care, a system where the State would subsidize routine screening and medical visits, allowing residents to pay a portion of the charge based on a sliding payment scale depending on their household income. More than 40,000 people could benefit from this system.
Under our current system most get insurance through their employer. Those who make up the so-called "working poor" in this State have to make a decision about every dollar they spend. Because health insurance is so expensive, it is rarely within reach of those with lower incomes, and even out of reach for some families with moderate incomes. Consequently, many times they only go to see a doctor when there is an emergency, often when an illness has progressed to a dangerous point.
There is no health care for people in this situation. They do not gain the benefits provided by annual checkups and screenings or primary visits for treatable small ailments or the early identification of more acute problems.
Delaware First Care will immediately make it possible for all Delawareans, regardless of income, to see a doctor for those primary and preventive care visits they might not otherwise be able to afford.
Establishing Delaware First Care will also be a major step in improving health care in the First State. It moves us closer to meeting what will be one of John's top priorities as governor, which is to make comprehensive health care coverage available and affordable to every Delawarean.
Another benefit of Delaware First Care is that it can save money for those who pay into our health care system. Right now, when an individual who is unable to pay for care visits an emergency room in one of our hospitals, they are not refused care. The cost of the care provided to that person is eventually written off as uncompensated care. One of the ways hospitals cover that loss is through shifting the cost to those patients who have health insurance.
Delaware First Care would allow some patients to visit a doctor instead of the emergency room. It would also enable people to make preventive visits that, for some, will help them avoid a path to a more acute condition or detect a disease at an earlier stage. Both scenarios will help prevent more frequent, expensive treatment, lab work and tests, and even hospital stays.
John proposes building the Delaware First Care system using the Community Health Access Program (CHAP). The existing CHAP system is made up by the Federally Qualified Health Centers across our state, several other community health centers and many doctors. CHAP already provides health care to Delaware residents who have household incomes between 100 percent and 200 percent of the Federal Poverty Limit.
Building on CHAP makes sense because most of the needed structure already exists - an enrollment system, an income verification process and an outreach program. Many doctors already participate in CHAP and the Medical Society of Delaware supports the system.
Currently, residents from households with incomes under 100 percent of poverty are eligible for Medicaid. Children from households between 100 percent and 200 percent are eligible for the State Children's Health Insurance Program, while everyone else from those homes can enroll in CHAP.
Under Delaware First Care, residents without any other coverage and whose income falls between 200 percent and 500 percent of the federal poverty limit would be eligible for subsidized primary and preventive visits on a sliding scale. Those near 200 percent of poverty would have more of the cost covered, while those closer to 500 percent would get a smaller subsidy.
The primary and preventive care visits would include physicals, immunizations, routine primary care and well-child visits, and could include other wellness programs as well.
Those visits could be extremely important to the uninsured who would be eligible. Of the approximately 105,000 Delawareans without insurance, between 40,000 and 50,000 would be eligible for this new program. The initial enrollment would probably be low, but would grow with each year. It might start around 4,000 and ramp up quickly, but the hope is that after a few years, we would be closer if not fully transitioned to universal care for everyone.
Given the health care needs of this under served population, and the cost shift being absorbed by insured Delawareans today, Delaware First Care is a program that makes sense both financially and in terms of meeting the health care needs of Delawareans. It is also the first step toward John's goal of universal health care and providing coverage for every Delawarean. He believes it is the right approach, and one that he will pursue in the next year and when he becomes governor.
Eliminating Health Disparities in Delaware
John Carney has spent much of his time as L.t. Governor focusing on ways to improve the health of Delaware citizens. As Chair of the Delaware Health Care Commission, he has been active in promoting better healthcare for Delaware citizens. John has worked to expand the Community Healthcare Access Program and develop a system of universal health insurance that would guarantee every Delawarean the care he or she deserves. And, through his own initiative, the Lt. Governor's Challenge, he has helped over 40,000 Delawareans, including 25,000 children, add physical activity to their daily lives.
A major challenge to improving health and wellness in this state is addressing the health disparities that exist between the white population and racial and ethnic minorities. The health statistics for African Americans and Hispanics in the state are staggering.
African Americans:
- Have an infant mortality rate twice as high as whites
- Have heart disease death rates nearly 20 percent higher than whites
- Are more than 15 times more likely to die of HIV/AIDS
- Are more than twice as likely as non-Hispanic whites to die from diabetes
- Have significantly higher rates of high blood pressure and obesity
Access to Quality Health Care
One of our first priorities needs to be legislation requiring all health care providers to collect standard patient demographic data on race, primary language, and level of education. This will include a focus on the Hispanic community for which we have limited information. With this legislation, we'll be able to easily monitor our progress using the Delaware Health Information Network, and make the information public through a webiste dedicated solely to health disparities.
