Does Senator Grassley's ammendment unintentionally open the door for state single payer?

[grantcart]

Understanding the Rational for Mandates

One principle backed by President Obama and industry plans is that the health reform bill should include a requirement that health plans accept applicants with preexisting conditions, without charging them higher prices because of their health status, along with a requirement that individuals have health coverage, to protect health plans against the risk of antiselection.

If your going to require plans to accept everyone who applies for insurance 'blindly' without consideration of their preexisting health condition and not allow for a differentiation in price then it is not possible to have a viable plan without mandates. Large numbers of people simply would not sign up for insurance until facing a catastrophic illness and the insurance plan would be mandated to take all of the high expense cases without the ability of averaging those costs over a healthier population.

Such a plan, whether it is public or private would go bankrupt very quickly. All single payer plans in fact have a mandate, although in some cases the mandate is through a tax addition that seems invisible.



Senate Finance Committee considers alternatives to mandates

This insurance industry newsletter reports that the Senate Finance Committee is considering making mandates somewhat more flexible by allowing states to offer alternatives to mandates if they had alternatives that are "actuarially sound"

http://www.lifeandhealthinsurancenews.com/News/2009/9/Pages/Health-Mandate-Softens.aspx?nul

Here is what they report happened in the Committee on Friday


Sen. Charles Grassley, R-Iowa, today proposed an amendment to the AHFA bill that would let states opt out of the individual health insurance ownership mandate and switch to other arrangements approved by state insurance commissioners as actuarially sound.

Grassley said he proposed the amendment because he decided during the Senate's August recess that imposing an individual health coverage mandate would create new problems.

"There is of course a principle of personal responsibility," Grassley said. "We all one way or another pay for the health care for the uninsured. A mandate helps stabilize premiums, mostly by requiring younger people to buy insurance."

Moreover, "it's easy to see why the health insurers want the mandate," he said. "It's going to make them a heckuva lot of money."

But, under the AHFA bill, the government could impose up to $1,900 in new taxes per year on a family that goes without coverage, and the idea of requiring an individual or family to own coverage that meets lengthy federal benefits requirements is another cause for concern, Grassley said. He also questioned the idea of adopting a program that would create subsidies for families earning as much as $88,000 per year at a time when the United States has a giant budget deficit.

Sen. Ron Wyden, D-Ore., brought debate of the proposed Grassley flexbility amendment to a halt by noting that Baucus already has approved a state flexibility amendment that he has offered. That amendment already would let states go with alternatives to the health insurance mandate requirement, Wyden said.

"I wanted to give the maximum amount of flexibility," Wyden said.

Grassley agreed to hold back on further discussion of his flexibility amendment while he determines whether the Wyden amendment would really do the same thing.

We are now in the odd situation of considering the fact that Senator Grassley may have a good idea.


Here is what most people can agree on:

1) Mandates are anathema, nobody likes them. Mandates are best served on "other folks".

2) If you are going to require plans (whether they be public option or private plans) to receive everyone without discriminating on preexisting conditions then you simply have to have mandates, otherwise there is no way to meet the basic principle of insurance = averaging out risk over a large representative population.

3) Mandates will (as Grassley surprisingly admits) "earn the insurance companies a lot of money". That is true unless there is a public option and people are free to choose the public option, and do so in very large numbers. Hence the absolute necessity of having the public option if you are going to have mandates.

4) Having options for the states seems a very reasonable option. When asked what those state options might be he said that they might be policies "we haven't thought of yet".

5) Well one option that could be tried out in a small state could be single payer.

Canada's single payer system was not initiated at the federal level it was initiated province by province. One very realistic scenario is to make the Health Care bill flexible enough to allow states to opt of the federal system if they still meet the principles of universality and actuarial soundness.

Did Senator Grassley just open the door to state by state single payer systems?

[drm604]

1. Shhh...

Don't tell him...

[grantcart]

2. well actually this thread was supposed to go to the bottom with only 4 people reading it

until you kicked it lol