Reforming Health Insurance (not Healthcare)

This post was originally published on our old Wordpress site.

Both the Washington Post and the New York Times report that the Obama administration is signaling a new willingness to jettison the public plan element of healthcare reform legislation. Jonathan Cohn at The Treatment questions whether anything’s really changed, though, because Obama has consistently praised the public option as a good idea without insisting that it be included in the final bill.

As the summer has worn on and Congressional committees have come out with specific proposals, healthcare reform supporters are getting a better sense of what we can reasonably hope to get out of this round of reform and what will have to wait. Coverage expansion will probably happen, and subsidies will help more people afford health insurance. On the down side, I have yet to see anything that makes me think we’ll make any substantive progress towards slowing the growth in healthcare costs.

In other words, we’re not going to get the full-scale overhaul of the healthcare system that our country needs, but we can make substantial improvements. President Obama seems to be trying to give us more realistic expectations for the pending legislation, and one of the most visible changes he’s making is to refer to the current effort as “health insurance reform” rather than “healthcare reform.” With his list of “Health Insurance Consumer Protections,” he’s trying to end some of the worst abuses of the insurance industry, like refusing people coverage based on past medical history, dropping coverage for those who become ill, and placing annual or lifetime caps on the healthcare expenses they’ll cover. These changes won’t solve the problem of rising healthcare expenditures overall, but they can prevent a lot of health-related bankruptcies. Here’s the complete list:

• No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
• No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
• No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
• No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
• No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
• No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
• Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
• Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

Of course, whether the legislation actually accomplishes these goals will depend on how it’s written. Trudy Lieberman at Columbia Journalism Review provides a helpful primer on provisions to watch (and watch out) for.