Health insurance exchange: Point/Counterpoint
Should Virginia take steps this year to set up a health insurance exchange as envisioned by the Patient Protection and Affordable Care Act?
Bad policy is bad no matter how it’s spinned
By Chris Head
Head, of Botetourt County, represents the 17th District in the Virginia House of Delegates.
I have been interested that few have offered feedback concerning the creation of a state insurance exchange. A couple of those who have contacted me directly have indicated that they didn’t understand what an exchange is supposed to be.
An exchange is, as described by Del. Jennifer McClellan, a marketplace. It has been described as being like Travelocity, but for insurance. On first glance this seems like a good idea, and if it could provide a completely transparent, tailored set of options that were available across state lines and run as a private, for-profit entity, it possibly would be.
Unfortunately, exchanges under the PPACA would have to meet guidelines dictated by the federal government. No one knows what that would look like or how, if at all, it would function. Additionally, in order for the concept of an exchange to work at all it needs to have a customer base with ready cash to spend. In the case of the Obamacare exchanges, the cash comes from federal tax credits, which add to the deficit. The creation of an exchange amounts to nothing more than a rearranging of the financial deck chairs, and, as is the case with the rest of the bill, does nothing to address the actual cost of care.
Bad policy is bad, no matter how you try to perfume the pig. I have stated before, if we want to lower the cost of insurance and health care delivery, we should encourage Congress to allow the purchase of insurance across state lines, re-examine and minimize insurance mandates in Virginia in order to allow companies to provide a basic policy without any “bells and whistles” and further examine tort reform to allow our health care professionals more protection, while still respecting the rights of the consumer.
Exchanges are a Republican invention
By Jennifer L. McClellan
McClellan, of Richmond, represents the 71st District in the Virginia House of Delegates.
While my colleague, Del. Chris Head, repeats the Republican talking points against the Affordable Care Act, or Obamacare if you prefer, he does not provide any real argument that a state health benefits exchange is a bad idea.
Instead, he illustrates how good government and public policy can get tangled up in politics. His central point seems to be if it is a part of Obamacare, it must be bad. Never mind the fact that exchanges are a Republican idea, first implemented by Republican governors Mitt Romney and Jon Huntsman before President Obama was ever elected.
Again, another Republican, former U.S. Senate Majority Leader William Frist has argued for states to adopt health benefits exchanges far better than I can. He explains that the exchanges will offer a menu of private insurance plans to pick and choose from, all with a required set of minimum benefits, to those without employer-sponsored health insurance. These exchanges are expected to bring private health insurance to an additional 16 million Americans who can choose the plan that’s right for them. You would think Republicans loath to expand Medicaid would jump all over that opportunity.
As outlined in my initial article, Virginia had already taken steps over the past two years to lay the foundation for an exchange to meet the needs of Virginians before Gov. Bob McDonnell introduced presidential politics into the mix. Establishing an exchange and giving Virginians without health insurance the opportunity to purchase it on the open market is the next logical step to accomplish the goal Head and I share — making sure every Virginian has access to affordable, accessible health care.
That’s why the governor’s own Health Reform Initiative recommended establishing an exchange to “preserve and enhance competition” and why three Republicans and three Democrats introduced bills to do just that.
These exchanges will make health care more affordable and accessible for thousands of Virginians who are counting on us to lead. Let’s not let ideological battles prevent us from getting them the best deal we can.
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August 26, 2012 - 8:06 AM
” if we want to lower the cost of insurance and health care delivery, we should encourage Congress to allow the purchase of insurance across state lines, re-examine and minimize insurance mandates in Virginia in order to allow companies to provide a basic policy without any “bells and whistles” and further examine tort reform to allow our health care professionals more protection, while still respecting the rights of the consumer.”
Is this the best that you and the Republican Party can come up with? Would you approve of a stripped down health plan that doesn’t cover home health services. My guess is no because you own a home health agency.
I am a conservative and I am ashamed of the Republican Party’s lack of a comprehensive health care plan. The idea that allowing out-of-state insurance companies and stripped down policies would have any impact on affordability is ridiculous.
On the question of should Virginia offer an exchange, of course Virginia should offer a health insurance exchange…duh.
I’d love to see an example of what constitutes a bell or whistle. Other than that, Mr. Head’s counter to Ms. McClellan’s argument boils down to “evil Obamacare…bad”.
Head is talking pennies instead of dollars and he knows it. NONE of his “reforms” will begin to affect the cost of health care, the millions without insurance or the problem of it being tied to employment. It is sad that people even entertain his idea of reform as helping the real problem. This nation cannot move forward with people who are in denial.
This is a unique instance where both are equally correct. Del. Head is correct in stating that exchanges, at least in the case of constraining rapidly rising costs are “a rearranging of the financial deck chairs”.
While an exchange can reduce costs on the consumer end, they do nothing to mitigate them in the broader macroeconomic capacity. These costs will continue to rise as the demand for services rises; and rise they will with an aging population. It is also true the tax credits (for many individuals a robust 80% of cost) will be adding to the deficit.
