Pennsylvania Gov. Ed Rendell (D) on Wednesday announced a proposal that would expand access to health care services, improve quality and reduce the state's health costs, the Philadelphia Inquirer reports (Worden/Goldstein, Philadelphia Inquirer, 1/18). The "Prescription for Pennsylvania" proposal would phase in a requirement that state residents whose annual incomes exceed 300% of the federal poverty level obtain health insurance. Residents with lower incomes would not be required to obtain coverage but would have the option of buying it at reduced rates. The proposal also would expand Cover All Kids -- a program that aims to provide affordable health coverage for children -- to create a new initiative called Cover All Pennsylvanians that would help uninsured adults and small businesses obtain basic coverage through private insurers. Premiums for the plans would be determined by a sliding scale based on income. Rendell's proposal would create financial penalties for businesses that do not offer health insurance coverage to employees (Fahy, Pittsburgh Post-Gazette, 1/18). In addition, four-year colleges and universities would be required to guarantee that students are insured or have access to a health clinic (Philadelphia Inquirer, 1/18). Rendell also plans to meet with other large purchasers of health care to develop a pay-for-performance program that would link payments for health care services to the quality of care.

Other provisions
Rendell's proposal also contains provisions that would:

• Allow nurse practitioners, midwives, dental hygienists and other licensed health care professionals to practice within the full scope of their training, as part of an effort to expand access to health care services (Pittsburgh Post-Gazette, 1/18);
  
  
• Provide incentives for health care providers that offer evening or weekend hours;
  
  
• Require health insurers to provide policies that allow parents to cover children up to age 30;
  
  
• Restrict insurers from considering factors other than age, location and family size to determine premiums for small-business group plans (Philadelphia Inquirer, 1/18);
  
  
• Require insurers to spend a certain percentage of premiums for small group plans on medical services, and require insurers to offer rebates if they spend below that amount (Pittsburgh Post-Gazette, 1/18);
  
  
• Require hospitals to improve access to translators;
  
  
• Provide hospitals with incentives to develop less costly procedures for treating patients with nonemergency health problems who visit emergency departments;
  
  
• Stop reimbursements to hospitals for unnecessary care in EDs or for services to treat conditions resulting from hospital-acquired infections for Medicaid beneficiaries or those enrolled in other state health programs; and
  
  
• Encourage hospitals to invest in health information technology, such as electronic prescribing systems to help reduce medical errors and electronic systems to track hospital infections to ensure accurate reporting of problems.
  

Funding
Rendell did not release cost estimates for the program, but state officials said it would be funded using contributions from workers and employers, federal matching funds, state funds currently allocated to other health programs, increased state cigarette tax and a state tax on smokeless tobacco and cigars. Rendell said the proposal would require several dozen bills, regulatory changes and federal approval. The governor said he would release more details next month after he unveils his budget proposal (Pittsburgh Post-Gazette, 1/18). No legislation has been drafted, and legislative leaders said they would hold hearings before considering action on any legislation (Philadelphia Inquirer, 1/18).