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Health Reform Process Myth

February 9, 2010

In efforts to more easily pass health reform legislation, one strategy recently proposed is for Congress to only pass certain provisions of the current reform bills.  Critics of comprehensive health reform are calling for this piecemeal approach as an alternative process, but tweaking only a couple of cogs in the health care system will not do the trick for real reform.

The piecemeal process is destined to fail as a reform measure.  For example,  if legislation required insurers to cover all individuals regardless of health status without any other reform provisions, we could see what health policy experts call a “death spiral.”  As insurers are required to cover everyone regardless of their health status, the average person’s premium, even if they already have health insurance coverage, will likely rise even faster than presently.  Insurers will have to cover the costs of insuring the sick and those with chronic conditions, but as premiums rise, healthy individuals would begin to opt out of health insurance, deciding that the high premiums simply are not worth coverage.  This would leave insurers with an even unhealthier pool of the sickest and those with the most severe chronic conditions, further increasing these individual’s premiums.

Similarly, requiring all individuals to purchase insurance sounds like a good idea, but in isolation the practice would be impossible.  Too many people are unable to qualify for insurance due to pre-existing conditions, and many others are unable to afford insurance because of high premiums as a result of their pre-existing conditions or their moderate income.  Without some sort of mechanism to require insurers to cover everyone and assist low- and moderate-income families with purchasing insurance, the individual mandate simply could not work.

Iowans and Americans need comprehensive health reform that takes into account issues like these simultaneously to ensure that everyone has access to affordable, quality health care.

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