Assemblyman Greenwald, the youngest member of the assembly, and partner in his own law firm, began the discussion with remarks reflecting some of the goals common to both government and the insurance industry. In his view, both government and the insurance industry emphasize the pooling, or sharing of resources to minimize risk. Assemblyman Greenwald cites his experience as a businessperson in the private sector as invaluable in his role as legislator. He feels very strongly about "reinventing government" to respond effectively to public needs while balancing the interests of business.

A serious concern shared by Greenwald and many of his constituents is the rising cost of healthcare, especially for senior citizens and others on limited incomes. Greenwald acknowledges that government bears some of the responsibility because of the many mandates passed on to the healthcare industry. These unfunded mandates increase the cost of coverage directly, and indirectly through assessments to HMO’s as well as taxpayer subsidy of insolvencies like the HIP debacle.

A closely related issue in New Jersey is the growing cost of charity care; the expenses incurred by hospitals for the treatment of the "working poor" and those whose employers cannot afford coverage at all. Greenwald cites the 6^th District, which he represents, as an example. Four of the top five employers in Camden County are healthcare systems. Across the state, 90% of all healthcare systems lost money in 1999. Greenwald suggests that the $400 Million in charity care costs incurred by those healthcare systems in 1999 played an important role in those losses. Greenwald indicates that the state reimbursed the providers for roughly $250 Million, leaving $150 Million in costs unpaid. Specifically, he cites the Virtua system, which last year incurred $10 Million in charity care costs, while receiving only $180,000 in reimbursements from the state.

In order to make healthcare more affordable, and universal, Greenwald suggests that the state go beyond the proposed creation of an "insurance ombudsman". He raised the possibility of adopting a "real word" test for new mandates, in which the state would have to pay for the mandated coverage for the first year, giving it hard data on the cost to the market of the mandate. He went on to suggest that the state utilize some of the $7.6 Billion in proceeds from the recent national tobacco settlement to fund the charity care program and increased health educational programs.

Representative Reinard, 1999 winner of the Philadelphia CPCU Chapter "Franklin Award", added his view as a long-time member of the Pennsylvania House of Representatives. Reinard, who has served on the House Insurance Commission for eighteen years, feels that Pennsylvania shares the same concerns about the rising cost of healthcare. Like Greenwald, Reinard is a businessperson. He partially owns and operates an insurance agency in addition to his duties in the legislature. One of the most important functions he and the other members of the insurance commission carry out is to serve as gatekeepers, restraining the flood of new legislation. Though many proposals never move out of committee, he cites several recent examples of important legislation that have been passed. Among those examples are the recent managed care reform and patients rights bill, the mandate for coverage of post-mastectomy reconstructive surgery, and mandated mental health care coverage changes.

Reinard is aware of the burden placed on both the healthcare industry, and the consumer by these mandates. He observed that there are presently as many as twenty-three state mandates on each Pennsylvania healthcare policy. Reinard pointed out that Pennsylvania’s response to the rising cost of healthcare includes the creation of the Healthcare Cost Containment Council. The Council’s role is to review, and to estimate the fiscal impact caused by any new mandates before they are imposed. According to Reinard, the Council has had the effect of slowing down the imposition of new mandated coverages.

One of the unintended results of the many mandated coverages imposed upon Pennsylvania health plans has been the growing trend toward self-insurance. Self-insured funds have the benefit of being ERISA exempt, and thus not subject to many of the mandates. Thus, legislators find that future mandates are being imposed upon an ever-diminishing pool of insurers who must bear an increasing share of the burden.

Finally, Representative Reinard spoke about Governor Ridge’s proposal to extend the popular Children’s Health Plan, which funds healthcare for uninsured children. Governor Ridge proposes using part of Pennsylvania’s $20 Billion tobacco settlement to fund an expansion of the plan to cover uninsured adults. Representative Reinard predicts quick passage of the plan, which has drawn little opposition to date.