March 09, 2010
1:37 pm
In order to boost public support for its health reform push, the White House added a new wrinkle to the Senate-passed reform bill it has, by and large, embraced. The White House proposes to create a new federal agency with the power to review, regulate and, if it so wishes, block health insurance rate increases.
It’s not difficult to see the political strategy involved here. With health insurance premium increases in the news as of late, the health reform debate has been cast as a heroes-versus-villains morality play. A new federal rate commission will save vulnerable Americans from the health insurance industry and its, as one Administration spokesman termed them, “wildly excessive rate increases.”
But, as veteran health policy journalist Robert Pear writes in today’s New York Times, there are serious flaws with this populist initiative.
For one, health insurance premiums are already regulated by the states. As Sean Dilweg, Wisconsin’s insurance commissioner, said, “The federal proposal would be a huge pre-emption of decisions that states have made over their history.”
It’s important to note here the difference between what states actually do and the new federal responsibilities being proposed. When states analyze proposed insurance rate increases, they look at the entire picture. What are overall healthcare costs? How much of an increase can consumers reasonably absorb? What is essential to keep health insurers solvent?
In Pear’s story, Kansas insurance commissioner Sandy Praeger put it this way, “You are not necessarily helping the consumer if you keep rates artificially low. What’s worse for the consumer: having a premium increase or having to pay the full amount of a medical expense because the company is out of business?”
State insurance commissions work without fanfare, making their decisions on the basis of objective data and analysis. A federal rate commission would be under a harsher spotlight and under greater pressure to reject rate increases, regardless of their merit and necessity.
This issue is another indicator of how the health reform debate has lost its essential focus. When we should be discussing how to implement delivery reforms to improve both the quality and cost-effectiveness of care, as well as steps to expand the accessibility of private insurance, instead a disproportionate amount of attention is being devote to excessive hyperbole about insurance companies and proposed “solutions” that could make those companies less solvent and, thus, less available to those who need coverage. Consumers are not being well served by the direction of this debate.
February 09, 2010
11:42 am
Recently, I had the opportunity to write a post for the esteemed website, Disruptive Women in Health Care. I shared my concerns about the number of states – Virginia being the most recent – that are moving legislation or introducing constitutional amendments to prevent the federal government from requiring their citizens to acquire health insurance.
The concern here is that erecting barriers – be they legal or political – to prevent an individual health insurance mandate makes essential health reform impossible. Everyone wants to ensure that every citizen can purchase health insurance regardless of whether they have a pre-existing health condition. We can’t take that step, though, unless everyone – young and old, high and low healthcare spenders – are in the system. Read more
February 02, 2010
2:08 pm
Below is my commentary piece which was featured yesterday in Modern Healthcare Magazine:
Political analysts and pundits have already begun conducting an autopsy on the Obama administration’s effort to reform America’s healthcare system. Dismal poll results, the Scott Brown Senate victory in Massachusetts and squeamishness over the upcoming November elections have combined, they say, to bring yet another health reform effort to a crashing demise.
Call me a stubborn optimist, but I still believe it’s possible to find a cure for this patient rather than give up the ghost. The need to improve our healthcare system is just as imperative today as when this legislative process started. Failure should not be regarded as an option. Read more
January 27, 2010
2:53 pm
One of the best forums for diverse opinions on current healthcare issues is the National Journal’s Health Care Expert Blog. National Journal’s healthcare correspondent, Marilyn Werber Serafini, has assembled a large panel of contributors from associations, think tanks, Capitol Hill, academia and other circles to address the most important questions of the day.
This week, the question concerns the disarray that characterizes the current health reform process and, if lawmakers have to go back to the drawing board, what are the easiest, most cost-effective ways to make health coverage more accessible for uninsured Americans?
I’ve given my thoughts on the issue, which include subsidies for working families and more effective outreach to identify those who are eligible for public programs but not enrolled.
To read my submission as well as those from Congressman John Dingell (D-MI), New America Foundation head Len Nichols and others, go the National Journal expert blog.
November 23, 2009
9:22 am
There was a great deal of hoopla Saturday night over the Senate Democratic leadership’s success in gaining the minimum 60 votes necessary to bring health reform legislation to the floor to begin debate after the Thanksgiving holiday. It’s perhaps a story in itself that there was so much drama over a procedural vote simply to allow debate on the President’s signature policy issue.
Despite Saturday’s successful vote, the road to health reform enactment seems more fraught with potholes than ever. The Capitol Hill newspaper, Politico, has a good summary story today on the current state of play, headlined, “How Health Reform Could Fall Apart.” Sunday’s news shows and interviews undermined any supposed momentum that was claimed on Saturday. Centrist senators made it clear that they will not vote for a bill that includes the current public option language. Senators on the left, like Bernie Sanders (I-VT) and Sherrod Brown (D-OH), said Sunday that they’ve compromised on the issue as much as they’re going to.
Adding to the difficulty of the task at hand, Rasmussen polling shows, for the first time, public support for Democratic health reform plans has dropped below 40%. Only 38% support the current legislation compared to 56% opposed. Read more
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