The New Democratic Leadership Council Report On Health Care Reform
Excerpted from The New Democratic Leadership Council's report on Health Care Reform:
There is general agreement on what type of rules should be put in place: require insurers to accept all applicants (a term known in health policy as “guaranteed issue”); prevent them from excluding pre-existing conditions; limit the amount that insurers can charge due to age, gender, and health status (known as “community rating”); and prohibit insurers from limiting benefit plans and lifetime limits. Taken together, these reforms would assure that individuals can buy quality meaningful coverage in this market and their coverage won’t be dropped just when they need it most. These are critical reforms, but their application in the states demonstrates that, in a vacuum, they won’t fix the market. The few states that have put in place guaranteed issue and full community rating ended up with an individual insurance market with very high premiums as people were allowed to buy insurance only when they needed health care.
"Sarah Bianchi that outlines three issues critical to successful health reform: overhauling insurance rules while requiring all individuals to be part of the system; assuring health care is affordable; and creating a competitive marketplace through effective insurance exchanges. The report, "What It Takes: Three Keys to Successful Health Care Reform," is available in its entirety here at http://www.dlc.org/documents/DLC_Bianchi_Health-Reform.pdf"
Banchi served as the national policy director of the Kerry campaign in 2004, has advised President Bill Clinton, Vice President Al Gore, and the late Senator Edward Kennedy on health care policy. She argues that, regardless of whether the final health bill includes a "public option," Congress needs to get the following three issues right:
- Insurance Reforms Won't Work Without an Individual Requirement: There is a general consensus on the real need to prohibit insurance companies from excluding those with pre-existing conditions, limiting what insurers can charge due to age, gender and health status, and requiring them to offer adequate benefits. However, these reforms won't fix the market unless there is a meaningful requirement that individuals buy health insurance.
- Affordability and Cost Savings Are Crucial for Expanding Coverage: An individual requirement won't succeed unless health care is affordable. Thus, health reform must include real cost containment provisions and meaningful subsidies. Congress should resist efforts to water down the subsidies.
- A Well-Functioning Exchange Is Essential to Creating a Healthy Marketplace: A well-designed exchange that offers a variety of private options would bring costs down both by encouraging insurers to compete for their business, and reducing administrative costs. But for the exchange to succeed, Congress will need strong rules that prevent businesses from dumping high-cost employees into the marketplace, and stop insurers from cherry picking the least costly enrollees."
"2001 study by researchers at Georgetown University’s Institute for Health Care Research and Policy had seven different consumer profiles submit 420 applications for coverage in the individual market. Taken together, this group was denied insurance altogether 35 percent of the time. Only 10 percent were given a so-called “clean offer,” which basically means that the rest were given some type of extra premium or benefit limitation. The personal stories behind these numbers are heartbreaking – people who pay for insurance that doesn’t cover their cancer treatment or heart medication, or that still leaves them awash in debt after a hospital stay, or those who are turned away altogether.
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