We’ve never had a comprehensive, nation-wide health insurance program in the US. We’ve never had a system that involves all health insurance policies being guaranteed issue, and we’ve never had a system that requires everyone to purchase health insurance. So the ramifications of such programs are all speculation at this point. I’ve speculated on it. And so have a lot of other bloggers over the last few months. Bob Vineyard, at InsureBlog, has written an article about the potential guaranteed issue/mandatory insurance debate that brings up a good point and deserves some mention.
If we make health insurance mandatory, how are the 48 million people who are currently uninsured going to pay for coverage? True, there are some people who are currently uninsured because they don’t have access to group health insurance, don’t meet underwriting guidelines for individual health insurance, and don’t live in a state with high risk pool coverage available. They have the means to pay for health insurance, but coverage isn’t available to them at any price. For those people, guaranteed issue individual health insurance with a mandate that they purchase health insurance would be just fine. But I honestly think that they make up a small chunk of the uninsured population here in Colorado and across the US.
Bob points out that states with guaranteed issue individual health insurance currently have much higher average premiums than states (like Colorado) where underwriting is used. Although a big part of the problem in those states is that they don’t mandate that everyone purchase health insurance. So the population of people with health insurance in those states is obviously skewed towards the less healthy end of the spectrum, and it makes sense that the health insurance premiums would be higher in order to cover higher average health care costs per insured. I think that with a mandate that everyone purchase health insurance, the premiums would be much lower than they currently are in states with guaranteed issue health insurance.
But what about all of the people who are currently uninsured because they can’t afford the premiums? Although I don’t think that health insurance premiums will double or triple if coverage is guaranteed issue and everyone is required to be insured, I can’t imagine the premiums will actually go down unless there is some reform in the area of health care costs. So if people are uninsured now because they can’t afford to pay for health insurance, will it really do them any good to make health insurance mandatory? Without serious government intervention to help pay premiums, most of the uninsured population would still struggle to pay for health insurance.
So while reform that involves getting rid of underwriting and requiring everyone to purchase health insurance would help some people (those who can afford coverage but can’t qualify), it won’t make much of an impact for the millions of people who can’t afford health insurance, regardless of underwriting. It might end up being a piece of the puzzle, but it’s not going to fix our health care system or dramatically expand access to health care.
I found Bob’s article in the Health Wonk Review, hosted last week at Health Access WeBlog by Anthony Wright.