October 2, 2009|
Health Reform on a Dime
By JP Wieske,Hawaii Reporter
While Washington once again debates reforming our
health care reform system, the states have marched
on. Washington-based proposals, like those currently
before Congress, are too expensive and ignore the
fact that most Americans don't want and are
concerned about a big-government takeover of the
U.S. health care system. President Ford had it right
when he said, "A government big enough to give you
everything you want is a government big enough to
take from you everything you have."
Instead of throwing away our state-based system, we
should build on it. Take the problems of access and
affordability. Most states guarantee access to health
insurance despite a clear lack of federal support, and
some states have taken significant steps to increase
the affordability of health insurance. As one regulator
stated, "Affordability without access is meaningless
but accessibility without affordability is equally
There are many reasons why people don't have
coverage (e.g., they have low incomes, are in job
transition, don't think they need it, etc.), and the
solutions can and should be equally diverse. Instead
of throwing away our current system, which relies
heavily on state oversight and regulations, we should
improve upon it -- guaranteeing access without
health insurance unaffordable. Several limited and
targeted reforms would do exactly that.
Guaranteed Access. The healthy can always
coverage when they need it, but the sick can't. So
President Obama proposes requiring health insurers
selling to individuals to accept any applicant (that
already happens in employer-sponsored coverage).
But that's like requiring an auto insurer to accept a
person after a car wreck.
A better solution for the uninsured with pre-existing
conditions is what we call the "Tri-Share Guaranteed
Access Plan." It is similar to the current state-based
high risk pool system but with standardized federal
guidelines and increased funding.
Tri-share (i.e., three funding sources: federal and
state, health insurers and premiums from
participants) would provide health coverage for those
with a pre-existing medical condition, creating a true
safety net for the uninsured. The guaranteed access
plans would preserve what is good about the state-
based system, protect the vulnerable and keep health
insurance premiums more affordable.
Affordable Choices. Any American who has
lost a job
can tell you employer health insurance is expensive.
The stimulus bill provided a temporary subsidy for
coverage, but only to continue the employer's
expensive coverage. The unemployed should have
access to Affordable Benefit Choices (ABC Plans),
which allow them to choose not only from the plans
offered by their employer, but a less-expensive "basic"
health insurance plan that's sold in any state.
Equalize Tax Treatment. Most of the
for employers but don't have access to employer-
provided coverage. It is fundamentally unfair that these
employees who decide to purchase health insurance
on their own do not get the same tax break as those
who have employer-provided coverage. Congress can
fix this disparity by providing them with a "refundable"
tax credit (in essence, a voucher) to help offset the
cost of coverage.
Increasing Competition. If President Obama
concerned with competition -- especially in states like
Maine, Massachusetts and New York, which have
ruined their market with onerous regulations -- he
would allow individuals living in one state to buy
health insurance that's approved and being sold in
Safety Net for the Poor. The most important
the poor is not access to health insurance but access
to needed medical care. Some people will not get
health insurance or are too transient to have a
medical home. Federally qualified health clinics
provide medical care in locations that are easy for the
poor to access. In 2007, this safety net program was
funded at a $1.99 billion dollars -- not nearly enough
provide a true safety net.
Malpractice Reform. One area where the
leading is malpractice. California, Texas and recently
Oklahoma have passed significant tort reform
legislation. The downward pressure on malpractice
premiums in Texas, for example, and the reduction in
needless lawsuits prove the value of reform. States
may continue to lead on tort reform, especially if the
federal government refuses to take any significant
We need to free ourselves from the idea that we need
to achieve universal coverage through a federal
mandate. Building on our current system allows us to
refocus on solving the targeted problems we can fix
while maintaining long-term financial sustainability --
and get close to universal coverage in the process.
J.P. Wieske is director of state affairs for the
Council for Affordable Health Insurance.