Two of the blogs that we regularly read have written articles this week about the flaws in McCain’s health care plan. Bob at Insure Blog has written about how allowing people to purchase individual health insurance from other states would have an overall negative impact, and Joe at Managed Care Matters has addressed the pitfalls of expanding the medically underwritten individual health insurance market. It makes sense that McCain’s health plan would involve less federal intervention into the health insurance industry, since decreased federal regulation is a hallmark of Republican idealogy. According to McCain’s website, he wants to “work with states to establish a guaranteed access plan” for people who cannot qualify for medically underwritten individual health insurance, and he “will work with Congress, the governors, and industry to make sure this approach is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs.” What exactly does that mean? It sounds like a get out of jail free pass for the federal government. They can “work with” the states and encourage them to set up programs to cover their uninsurable residents, but where is the accountability? Who is actually responsible for making sure that those people do indeed have access to health insurance?
In Colorado, we’re lucky to have Cover Colorado available for uninsurable residents who do not have access to other coverage. At least our state has a high risk pool that is open to new enrollees and provides health insurance for people who would otherwise be uninsured. But it’s far from ideal. The policies are expensive and the out of pocket costs are higher than most people are used to with traditional employer-sponsored health insurance policies. Many people are forced to enroll in the higher deductible options in order to be able to afford the premiums – and then they have to hope that their health condition doesn’t force them to meet the deductible anyway. We’ve talked with clients who have said that they just cannot afford the high premiums and high deductible that come with risk pool health insurance, so they do without and try to figure out a way to manage their health conditions without health insurance. Or they try to get a job with an employer who offers health insurance. Even in a state with a functional risk pool, the solutions are by no means perfect. It sounds like McCain’s health plan would encourage more use of state-run risk pools, since the plan would rely more on individual health insurance instead of employer-sponsored policies. The way they spin it, it sounds good – individual health insurance isn’t linked to your job, so you have more freedom to change jobs and move around without losing your health coverage. But the flip side is that in almost every state, individual health insurance is not guaranteed issue the way most employer group plans are. So more people with pre-existing conditions would find themselves uninsurable through the “free market” and would need to enroll in a state risk pool. Since McCain’s plan leaves insuring these people up to the individual states, there will likely be some pretty wide cracks for people to fall through.
It seems that McCain’s plan would leave individual states between a rock and a hard place, since they would be responsible for insuring their residents who don’t qualify for individual health insurance, and yet their health insurance regulations would have little meaning if their residents were allowed to purchase health insurance from any state they want. It gives states a lot of responsibility without giving them the regulatory tools they need in order to actually spread costs across a large group of people.
From another angle, I’m curious about how maternity coverage would change if we were to move away from employer group plans and towards a system that relies more on individual health insurance. In most states, employer group health insurance plans cover maternity care just like any other covered expenses. But the vast majority of individual health insurance plans do not cover anything to do with routine prenatal care or childbirth. Maternity care is something that the majority of American women will need at some point in their lives, and I wonder how many of them would be ok with a health insurance system that requires them to pay for it themselves? I haven’t seen this topic addressed in the debate about group versus individual health insurance, but it does deserve a mention since it’s a significant expense incurred by a large number of people every year.
