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Category: All > Health InsuranceWe Need a National Market for Health InsuranceAugust 27, 2008
by Grace-Marie TurnerPublished in The Wall Street Journal August 27, 2008 Much to our surprise, the Census Bureau reported yesterday that the number of people in the U.S. with health insurance actually increased by 3.6 million last year. That's the good news. The bad news is that nearly three million of them got their coverage through government programs. The slide toward a government-dominated, taxpayer-supported health sector will continue unless the 45.7 million Americans who don't have insurance now are given more opportunities to buy private coverage. States could help by lightening their regulatory burdens to encourage greater competition for more attractive and affordable coverage. The federal government needs to do its part by updating today's tax policies to better fit a mobile, 21st-century economy. A new study by University of Minnesota economists Stephen Parente and Roger Feldman shows that Congress could boost by more than 12 million the number of people who have health insurance without spending taxpayer dollars. The change required is to allow people to buy health insurance across state lines, so they can shop for less expensive policies. The cost of health insurance varies widely, but it is closely tied to state regulations and legislative mandates dictating what services and providers must be covered. More regulation and less competition generally mean less affordable coverage, and vice versa. For example, a typical health-insurance policy in heavily regulated New York costs more than three times as much as in less regulated Iowa ($388 a month versus $98 a month for the same coverage). Every state requires health-insurance policies to cover certain services, ranging from maternity care to bone marrow transplants and hair prostheses. Nationwide there are more than 1,900 coverage mandates in all. The Council for Affordable Health Insurance estimates that these mandates add 20% to 50% to the cost of health-insurance policies. Each mandate can be defended in its own right. But as the burden increases, fewer people can afford to buy insurance. Usually, individuals and small businesses are the first to be priced out of the market. Yet laws designed to make health insurance more affordable often backfire. Many states tell insurance companies they must charge similar rates to everyone; they also force insurers to sell policies to people who wait until they are sick to buy coverage. It's a little like allowing a person to wait until his house is on fire, and then requiring an insurance company to sell him a homeowner's policy at the same rate as those who paid the premiums all along. States should be giving residents more options to buy policies that suit their budgets, not the priorities of politicians. Rep. John Shadegg, a Republican from Arizona, has proposed federal legislation that would allow people to buy health insurance across state lines. But Congress could do more than simply knocking down the barriers to interstate health insurance. For starters, it could make health insurance more portable. One way to do that would be to change the tax subsidies already going to those who get health insurance at work and turn them into refundable tax credits. This would make the subsidies available to everyone, and help millions of people buy coverage who can't afford it now. It would also help people keep their health insurance when they lose their jobs or move. Freeing Americans to buy health insurance across state lines would give people more choices in health care. And giving individuals a direct tax break for purchasing coverage would put armies of consumers to work to find affordable policies. That would force states to lighten their regulations or lose out to other, less regulated states. The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention. Ms. Turner is president of the Galen Institute, a nonprofit research organization that focuses on health-care reform. Comments1 2 Next >thanh99 at 10/28/2008 05:52:36anonymous at 10/25/2008 07:44:06Best wholesale service, quick china wholesale delivery, nice wholesale products, is there anything more you can expect on this platform? This net will build up a link between you and you supplier so that to be sure you would have a satisfied wholesale apparelwholesale apparel trading. The account managers will take care of all your wholesale products questions, inquires and help you manage your account. We provid popular wholesale products such as wholesale watch and wholesale necklaces . 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Usual Customary and Reasonable charge is a loop hole for the insurance carrier to charge whatever the hell they want and permisson to deny claims. HDHP is a fad and will become the only choice of coverage in 10 years if the system is not revised. klaus illian, CLU at 09/04/2008 17:45:43Any changes to market-driven plans, pools or the like is going to be a temporary fix at best while at worst, these changes will lead to mass confusion for the average consumer. For all their efforts, managed-care health insurance companies will die a slow death. They are struggling valiantly but the course is irreversable. Why have mainline insurance companies, like Prudential Insurance Company of America and many others, exited the health insurance market? Because health care is maintenance, and thus not insurable. Study Insurance 101: there are three factors that must be in place for insurance to be marketable and stabile. They are: large numbers, ascertainable risk and preventing adverse selection. I'm not going to go into any detail, suffice it to say that health insurers can't ascertain the potential claims as fast as medical technolgy is changing; they are always raising their premiums and hoping the increases are enough. The result isn't insurance; it's more akin to a cost-plus profit maintenance contract. It doesn't matter how much they pay out as long as they can charge premium to cover their expenses. The insurers are doing a good job of preventing adverse selection-- being saddled with too many high-claims customers-- but