The House of Representatives has pledged to have a sweeping health care reform bill on the House floor by the end of July, and details are starting to come out about the direction they want to take. Requiring everyone to have health insurance coverage is one of the cornerstones of the reform, and I strongly believe that without this piece of the puzzle in place, no reform will truly be effective. Without a mandate to spread health care costs across the entire population, the population with health insurance will always be skewed a little towards the less healthy side. It makes sense – people who are ill tend to see more value in health insurance, and will fight to get and keep coverage in place. People who are healthy like to have health insurance coverage too, but if money is tight they may see health insurance as one of the first places where they can make budget cuts. When that happens, the premiums for the healthy person (who is not currently submitting claims) stop flowing into the health insurance pool, while benefits continue to be paid for those who are ill. The only possible scenario is more rate increases, which doesn’t benefit anyone.
The House is proposing that individuals and employers share responsibility for securing health insurance, and also that the government help families pay premiums if their household income is less than $88,000. This would be a significant improvment over systems like Medicaid, which focus on low income families but don’t do much for the middle class. Most people want health insurance and the peace of mind that it provides. But most of the nearly 50 million Americans who are uninsured cite cost as the primary reason, and the majority have household incomes below $75,000. So a system that would require them to secure health insurance coverage would have to provide some financial assistance to do so.
In addition to helping with the premiums, there will have to be universally available high risk pools, or else private health insurance carriers will have to begin accepting applicants regardless of health history. I do believe that individual health insurance could be guaranteed issue if everyone were required to have health insurance (which would keep the premiums down). One way or another, there would have to be a viable way for everyone in America to obtain health insurance. Currently, 35 states have programs like Cover Colorado, which is an option for people who don’t have access to a group plan and can’t qualify for individual coverage because of a medical condition. But states that don’t currently have a risk pool option leave a lot of people out to dry when it comes to getting health insurance coverage in place. That would obviously have to change if health insurance becomes mandatory.
It will be interesting to watch our representatives battle this out over the next few months, and I’m eager to see what they come up with. Hopefully we will be a fully insured nation by the time this is all said and done.
If you haven’t already visited Health Blogs Observatory to check out Grand Rounds this week, I encourage you to do so. It’s a tribute to nurses, and there are lots of great articles.