Wolf Blitzer’s question about how a Republican president would provide health care to a 30-year-old uninsured man who is in need of six months of intensive treatment elicited calls to let the person die from the audience at last night’s Tea Party/CNN debate, but it also revealed the inadequacy of the GOP’s health care prescriptions. The eight Republican candidates may not have joined the audience cheering, but their health care proposals would do little to help chronically ill and uninsured Americans.
All of the candidates have pledged to repeal the Affordable Care Act, adding 32 million people to the rolls of the uninsured, increasing health care premiums for American families and growing the national deficit by $230 billion over 10 years. They would effectively reset the progress in expanding coverage and containing costs and offer a series of market-driven solutions that do little more than shift the cost and risk of coverage onto the individual.
In the meantime — as their replacement legislation makes its way through Congress — 45,000 Americans will die every year because they lack health care coverage, and thousands more could see their policies canceled or denied by private insurers that are more interested in reducing risk and increasing profit than they are in offering meaningful insurance to those who need it. Recent data compiled by the federal government found that while insurers turn down applicants for coverage at different rates depending on geographical location, “denial rates routinely exceed 20 percent and often are much higher.” One study of 459 insurers found that “a quarter of insurers had denial rates of 15 percent or below and a quarter had rates of 40 percent or higher.”
The GOP’s proposals would further deregulate the insurance market without providing adequate coverage to the sickest Americans or significantly reducing health care costs. For instance, front runner Mitt Romney’s Massachusetts reform would have provided health security to the 30-year-old without insurance, his plan for America likely won’t:
1. Romney would “reform the tax code to promote the individual ownership of health insurance” and “give individuals a choice between the current system and a tax deduction to buy insurance on their own.” He thinks this would create “the best of both worlds” by allowing certain individuals to leave their employer-sponsored health insurance plans and find coverage on the individual market. But this would only entice young healthy workers to buy cheaper but less substantive insurance in the individual insurance plan market place, increasing costs for sicker workers and forcing some to opt out entirely. Among those who would lose their health care are 56 million Americans with pre-existing chronic health conditions. Meanwhile, if the tax credit would have encouraged the 30-year-old to purchase insurance in the first place, it’s unclear that it would have covered the full cost or the policy or if he would have even qualified for a plan.
2. Romney says that “individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions” — that’s a start, but it doesn’t offer the kind of blanket protection for pre-existing condition exclusions that’s found in the Affordable Care Act and it’s unclear if our test case would have fit Romney’s definition of continuous coverage.
3. Under Romney’s proposal, the 30-year-old could have also purchased insurance across state lines, free from what Romney describes as “costly state benefit requirements.” But if the insurance he buys doesn’t provide coverage for the chronic care he needs — what good is it? Romney’s plan allows insurers would be able to circumvent consumer protections in certain states and sell bare-bone subprime policies to the healthiest (and most profitable) beneficiaries. Companies would have little incentive to do business in states that require coverage for such things as cancer screenings and sell plans across the country that deny coverage altogether to high-cost cases.
4. Finally, Romney proposes establishing Health Savings Accounts and eliminating “the minimum deductible requirement for HSAs.” This may help some healthy people but will do little to aid the 30-year-old with expensive chronic conditions who will quickly deplete his savings accounts.