they do so by rejecting applicants due to their health histories or by waiving coverage on claims having to do with pre-existing conditions. Insurers are forcing more and more people onto public sector plans, keeping the most profitable book of business, while at the same time pointing to the excessive claims of those same public insurance plans that cover the elderly, disabled, the ill and the poor. They then very proudly claim private insurers do a better job of controlling costs. We can't have both market-driven insurance and universal coverage. Insurance companies need to make a profit; that's the reason they are in business; that's why I have a business-- potential profit! Insurers will NEVER agree to insure every applicant that comes along. Nor should they be forced to do so; it's bad enough that medical providers are forced into treating all emergency cases regardless of their ability to pay. Just imagine government passing a law that says Home Depot must sell building supplies to everyone affected by Hurricane Gustav, regardless of their ability to pay! But most importantly, health insurance doesn't meet the criteria for insurance; life and casualty insurance does! The sooner everyone realizes we have a ticking time-bomb, the sooner we can reform this country's health care system as well as the way we finance health care. The two are separate but equal issues. And then health insurance companies can go back to marketing profitable, real insurance , like supplemental health plans. dental insurance and prescription drug plans along with the staples such as life and casualty coverage.The Libertarian Guy at 09/01/2008 13:27:23I am new to this site and have a question if I may. Do the regualtions that prohibit sales of insurance across state lines originate with the McCarran-Ferguson Act of 1948? MJW, springfield, MO at 08/31/2008 22:05:51I agree with Klaus. UCR is local. Contracts with insurance companies are based on a percentage of medicare payments for that particular region (eg. 1.35% of medicare). The private insurers negotiate the rate with each hospital and will vary. Thus, UCR will be higher in NYC than Iowa. it is my opinion that fixing insurance coverage as described above will not solve the problem at best and may only look good politically at worst. There are problems at each level of health and healthcare that must be addressed. The patient must bear the responsibliity of their lifestyle choices. The hospitals must be forced through the free market to address their inefficiency (possibly the biggest problem). Physicians must improve quality and work with hospitals to lower cost (Stark laws virtually eliminate incentive). Any willing provider laws will bring hospitals and insurance companies closer open market competition. Matthew Heath in Birmingham, AL with Innovative Benefits Consulting at 08/29/2008 12:39:41The pre existing issue would not be a issue if our health insurance wasnt tied to the Job. Now this is a big problem. 75% of medical bancruptcies happen to people who had HAD health insurance with their employer. The second you become to sick or injured in an accident and can no longer return to work you lose your health insurance. According to the Department of Labor 4 out of 10 working Americans change jobs every year. Meaning that they lose their health insurance. Surprise surprise, 40% of the uninsured are uninsured for less than 4 months. To me that is a function of having to wait 90 days to enroll in the next employer plan. If people owned their health insurance in the first place they wouldnt have to change plans everytime they changed Jobs. Pre x wouldnt be a problem because they wouldnt be changing jobs because of job lose of change. You may be right about the UCR being local as opposed to national. I do believe it is more complicated than that. I am not positive about it. Just for everyones info I design portable health plans for companies. Called a Defined Contribution Health Plan. The employer gives the EE a fixed monthly allowance and the EE chooses to keep the group plan or purchase their own individual plan. If they want their own plan and can not get one because of conditions we get them on the state AHIP plan, which is a guaranteed indovidual plan with no Pre x. AHIP has a great proposal for a Guaranteed Access Plan for those that would like to purchase their on portable plan but can not because of health. Remember, pre x wouldnt be the problem it is today if health insurance wasnt tied to the job. Most people that I deal with are healthy enough to where they can get their own plan with no Pre x. Some may be rated up a little because of conditions but they are still paying less than the group plan. If they have an HSA, which is 90% of what I do, they can use the HSA to cover things as well. Sorry I didnt spell check bart ingles at 08/29/2008 12:06:27As usual I find myself stuck squarely in the middle in this debate. I don't favor federal mandates for guaranteed issue or community rating, but I do favor a federal tax credit with restrictions roughtly mirroring the pooling function provided by the present employer exemption. In other words rather than guaranteed issue, there should be guaranteed renewal and portability between insurers for anyone who has maintained continuous coverage. Rather than community rating, keep form of group rating already used in group plans, which allow for risk segmentation by age and geography but not by health status. Individual policies that don't meet these requirements should still be available, but should not qualify for the tax exemption. The feds would still need to come up with a set of rules to define what constitutes a qualified risk pool, but the actual insurance regulations already exist as HIPAA Title I. The tax credit provides the motivation, so there should be no need for federal mandates. The feds would still need to finance the tax credit, but this would still cost less than other proposals. If a qualified tax credit were adopted at the federal level, states would have less incentive to impose their own mandates. Add Comment |
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anonymous at 11/05/2008 07:47:23
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