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Sunday, November 01, 2009

Is it Much Ado About Nothing?

The AP has a story out today asking if the uproar over the "Public Option" in the current health care reform bills is much ado about nothing. If you read only the public option portion of the bill, you'd probably have a hard time disagreeing with that assessment.

The reason they give for believing it's a lot of hot air over a little thing is the CBO estimates of the number of people who will opt for the public insurance program. The CBO says only about two percent of the population would take the public option. In the current House bill you can't get into the public option if you are covered by a plan through your job. To be eligible you'd have to work for a small enough company that the rest of the bill doesn't compel it provide coverage, or already be buying insurance on your own.

I think the CBO has done a good job in point out costs associated with all of the health care legislation, but as always, they do it with static numbers. They assume that no individuals or businesses will change their habits based on the new law. That's where the problem lies with their current estimate. I also understand that it would be nearly impossible for the CBO to run dynamic computer models on behavior in the short amount of time Congress gives them to review legislation. I often wonder if that isn't by Congressional design.

History has already shown in Maine, Massachusetts, New York and New Jersey that the guaranteed issuance and group rating methods drive private insurance companies out of the markets after raising costs to the point they can't be profitable. Both the House and Senate bills contain each of these provisions in them, and I doubt that history will suddenly undo itself, and they'll work without raising costs.

The result will be (as it has been already) that as costs go up insurance companies will drop out of the exchange program, and choices will dwindle to a few not-for profit companies and the public option. Don't think so, go online and try and get a health insurance quote in Maine. There are about 5 companies left doing business there.

Another cost driver in the bill, which seems innocuous at first, is the rescission rules. We all get to hear the breathless stories on the news of the woman who had her insurance dropped right before she started treatment for cancer. "Oh those heartless insurance companies!" the anchor will opine. What the news doesn't tell you is that for every one person who is wrongfully dropped about two hundred and fifty are rightfully dropped for fraudulently obtaining insurance.

The House fix for this is to compel insurance companies to pay for care for anyone they want to drop until a mediator has decided if it's a case of fraud where the person should be dropped. That sounds fair enough, if you are the patient. However, if you are the insurance company, you now get legal bills and medical bills for the 99% of people you can legally drop for fraudulently obtaining insurance. How much of that money does anyone think will be recouped from the fraudster? Who do you think will make it up to the insurance company? Congress isn't going to pay them for it, which means the folks who are legit will get higher premiums to pay for both the care, and legal bills of someone else.

I also think this is going to end up one of the bigger legal entanglements of the bill. Guaranteed issuance says you can't be denied coverage due to a pre-existing condition, and community ratings say you can't be charged more because of it, but the proposed law also says if you don't reveal it you have obtained insurance fraudulently. I'm pretty sure this will end up in court about as fast as any other provision in the bill.

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