May 27, 2009

Health reform: the "trigger" has already been pulled

Last week, I wrote about a how the state of the health insurance industry in this country has gotten so bad, Health Care for America Now has requested that the Justice Department conduct an investigation into the companies that dominate the health insurance markets in most states. Basically, a study came out that said if you want to buy health care on the free and open market you can a choice between…pretty much “Option A” or “Option A.” More than 94% of insurance markets in this country are highly concentrated and offer few options for consumers.

What response do we get from our senators? Despite overwhelming evidence that not only does the American public support the option of a public health insurance plan and that it would actually help fix the private insurance mess, some politicians (like Senator Ron Wyden) are backing away from offering the American people more choices through a solid public health insurance plan. Why?

Real reform is scary. Because what if, you know, it changes things?

The media is calling the compromise they have come up with a trigger proposal. What this means is that if certain conditions are met in a state, that will trigger the set up of a public health insurance plan in that state. I'm assuming the logic is that this way, if private insurance is doing ok in a state, then there isn't any need to rock the boat or go about making yourself unpopular with the insurance companies.

I've shopped the individual health insurance market before. When I graduated from college, I wasn't able to get a job right away that offered health benefits. As broke as I was, I kept having nightmares about getting hit by a bus and my parents selling the house to pay for medical bills. I tried to shop around for a plan I could afford, but which would protect me if something really bad happened. I was willing to go without basic care for a few years because, after all, I was young and healthy.

I comparison shopped as best I could, but at the end of the day, you don't really learn exactly what your insurance specifically covers until youve bought it and are juggling doctor visits and medical bills. Plus there really only seemed to be two companies I could chose from and the different kinds of plans those offered looked pretty much the same to me. All I could tell was that most of the plans seemed overpriced for what they offered, and all of the plans I looked at charged me more for being a woman-despite not covering reproductive or urinary care. Didn't make any sense, but then again, what were my options? In the end, I just went with what I could afford.

I would have loved a public health insurance option, even if it was just to have something I felt like I could trust to compare the other plans to. When there are no real options in front of you, you feel powerless. No one deserves to feel powerless when it comes to their health.

Even if political wonks want to pretend there are places in the US where private insurance is working, the "trigger" proposal still leaves us with an arbitrary set of standards that denies the option of a public health insurance plan to people in one state while those living in its neighboring state do not have access to a public plan because their private insurance is just a tiny bit less dysfunctional.

This gets even more problematic when we take a closer look at how insurance works within a state. For example, New Yorks statewide market is more competitive than in most states. Statewide, the top insurer (GHI) controls 26% of the market, but in Ithaca, the top insurer has 76% of the market and the top two insurers control 91% of the market.

Under the trigger plan, it is likely that those people in Ithaca would be told they didn't qualify for a public health insurance option. But even though New York has one of the more competitive markets, if you are an individual living in Ithaca, youre still stuck with what is available.

And what if you live in a state with a public option, then move to one that doesn't?

We don't need 50 different state plans. We need one, stable, federally-backed public health insurance plan that will ensure all Americans have access to quality, affordable care and which can be managed efficiently and effectively.

I spent well over 50% of my income on medical and premium expenses that first year out of college. I ended up being unable to afford the premiums because of medical bills for procedures that my insurance didnt cover but that I could not do without. I dropped my coverage entirely. I decided to go without tests to see if a tumor that developed was cancerous, because I was afraid if tests were positive, I could be locked out from future coverage due to a pre-existing condition. So I waited.

Our representatives in Washington might be scared to make real decisions, but we really need them to step up to the plate on this one. If they need us to hold their hands and remind them what real health reform looks like, then that is what we are going have to do. America needs a public health insurance option. We've waited long enough.

Call your representatives. Let them know you oppose any trigger style compromises and support the right of every American to have the option of a public health insurance plan.