Fellow blogger David Williams hosted the October Surprise edition of the Health Wonk Review this week, and it’s a great collection of articles. One in particular that everyone should read is from Joe Paduda of Managed Care Matters. Joe’s article includes several excerpts from Bob Laszewski’s article about the practical implications of the healthcare reform proposal that has been put forth by the Romney/Ryan platform as an ACA alternative.
I found it particularly interesting to read that the ACA provision that allows for states to be granted waivers from the ACA doesn’t go into effect until 2017. I would say that Bob and Joe’s assertion that “day one” waivers from Romney in 2013 would be met with legal action is probably very true.
Another excellent point pertains to the purchase of health insurance across state lines. Bob and Joe note that although health insurance mandates vary tremendously from one state to another, “[they] know of no state that has truly affordable health insurance.” I can see the appeal of letting people purchase health insurance across state lines – after all, we allow interstate commerce with most other commodities, and it would appear to be a solution to the problem that some people describe as “nanny state” regulations that force health insurance policies to be quite comprehensive in some states. But I would say that the major issue that causes health insurance to be dramatically more expensive in some states has more to do with health insurance being guaranteed issue (without a mandate that everyone purchase health insurance) and less to do with specific laws regarding coverage details. I’ve written in the past about some of the problems that could go along with selling health insurance across state lines, but Bob and Joe’s point about no state having truly affordable health insurance is really the crux of the issue. In order to make health insurance more affordable, we have to get a handle on the cost of care, since that’s what drives health insurance premiums. And although some states are making progress on their own (including Colorado), it’s not realistic to think that a handful of states will get healthcare costs low enough that their health insurance premiums become substantially lower – and then stay that low once the policies start being sold outside of that state.