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Health reform bill and preexisting conditions

by Brian Schwartz | 1:45 pm, November 8, 2009 | Comments Off

Section 211-213 of HR 3962 basically says that insurance companies must offer coverage (guaranteed issue) and charge the same premium (community rating) to everyone regardless of their medical history. The November 8 Daily Camera (Boulder, CO) printed my brief opposition to such political controls:

Should government force you to pay more for medical insurance so others can pay less? Dr. Laura Rosenthal thinks so, calling it “compassion and kindness.” It’s more like charity at gunpoint.

In a recent Camera article, Rosenthal advocated making it “illegal for health insurance companies to discriminate on the basis of pre-existing conditions.” That is, insurers must sell policies to everyone at the same price.

These mandates have dire consequences, including more people without insurance. “Individual insurance markets deteriorated,” concludes a Milliman actuarial study. “Insurance companies chose to stop selling individual insurance,” “premium rates tended to increase, sometimes dramatically.”

This legislation encourages insurers to design products that sick people don’t want, as insurers lose money by insuring the sick because it’s illegal to charge higher premiums. Such policies lack features higher-risk customers want, like comprehensive coverage and minimal bureaucratic obstacles to doctor-recommended treatments.

These political controls cause a “death spiral”: premiums increase, so the healthiest stop buying insurance, the remaining risk pool is less healthy, and premiums rise again. Repeat. To prevent this, politicians want mandatory insurance, which Massachusetts imposed in 2006. Since then Massachusetts insurance premium costs have skyrocketed, affordable policies become illegal, and patients have poor access to care.

Preexisting conditions are a problem because the tax code favors non-portable employer-based insurance. This prevents people from buying guaranteed renewable policies before contracting a chronic condition. A free-market in insurance would also offer innovative products such as health status insurance, which would pay for premium increases should you get sick.

Thanks to Ari Armstrong for pushing me to use a strong lead.

Category: PPC
Tags: PPC > Syndicated

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