InsureBlog’s Bob Vineyard isn’t impressed with Dr. Justin Kleaveland’s support for health care reform. Dr. Kleaveland’s article is basically a summary of the major points included in the House and Senate bills, along with his reasons for supporting the reform efforts.
On several points, I agree with Bob. There are a lot of ideas in the reform proposals (like maternity care on all policies, guaranteed issue coverage, and limits on premium variation with age, for example) that sound good, but are tough to afford. And Bob is correct in noting that in states where health insurance is already guaranteed issue, premiums for individual policies are much more expensive than in states like Colorado, where we have medical underwriting. Simply expanding access to health care without significantly impacting the underlying cost issues isn’t going to fix anything.
In the discussion about guaranteed issue health insurance, Bob mentions that:
“Pious platitudes but this demonstrates how little the good doctor actually knows about the current system. Every state has provisions that allow access to health insurance on a guaranteed issue basis. Every one. Yet this fact is ignored over and over.”
It is true that HIPAA provides some access to guaranteed issue health insurance in all states, since it’s a federal regulation. But HIPAA eligibility is limited to people who have had at least 18 months of group health insurance coverage (and elected and exhausted COBRA if it was available), and who have been uninsured for no more than 62 days. That means that a person who has been uninsured for more than a couple months is out of luck, as is anyone who didn’t have prior group coverage.
In a few states, health insurance is guaranteed issue for everyone (and quite expensive). In the rest of the country, for those who can’t get health insurance under HIPAA regulations, there are high risk pools in many states. But there are a handful of states that don’t have any sort of guaranteed issue health insurance for people who aren’t HIPAA eligible. To verify, I contacted the Divisions of Insurance in several of these states (AZ, FL, DE, NV, and HI) and was told that none of them have any sort of guaranteed issue individual health insurance. The HI representative mentioned that they have an employer mandate that requires employers to provide health insurance for any employee working at least 20 hours a week, so that likely solves the problem for most people there. But in the other four states, according to their Insurance Commissioner’s office, there are no options for people who can’t qualify for individual health insurance. One representative told me that people just have to “keep trying” for individual health insurance.
We’re lucky to have Cover Colorado, a high risk pool policy, which provides fairly good coverage with reasonable rates. But even with a good program in place, there are still people who fall through the cracks. Cover Colorado requires an applicant to have lived in Colorado for at least six months before being eligible for a policy (unless the applicant is transferring from another state’s high risk pool). We have spoken with clients over the years who have moved to Colorado only to find out that they will have to go uninsured for six months before becoming eligible for coverage (which means that once they do become eligible, they will be subjected to a pre-existing condition limitation because they have a gap in coverage).
High risk pools are definitely better than nothing, but they don’t solve all insurance problems for people who have pre-existing conditions, and they don’t exist at all in some states. One of the aims of reform ought to include truly making health insurance available – in all states – to all applicants who want to purchase it. If we make all health insurance policies guaranteed issue (without also significantly expanding the pool of healthy insureds via a strong mandate), we’ll likely see higher costs for all insureds. But a good start would be to make sure that everyone, regardless of where they live, has access to at least one guaranteed issue health insurance policy (and no, discount plans and limited benefit policies don’t count).
I found Bob’s article in Grand Rounds, hosted this week at Healthcare Technology News.