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'Sick tax' proposed as health care fix

| Tuesday, June 3, 2003

The Rendell administration is considering taxing patients for every doctor's office visit as a way of helping physicians offset the high cost of malpractice insurance.

The proposal surfaced last week during a meeting between Roger Mecum, executive vice president of the Pennsylvania Medical Society, and Rosemarie Greco, director of the Office of Health Care Reform, which is leading Gov. Ed Rendell's efforts to improve health care in the state.

On Monday, a spokeswoman for Greco's office downplayed the significance of the discussions.

"It is one idea among many ideas on the table being considered," Amy Kelchner said. She added that the proposal is so preliminary that "I can't even give you details."

Although the medical society hasn't taken a position on the proposal, Mecum said physicians have "serious, serious concerns" about the prospect of being forced to levy an extra fee on their patients for every visit. The sicker patients are, the more visits they make and the more it costs them out of their own pockets, he said.

Dr. Jitendra Desai, of Aliquippa, Beaver County, president of the Pennsylvania Medical Society, said the measure would turn doctors into "tax collectors."

"We are opposed to that," Desai said. "It's a tax on people in addition to the co-payment. ... We'd be tax collectors. We don't want to tax the patient. I practice in a small, rural area with poor people who can't even come up with the co-payment."

Only two other states have imposed patient taxes -- Minnesota and West Virginia. The money was used to help pay for health care for low-income families.

Minnesota imposed a 1.5 percent out-of-pocket tax on all medical services in 1992, and groups have been trying to repeal it ever since. In 2001, West Virginia repealed a 2 percent tax on a doctor's gross income that was used to help pay for Medicaid costs.

The revenue generated by a patient tax would be used to help offset the costs physicians must pay for supplemental insurance from the state through the Medical Care Availability and Reduction of Error Fund, or MCare. In addition to a primary coverage policy, doctors must obtain the supplemental policy from the state to cover malpractice awards or settlements that are not covered by primary policies.

Mecum said a tax of $2 to $4 per visit, based on an estimated 30 million patient visits a year, would yield an estimated $100 million.

"In general, we have very serious concerns about such a tax and are not in favor of what we look upon as a sick tax," Mecum said. "Our real concern is about access to health care, about not going to a doctor when you should because of hesitation about paying an extra fee."

When Rendell became governor, he pledged to help physicians find a way to cope with the increasing malpractice insurance premiums, which have risen between 250 percent and 300 percent over the past four years, according to Mecum. Rendell promised to find revenue sources to pay for the MCare surcharges.

Greco's office is continuing to hunt for financial solutions, Kelchner said.

"Groups are constantly contacting her about the problem," she said. "The governor is studying those proposals."

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