The Health Care Coverage for Louisiana Families Protection Act would go into effect “If a court of competent jurisdiction rules that the Patient Protection and Affordable Care Act, P.L. 111-148, is unconstitutional and the judgment of that court becomes final and definitive,” the bill’s text states.
The legislation is aimed at people not covered by an employer plan, with a key feature being guaranteed coverage for people with preexisting conditions. These individuals would be assigned to the Louisiana Guaranteed Benefits Pool, a high-risk pool the legislation would establish. The bill text describes this pool as “a risk-sharing program to provide payment to health insurance issuers for claims for healthcare services provided to eligible individuals with expected high healthcare costs for the purpose of lowering premiums for health insurance coverage offered in the individual market.” The pool would be funded through monthly charges on all health insurance policies sold in the state.
Like Obamacare, the plan would allow people to buy insurance after they become sick, restrict underwriters from pricing policies based on risk factors, mandate that plans cover adult children under age 26, and eliminate lifetime coverage amounts. Those stipulations drive up the cost of health insurance, which could put pressure on Louisiana lawmakers to expand Medicaid in the future.
Lessons Not Learned
Merrill Matthews, a senior fellow at the Institute for Policy Innovation, says GOP state legislators in Louisiana and elsewhere haven’t learned a thing from the Obamacare disaster.
“It’s Obamacare’s requirement that insurers must accept individuals buying their own coverage regardless of a preexisting condition which led to imposing so many requirements and mandates, like the mandate to have coverage,” Matthews said. “All of that was to keep individuals from gaming the system by waiting until they have a major medical condition to buy coverage.”
The “guaranteed issue” provision compelling insurance companies to accept individuals with preexisting conditions won’t address the challenges of Obamacare and may make them worse, says Matthews.
“About 85 percent of the nation’s population receives health insurance through an employer, Medicare, Medicaid, or the military,” Matthews said. “All of those plans accept individuals with preexisting conditions. Until Obamacare, plans in the individual market could select who could be covered, and states offered their own programs for those with preexisting conditions, such as giving favored rate status to insurers who agreed to be insurers of last resort. Obamacare ended that.”
Matthews says there is a simple way to solve the preexisting-condition problem.
“If Republicans are worried some individuals with a preexisting condition might not be able to find coverage, [then] allow them to join the state employees’ health insurance plan and indirectly subsidize those policies to keep premiums within the normal range.”
Risk of Risk Pools
John Dale Dunn, M.D., J.D., an emergency physician in Brownwood, Texas, says the concern over preexisting conditions is mainly a talking point for activists pushing for even more government involvement in health care.
“This is the ultimate argument for why we have to have government-run health care, because poor people with medical problems can’t get insurance because of their preexisting medical conditions,” Dunn said. “First of all, that’s a lie. Second, it isn’t the government’s job to figure out how people with preexisting conditions can have all the health insurance they need. This is just another stalking horse for government-run health care insurance.”
The Louisiana Republicans’ plan cannot work without a high-risk pool, says Dunn, but there’s a huge risk to the state’s taxpayers if the prices in the risk pools don’t reflect the costs of payouts.
“It’s pretty simple,” Dunn said. “If I’m 45 years old, and they find out I’m a smoker, they’re going to ding me and I’ll pay extra for my premium, and when it comes down to it, then what’s wrong with that? But these people are going out of their way to not make that a factor about the cost of what your health insurance is going to be. What they want to do is introduce the government into a system where there is no such thing as underwriting.”
Putting Taxpayers at Risk
Dunn says this is an important difference between private and public health insurance.
“In the insurance industry, there are people called underwriters, who decide how much risk is involved in insuring someone who smokes cigarettes and skydives,” Dunn said. “What the government tries to do is say, ‘These poor people with diabetes and high blood pressure, heart trouble, etc. shouldn’t be part of an oppressed class, should they?”
Dunn says the push to eliminate underwriting is all about politics, not providing health care.
“There you go: social justice warriors to the front,” Dunn said. “Let’s find a way to make sure no one has to pay the price for their inequality with the person who is perfectly healthy and has no risks. Let’s see if we can, as government, take care of this poor, oppressed class.”
Dunn says proponents of big government repeatedly appeal to the emotions instead of reason.
“If you want, you can do what’s typically done at the state level,” said Dunn. “You have a hearing, and then here come the people in wheelchairs.”
Kenneth Artz ([email protected])writes from Dallas, Texas.