I am somewhat puzzled by his wariness of the federal guidelines being involved though. The federal government has been invovled in regulating insurance for decades, and the states that set up their own exchanges will have more freedom then those that have Washington do it for them. It appears Virginia will be choosing the latter. Like it or not states must comply with federal law. This is an instance where procrastination will not pay.
Enabling the purchase of insurance across state lines is one of those good on paper ideas, but in practice you would see consumers from high costs states such as NY, CA, and FL buying policies from issuers in low costs states like MS, GA, and SC, probably bankrupting them or forcing them to raise premiums to the point they’re not so affordable anymore.
Unintended consequences must be considered.
Del. McClellan is also correct in touting the inherently market friendly idea of an exchange, but it’s really only one small facet of the whole; the price of insurance premiums.
Which, I need not remind anyone, only go up annually, sometimes in the double digit percentage range.
It is interetsing both presentors seem united in continuing the status quo of managed care, only disagreeing on precisely how to go about it and what role (if any) the federal governmet should have in it.
#1 & #2 Everything Mr. Head suggests are steps in the right direction. Not everyone wants or needs “Cadillac” policies, competitive marginal policies would provide market oriented choices, no different than other products including other insurance products, auto, life, business, etc. A true market “exchange” would be no different. Such “exhanges” without genuine market forces is just another entitlement.
Whether one advocates such expansion of entitlement by federal policy without such market forces is the question.
Competition for such business & marginal pricing will benifit all concerned.
#3 It would appear the only “solution” you see is government entitlement, the progressive “solution” for everything, & why we are spiraling into unsustainable debt. Talk about “denial”.
Yes, let’s do talk about denial. The denial that the debt and deficit are anything more than products of “progressive solutions”! Let’s talk about that whopper of a denial.
Virtually every administration since Nixon has acknowledged the increasing juggernaut of health care and I am sorry but the baby boomers did not sneak up on anyone. These are ALL problems that a Congress as well as states that are run well would have faced and fixed long ago. Now it is at critical mass and still they fight, indeed over “deck chairs on the Titanic” and with even more panic apparently.
I repeat Chris Head is offering pennies when we need dollars and he is fighting what should be a no-brainer, all because they chose to call it “Obamacare” and they would bankrupt the states or the nation to deny him any success.
How is what we have now, NOT an “entitlement”? Who is paying now?
I am so totally sick and tired of this whole “entitlement” mantra! Even if you could make the notion that the “Founders” never intended for us to be a nation that looks after her own (and I do not believe you can), that is still not an indictment.
Regardless of how you view Medicare/Social Security or any other program you call an “entitlement” as a pejorative, they are programs that the participants in some form or fashion “paid into”. Certainly SSI/Medicare is a promise and something that workers have seen withdrawn from their paychecks and included in their benefits package as workers. The other safety net programs are paid for with tax dollars that also came out of paychecks, purchases, and a myriad other taxes that people pay to live here.
It is a decision and a direction this nation chose to go in. It is what we decided separates us from countries who make no provision for the public good, to promote the general welfare or to make the nation stronger by caring for the weak. It is a noble effort well worth it.
Health care may not be an enumerated civil right, but given the oath of doctors, the aim of medicine and the dictates of the God in whom we trust, it is the right thing to do.
I truly wonder what it is you think the poor, the working poor, the disabled and the elderly are supposed to do? Fend for themselves? How exactly is that?
You KNOW that this nation has people unable to fend for themselves. You KNOW that this nation has elderly people and the working poor whom we have depended on for over 200 years to do those low wage but necessary jobs and you still, with what brain think they can afford to save for retirement and health care after they can no longer work, or while working for minimum wage? What area of your brain figures these things for you?
Of course we need these exchanges and the other properties of the ACA to be enacted to alleviate what is true suffering and need. I see too many workers losing teeth because they cannot afford dental care. I see too many workers dying of curable (if caught early) disease. I see to many families struggling in poverty and being blamed for it. Like I said, I am damned sick and tired of the idea that we can pay for bombs, bombers, ships, a bloated military, troops all over the globe, foreign aid to rich nations, more tax cuts for the wealthy, an unfair tax structure, a unfair and imbalanced judiciary, and yet shun and demean people needing health care! You keep pushing Marie Antoinette!
Sandi, you said, “I truly wonder what it is you think the poor, the working poor, the disabled and the elderly are supposed to do? Fend for themselves? How exactly is that?”
While I agree with you in that I think we as a society would have been better to invest in healthcare than the military-industrial complex, the truth is prior to Medicare/Medicaid being enacted in 1965, the groups you mention above were not dying in droves.
And for an ironic twist the chronic health problems so rampant in America today (type 2 diabetes, obesity, coronary artery disease, and hypertension) were traditionally the ills of the rich.
#7 – “I truly wonder what it is you think the poor, the working poor, the disabled and the elderly are supposed to do?”
My heart goes out to those in that situation through no fault of their own…they deserve all the help they can get.
Unfortunately, too many poor are poor due to themselves. If you make stupid decisions in your life, why should the rest of society take care of you?
Like the saying goes, “I’ll be happy to give you a hand up…but I will NOT give you a hand out.”