Comments on: Guaranteed Issue? Only With An Individual Mandate http://healthaffairs.org/blog/2008/03/10/guaranteed-issue-only-with-an-individual-mandate/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: Health Insurance Lobby Reiterates Its Support for Tougher Laws Requiring People to Buy Health Insurance - Hit & Run : Reason Magazine http://healthaffairs.org/blog/2008/03/10/guaranteed-issue-only-with-an-individual-mandate/comment-page-1/#comment-31214 Health Insurance Lobby Reiterates Its Support for Tougher Laws Requiring People to Buy Health Insurance - Hit & Run : Reason Magazine Tue, 20 Oct 2009 17:01:14 +0000 http://healthaffairs.org/blog/2008/03/10/guaranteed-issue-only-with-an-individual-mandate/#comment-31214 [...] that insurance market reforms like guaranteed issue and community rating have a long history of driving up insurance premiums. And it's also true that the insurance industry has for years pushed the idea that those reforms [...] [...] that insurance market reforms like guaranteed issue and community rating have a long history of driving up insurance premiums. And it's also true that the insurance industry has for years pushed the idea that those reforms [...]

]]> By: L Ozeran http://healthaffairs.org/blog/2008/03/10/guaranteed-issue-only-with-an-individual-mandate/comment-page-1/#comment-16719 L Ozeran Fri, 14 Mar 2008 13:56:11 +0000 http://healthaffairs.org/blog/2008/03/10/guaranteed-issue-only-with-an-individual-mandate/#comment-16719 As a California physician heavily involved in last year's reform discussion, this topic is very important to me. I am posting comments in other areas on this site, so I will focus these remarks on the specific aspect addressed. Patricia Lynch's comments relate to individual mandates. Even ignoring the data, it is simple logic that if you guarantee issue of insurance without regard to health status, more sick people will buy insurance and premiums will rise. As a result, guaranteed issue cannot work if it is decoupled from individual mandates. Further, individual mandates cannot work if they are not mandates. As I have posted elsewhere on this site, there can be no exceptions. How one satisfies the mandate should be flexible: individual policy, employer coverage, even posting a $30,000 bond. Any exceptions will lead to more exceptions which will ultimately invalidate the mandate and kill the system. If there are individuals with financial needs, then some mechanism is required to ensure they can meet the mandate. One option is financial support (state subsidies, tax credits), another is providing a basic health plan to every Californian (not single payer). There must also be significant penalties for non-compliance such that it is both cheaper and easier to comply with the mandate than to shirk the responsibility and get caught. The bottom line is this, as long as we have a mandate on providers to treat (emergency rooms), we must have a mandate on patients to ensure payment if we are to avoid continuing down our current path towards insolvency in healthcare. As a California physician heavily involved in last year’s reform discussion, this topic is very important to me. I am posting comments in other areas on this site, so I will focus these remarks on the specific aspect addressed. Patricia Lynch’s comments relate to individual mandates.

Even ignoring the data, it is simple logic that if you guarantee issue of insurance without regard to health status, more sick people will buy insurance and premiums will rise. As a result, guaranteed issue cannot work if it is decoupled from individual mandates. Further, individual mandates cannot work if they are not mandates. As I have posted elsewhere on this site, there can be no exceptions. How one satisfies the mandate should be flexible: individual policy, employer coverage, even posting a $30,000 bond. Any exceptions will lead to more exceptions which will ultimately invalidate the mandate and kill the system. If there are individuals with financial needs, then some mechanism is required to ensure they can meet the mandate. One option is financial support (state subsidies, tax credits), another is providing a basic health plan to every Californian (not single payer). There must also be significant penalties for non-compliance such that it is both cheaper and easier to comply with the mandate than to shirk the responsibility and get caught.

The bottom line is this, as long as we have a mandate on providers to treat (emergency rooms), we must have a mandate on patients to ensure payment if we are to avoid continuing down our current path towards insolvency in healthcare.

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