Health Reform and the Orphan called Individual Health Insurance Market

Last week, the buzz in Washington, DC where I heard numerous lectures and personally talked to two U. S. Representatives and two U. S. Senators was about impending health care legislation in the Senate and particularly focused on the imminent crisis in Iowa where there probably will be no insurers for the individual insurance market in 94 of its 99 counties in 2018.

Seventy thousand Iowans may not have health insurance next year in a state that prides itself as an insurance state. Iowa is the poster child for the deficiencies in the individual insurance market. Across the nation, only a few counties in Tennessee have that known potential for 2018, though several potential fixes are being discussed at the federal and state levels.

I discussed my idea to stabilize the individual insurance market by allowing individuals ages 55 to 65 years old to buy into Medicare (see my blog entry titled, “Health Reform and Nick Bath”).

My point today is that the individual insurance Market was a mess before the Affordable Care Act (ACA). The individual insurance market is a mess now, under the ACA.  And, it will continue to be a mess if the House’s  American Health Care Act should become law as it currently exists without significant changes by the Senate. One of the imperatives of the ACA was that because of pre-existing condition exclusions, the individual market worked for the healthy but left many people with chronic diseases uninsured or placed those policyholders in unsatisfactory High-Risk Pools (I have had patients in that Iowa High-Risk Pool).

Now, with the continuation of the ACA and after the filure of Co-Opportunity Health—a federally established cooperative health insurance company—the existing companies could not survive the cost of the individuals with chronic illnesses and the lack of a majority of healthy policy holders.

I contend that the lack of the federally promised protections for Co-Opportunity Health, the lack of support from the State of Iowa to establish a state-based Exchange and having an inadequate public out-reach effort for insurance enrollment helped create the current crisis.

Furthermore, I believe the House’s proposal to allow states to re-establish exclusions for pre-existing conditions, change the essential benefits requirements, force older policyholders to pay higher premiums, and re-establish High-Risk Pools will simply place us in a time warp with the same inadequacies that we had in the pre-ACA world.

I fear we have two false premises driving the Republican efforts for health reform. One is the belief that unfettered capitalism with unrestricted free markets will succeed in the health insurance market. Unfortunately, such capitalism has winners and losers. This time the losers will be individuals with chronic illnesses and older Americans. The second false premise is that if we only had a health care system like we had in the 1950s, we would be happy.  Unfortunately, health care advancements that save lives, extend lives, and significantly improve the quality of life costs money. In the 1950s, people died of cancer, heart disease, and strokes. Today, people with those and similar conditions live well but at significant expense.

I recently traveled to France and I was struck by how many famous and gifted men and women in history died or suffered because of health problems that are now easily treated. My best example is my favorite painter, the impressionist Claude Monet, whose later work in the early 1900s was undoubtedly lessened by severe cataracts.

I hope the moderate Senate Republicans understand these thoughts regarding the inherently unstable individual insurance market. It has no parents and no one to care for it. It is orphaned. I hope the moderate Senate Republicans believe government exists to protect those who will lose in an otherwise unfettered free market system. I hope that moderate Senate Republicans realize that we are not living in the 1950s anymore. I hope that moderate Senate Republicans realize we live in the wealthiest nation in the world. I hope that moderate Senate Republicans realizes that no one should be without healthcare.