The sticker shock of ObamaCare-Lite

posted at 10:17 am on August 13, 2009 by Karl
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Neither end of the political spectrum will care much for what Ezra Klein wrote yesterday about the state of play for ObamaCare:

A bit later today, I’ll be putting up an interview with Nancy-Ann DeParle, director of the White House’s Office of Health Reform. But there’s a particular argument that I want to focus on. “When you step back,” she told me, “there is broad agreement about 85 percent of what we’re talking about.”

You hear this a lot from the White House. In fact, you hear it often enough that it’s tempting to think it untrue. But it’s very true. And in this moment of violent town halls and ferocious controversy, it’s worth remembering.

Here are the things that, broadly speaking, legislators agree about: insurance market reforms, including community rating, guaranteed issue, an end to rescission, an end to discrimination based on preexisting conditions, and an individual mandate. Subsidies for low-income Americans. Delivery system reforms. Health insurance exchanges. An expansion of coverage to about 95 percent of legal residents. Prevention and wellness policies. Retaining and strengthening the employer-based insurance market. Creating some kind of incentive for employers to offer, and keep offering, health benefits. Expanding Medicaid to about 133 percent of poverty.

The Left does not like reading it because the see the White House laying a foundation for declaring victory on some bill that lacks the most odious components of the Democrats’ proposals, particularly a government-run insurance plan.

The Right should not like it because the so-called insurance market reforms still amount to government-run health care, as everyone from Keith Hennessey to Michael Kinsley acknowledges.

People in the persuadable middle need to hear that. People in the persuadable middle also need to hear that the so-called insurance reforms the Democrats are pushing will jack up health insurance premiums. These government mandates have been particularly bad for the individual insurance market in the few states which already impose them:

Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.

Mr. Obama wants to wave away this reality with new regulations that prohibit “discrimination against the sick”—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.

That’s one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama’s proposal for “guaranteed issue” on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.

Another proposed reform known as “community rating” imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don’t join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.

New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.

Granted, these are state mandates, rather than national mandates, involving individual insurance, rather than employer-based insurance. But mandated benefits, community rating, and guaranteed issue requirements could increase health insurance premiums by as much as 20-94%.

Anyone looking to ask their Representative or Senator questions about ObamaCare could do worse than to ask for an estimate of how much health insurance premiums will go up if even these supposedly modest insurance reforms become law.

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