Health Care Reform and the Insurance Market


Requirements in the health care reform law may lead insurers to cease new coverage for high-risk individuals and businesses.

A predictable result of the absence of a public option is the veritable shell game we are about to see perpetrated by private insurers. Do you blame them? After all, their “medical business,” as opposed to the “business of medicine” (ie, health care) is threatened by reform. I fear the next administration will undermine what we have recently gained.

Left to the current health care reform plan, in 2014, you will have to have health care insurance. The federal government will help with subsidies and it will facilitate shopping for coverage by creating a centralized, competitive marketplace (ie, a health insurance exchange). Until then, however the people most likely to buy individual insurance are those who need it most: the sick and the infirm. Thus, the insurers will see this risky group as a liability and will find ways to reduce their exposure. Also, when the new law requires them to spend at least 80% of the premium dollars collected on service and to improve quality, some insurers "may curtail sales to individuals or small businesses if they find requirements too difficult to meet.” See this article from the NYT for more on this. To cover children who have a pre-existing condition, these businesspersons may stop writing new coverage for them in the individual insurance market.

Call these insurers at their word to help with reform; force them with your feet, votes, and letters to support the basic tenet of managed care: do the right thing at the right time and place. Let's make "caring" a predictable result.

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