A big reason right-wingers are better at getting elected than they are at governing once they get elected is that they can’t get facts straight. This is from the Wall Street Journal:
New Jersey is about the last place one might think to look for free-market policy reform. But this week Jay Webber, a Republican Assemblyman in Trenton, will introduce legislation to let Garden State residents buy low-cost health insurance from any registered policy in any of the 50 states.
I have major questions about how this would actually work if put into practice, especially for HMO policies that only pay for in-network care. But I’ll put that aside for now.
The average national cost for a family health plan is $5,799, according to America’s Health Insurance Plans, but in New Jersey that same plan costs $10,398 on average. The state’s politicians have driven up these costs by forcing insurers to provide gold-plated coverage – even for such voluntary medical services as in vitro fertilization.
I did not know this about New Jersey, so I looked it up. Under what’s called the “Family Building Act” passed in 2001, insurance policies that cover more than 50 people and provide pregnancy-related benefits are required to cover the cost of the diagnosis and treatment of infertility. I believe that means it would not apply to private health insurance, only to group health insurance. Even with the group insurance IVF may be covered in some circumstances, but only after the beneficiary has jumped through a number of hoops.
New Jersey also follows New York and Massachusetts – two other high-cost states – in requiring so-called “guaranteed issue.” That allows New Jersey residents to avoid buying health insurance until they get sick, which means they can avoid paying premiums until they need someone to pick up the bill.
As a purchaser of private health insurance in New York, I assure you one cannot wait until getting sick to purchase insurance and expect the insurance company to pay for treatment. If you acquire a new policy while already being treated for a medical condition, you’re on your own to pay for those treatments for several months before the insurer is required to take over payments.
“Guaranteed issue” means an applicant, whether an employer or an individual, cannot be turned down for insurance. According to the Kaisar Family Foundation,
Federal law (and all states) requires all plans sold to small groups (employers with 2-50 employees) to be guaranteed issue. That means small employers cannot be turned down by insurance companies because somebody in the group is sick. Small employers might be ineligible to buy coverage from private insurance companies for other reasons. For example, insurers might have requirements that small employers contribute a minimum percentage of the premium payment on behalf of employees, or that a minimum percentage of a small firms employees participate in the health plan. Federal law does not require guaranteed issue for self-employed persons (with no other employees). However, states can and often do apply broader guaranteed issue requirements. Health insurance sold on a guaranteed issue basis cannot turn applicants down based on health or risk status.
According to this Kaisar Foundation chart, neither New York nor New Jersey have “guaranteed issue” requirements for the self-employed purchasing individual insurance. My experience in New York is that if you apply for a private policy within a certain amount of time of losing another policy, such as COBRA benefits — I think it’s one month — the private policy must accept your application no matter what health problems you have. However, my understanding is that if you have been uninsured for several months and apply for a private policy, you can be turned down.
Back to the Wall Street Journal:
This one-policy-fits-all system tends to cause the young and healthy to drop insurance, which only raises the cost of insurance for the sick, which in turn makes coverage unaffordable for ever more families. It’s no accident that about 1.2 million people – one of every eight residents – is uninsured in the state.
But guess who’s Number One in the percentage of uninsured citizens? Good ol’ free-market Texas, m’loves. Based on the three-year average from 2004 to 2006, Texas had an uninsured population rate of 24 percent. That’s, like, about twice as bad as New Jersey, right?
The New Jersey uninsured rate is only shocking until you compare it to the other states’ uninsured rates.
Wall Street Journal:
Opponents of interstate insurance say families would be pushed into bare-bones health plans. Not so. Families could still buy the more extensive coverage, but those with modest incomes would have options other than going uninsured. The goal of public policy shouldn’t be to cover every medical procedure or doctor’s visit, but to prevent families from catastrophic expenses due to a health problem that is no fault of their own.
In other words, they’d be pushed into a bare-bones health plan that doesn’t cover routine and preventive care, just major medical expenses.
New Jersey is turning into a microcosm of the national debate on health care. Democrats in Trenton are rallying behind a plan to require that every uninsured individual in New Jersey purchase health insurance from a new state-administered program. So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 billion health subsidy.
What the Wall Street Journal is saying, without admitting it, is that states can’t get to the root causes of the crisis and create substantive solutions on their own. National policy is required. Further, if “market based” solutions worked, they would have done so already. What we’ve got now are a mess of state and federal policies created to patch those parts of the ‘free market” system that had already failed.
But I still don’t understand how purchasing insurance across state lines worked. If you buy into a network in another state, wouldn’t you have to choose a Primary Care Physician in that state? Meaning you’d have to travel to that state for medical care? While you’re sick? I don’t think so.
Your assumptions are very wrong here. If you choose a plan that is offered in another state, you would still be able to see a doctor in your state. Just about every major health insurance provider is nationwide at this point, and there are already people who have their primary care provider in a different state from their insurance policy (otherwise, employers wouldn’t be able to offer health insurance to people who live across state lines).
One of the biggest problems with health insurance is that states mandate that insurance policies cover a whole variety of different things, but not everyone needs every coverage. By purchasing insurance from other states, individuals can have more ability to choose the coverage that most suits their needs.
Just about every major health insurance provider is nationwide at this point, and there are already people who have their primary care provider in a different state from their insurance policy (otherwise, employers wouldn’t be able to offer health insurance to people who live across state lines).
Yes, but networks are localized, and my understanding is that physicians and hospitals are compensated at the local rates, not according to some national average. Would an insurance company allow me to pay for an insurance policy in, say, New Hampshire but then choose a primary care physician in New York? I doubt that. And most kinds of policies these days require that a PCP be the gatekeeper of whatever care you get.
One of the biggest problems with health insurance is that states mandate that insurance policies cover a whole variety of different things, but not everyone needs every coverage. By purchasing insurance from other states, individuals can have more ability to choose the coverage that most suits their needs.
And I say that’s bullshit, because you don’t know what your needs will be until you need them. I can safely say I will never seek treatment for infertility, erectile dysfunction or prostate cancer, but beyond that I cannot predict what my medical needs might be next week, even.
Do try to live in the real world, son.
States license insurrance comp. to sell their products not the federal gov. States make sure the insurrance co. has enough money to cover the cost of claims. Well if you allow people to buy isurrance from some Joe from somewhere…how is the buyer to know Joe will pay his claim when submitted? If they buyer needs to sue the insurrance co. in which state would the suit be filed…where there doctor was seen or where the insurrance co is based?? I could list about 10 more potential problems.