Yesterday, Ezra posted the Obama administration’s eight point checklist for what health care reform should do for you. And here they are. See if you can spot what’s missing.
* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.
Did you guess it? Here’s a clue: what’s the most immediate “out of pocket” expense that you pay for health care, unless your employer covers it 100%? Ding ding ding! Your premiums. Setting limits on deductibles and co-pays is great, as is making lifetime coverage limits illegal. No pre-existing condition/you can’t get sick excuses to take people’s money and then refuse to cover them? Great! But I fear that there’s a giant, lurking loophole.
If I was an insurance company and I didn’t want to cover someone who, for instance, has a history of cancer, then I’d just charge them twice what they make a year for premiums, and then not matter how much they had a “right” to buy my insurance, they wouldn’t have the ability. Which makes it just as well if there’s no mandates, because mandating that people buy coverage they simply can’t afford is cruel. Creating subsidies for people that are even 3 times the poverty line won’t help if they’re being charged $40,000 a year for premiums, and creating competition won’t help if everyone employs the same strategy to keep the undesirables out.
Is there something I’m missing? They explicitly left out premiums in the “out of pocket” expenses list, and I don’t think that’s an accident. That’s a loophole that insurance companies will absolutely drive a truck through.