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CAHI Issues & Advocacy

Legislation and regulation, both from Congress and state legislatures, can have either a positive or negative impact on Americans' access to affordable health insurance. For this reason, since its founding in 1992 the Council for Affordable Health Insurance (CAHI) has played an active lobbying role in Washington, D.C. and in state capitals. Our mission is to develop and promote free market solutions to America's health care challenges, so that all Americans have access to affordable health insurance.

What needs to be done to achieve that goal?

Provide tax credits for the uninsured - Workers with employer-provided health insurance don't pay taxes on the money their employers spend on premiums. And the self-employed get a 100 percent tax deduction. But workers without employer-provided coverage get no help at all. The Fair Care for the Uninsured Act (H.R.765), which is very similar to President Bush's tax credit proposal, would provide a $1,000 refundable tax credit per adult, and up to $3,000 per family, to use toward the purchase of a health insurance policy. As a result, millions of uninsured Americans could afford to buy their own health coverage.
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Expand Health Savings Accounts - Health Savings Accounts (HSAs) combine a high-deductible health insurance policy with a tax-deferred savings account. The high-deductible policy protects the insured from the cost of a catastrophic illness, prolonged hospitalization or a particularly unhealthy year. The savings account is controlled by the insured and is intended to pay small and routine health care expenses. HSAs encourage people to be value-conscious health care shoppers. Legislation proposed by the Bush administration (H.R.37) would expand HSAs by making the insurance policy tax deductible, making them even more attractive as an alternative to traditional health insurance.
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Fund high-risk pools - Roughly 2 percent of the population can't get health coverage because of a pre-existing medical condition. To address their problem, more than 30 states have established high-risk pools for their uninsurable populations. However, Congress needs to provide states with additional funding so that high-risk pools can serve as a safety net for all of the uninsurable (S.288).
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Tax-shelter long-term care premiums - Long-term care (LTC) refers to the medical and/or personal assistance that people require when they are unable to manage common activities of daily living on their own because of frailty, chronic illness or mental incapacity. Unfortunately, because of lax eligibility standards the federal-state Medicaid program has become the primary payer for long-term care, even for middle and upper-middle income families. If the government allowed individuals to use tax-deferred funds from their IRAs or 401(k)s to pay for long-term care premiums, millions of working Americans would protect themselves by purchasing insurance against that risk (H.R.976).
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Eliminate state mandates - Mandates are laws that require health insurers to provide coverage, or offer to provide coverage, for specific providers or procedures - driving up the cost of a policy and increasing the number of uninsured. The Council for Affordable Health Insurance has identified more than 1,800 state mandates nationwide. What's the solution?
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Allow reasonable underwriting - Underwriting is the process whereby an insurance company assesses how much risk an applicant brings to the health insurance pool. Several states effectively eliminated underwriting by imposing "guaranteed issue" (anyone can get coverage regardless of health status) and "community rating" (everyone pays the same price) laws. In every case, these laws have destroyed the state's individual health insurance market.
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Expand health insurance options - Health insurance in some states is outrageously expensive - in large part because of the laws and regulations imposed by those states. As a result, uninsured people can't find affordable coverage. There is an easy solution: let people buy health insurance that is approved and available to people in other states. Rep. John Shadegg (R-AZ) has introduced just such a bill (H.R. 2355).
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Reform medical liability - There is widespread agreement that the U.S. tort system is broken. Several states have passed tort reform, and President Bush has made it one of his top legislative proposals.
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Ensure access to prices - Consumers need access to price information if they are going to make good decisions. Yet the health care system historically has been very reluctant to provide that information. No where is this more evident than when the uninsured go to the hospital and get hit with a bill that is often three or four times what an insured person would pay, or more. This has to change.
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Protect Reinsurance - Reinsurance can simply be defined as a type of insurance for insurance companies. It is a way for a primary insurer to protect its business against unforeseen or extraordinary losses. Federal legislators, both Republicans and Democrats, are considering various policy options creating a national government subsidized health reinsurance program.
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