We also need to adopt John's Delaware First Care plan to guarantee access to primary and preventive care services for all Delawareans. This will be the first line of defense for people otherwise without insurance to prevent serious illness.
Access to care for low-income families is particularly important, and we can improve by increasing enrollment in SCHIP and Medicaid. Particularly for SCHIP, if we eliminate the monthly premiums and include the parents of eligible children, it will go a long way to providing regular coverage for low-income residents of our state.
Workforce Diversity and Cultural Competency
Doctors and nurses need to be able to relate to the patients they treat, and in many communities, this is just not happening. Through the Office of Minority Health, we will develop cultural competency training for healthcare providers, community center workers, and others who work with diverse racial and ethnic populations.
This knowledge should also extend to individuals and organizations within the Health & Social Services system so that they can more efficiently connect people with the resources they need.
Diversifying our workforce also needs to be a priority, and, with more efficient use of incentives and recruiting strategies, we can bring more minority healthcare providers to the state.
Environmental Quality
We need to do a much better job in Delaware, on both a state and individual level, of testing for environmental toxins. John's plan includes directing the Division of Public Health and DNREC to work together to study their impact on high-risk areas in the state, and make the information public for the affected families and communities.
On a household level, we need to make people more aware of their environment and what factors can impact their health. Minority communities in urban settings are particularly susceptible to hazardous materials, such as lead-based paint and radon. We need an aggressive outreach campaign to encourage people to test their homes for these substances and give them information on how to dispose of them.
Health Literacy
Health education is one of the most important aspects of addressing health disparities. Treatment is much more difficult when there is a disconnect between patient and provider. As Governor, John will take the lead in this area and hold a statewide Health Literacy Summit to identify gaps in our existing programs and develop new strategies.
We also need a public awareness campaign targeted towards specific disease categories. We've been able to do this for cancer through the "Screening for Life" program. It's time to expand these efforts and include more chronic conditions, such as heart disease and diabetes.
Physical Activity & Nutrition
John has been promoting the value of physical activity since he was first elected Lt. Governor, and he will continue these efforts as Governor. For many people, a healthy lifestyle requires significant change, and we need to make it as easy as possible for people to make better decisions. Many people in urban or high-risk communities do not have access to fresh food or grocery stores, so we need to create opportunities for such stores to thrive in underserved communities.
More than ever, young people are not getting the desired amount of exercise, partly because they live in neighborhoods where it can be dangerous to go outside. We need to increase the amount of safe, open spaces in our cities so that children can be more active. Similarly, students who live close to their school should be able to walk there. Using the Dept. of Education's Safe Routes to Schools program, we can give children the opportunity to get more daily exercise and be safe at the same time.
Finally, based on the success of the Lt. Governor's Challenge, we can create a more comprehensive health and wellness initiative that would both promote physical activity and a healthier diet, as well as teach children and adults alike about the connection between being overweight and an increased risk of chronic diseases.
John's plan to address health disparities in Delaware is aggressive and comprehensive. It's time that we put our energy and talents into addressing this important aspect of public health. To truly eliminate health disparities in Delaware, it will take a governor like John with the experience and new ideas to make a difference.
A Universal Health Care Plan for Delaware that Works
After building a foundation of affordability and cost containment, John's plan would achieve universal healthcare for Delaware in a smart, effective way. By combining individual and employer responsibility with state subsidies, we make health care more affordable and expand access without hurting economy growth.
Under John's plan, after implementing affordability measures, all Delawareans would be required to have health insurance. The amount of their contribution to that coverage will be based on their income and they will continue to be subject to whether their employer offered coverage. Employers who do not offer health insurance will be required to contribute through a payroll tax. All businesses would be able to continue to cover employers as they do now and get credit for that. For most, the credit would cover their tax.
The caps on income would be increased for Medicaid and SCHIP, cover more people, particularly children. We will obtain waivers from the federal government to maintain the same match Delaware currently receives for these programs.
A statewide purchasing pool would be created for those individuals who were not income eligible for a state subsidy and were not offered coverage by their employer.
Additional funding as necessary would come from tobacco settlement reserves, an increase in the cigarette tax and an assessment on those free standing surgi-centers that do not fulfill their commitment of charity care.
P.O. Box 2162
Wilmington, DE 19899-2162
(302) 225-9910
