The Mother of All Flip-Flops may be en route....

[Carmen813]

The phrase I've heard is that conservatives might soon find themselves as "the dog that caught the car." Apparently they are considering reversing course on several provisions that are in the healthcare reform bill. It'll be interesting to see if any of this plays out as reality, but it seems like there may soon be an interesting internal fight within the Republican caucuses. Mind you, this is a liberal source, but the statements quoted are pretty interesting.

http://tpmdc.talkingpointsmemo.com/...rting-obamacare-provisions.php?ref=fpnewsfeed

It's worth noting that nothing said here by the Republicans quoted is all that radical. They made similar statements during the health care reform fight when they were proposing their own bills, but they never made an actual effort to eliminate pre-existing condition clauses. It was left out of every single one of their proposals/bills (I read nearly all of them).

I'm specifically interested to see how they propose to keep the elimination of pre-exisiting conditions. Most information I've read suggests that doing so would utterly destroy the private insurance market in the absence of a mandate. During the Supreme Court hearings there was supposedly a third party by the justices who was directed to argue in favor of eliminating pre-existing conditions, while also eliminating the individual mandate. Apparently this person did a really incredible job, but I've been unable to find any more information. Anyone know more about this?

My suspicion is that the group insurance market is doing relatively fine without having a mandate in place, and that they main barrier to people buying insurance is often cost of premiums (which keep rising dramatically). It may be possible to eliminate pre-existing condition limitations by also implementing something like a 90 day wait for benefits to kick in. That isn't ideal in my book, but it's better than never being able to get insurance (and thus access to healthcare) again.

I should note that I used flip-flop in the subject line because I figured it'd garner some attention. Frankly, I don't care if they change positions if the goal is to help improve the healthcare system, specifically with regards to helping the under/uninsured.

 

[sactoking]

My suspicion is that the group insurance market is doing relatively fine without having a mandate in place, and that they main barrier to people buying insurance is often cost of premiums (which keep rising dramatically). It may be possible to eliminate pre-existing condition limitations by also implementing something like a 90 day wait for benefits to kick in. That isn't ideal in my book, but it's better than never being able to get insurance (and thus access to healthcare) again.

It depends on what you consider the "market" to be. Does the market consist solely of the insurers or does the market consist of insurers and consumers? Just saying "market" could reasonably connote either.

If you're discussing just insurers then yes, the market is currently doing fine without the mandate. In fact, the ACA as a whole is set to decimate the market, so it's safe to say that not only is the market doing fine without the mandate, it's doing better without the mandate.

If you're discussing both sides then no, the market is not currently fine. There are obvious systemic problems with the market such as low affordability, pre-existing exclusions, and lack of competition. The mandate seeks to address the pre-existing condition exclusion by transitioning health insurance from a sample with adverse selection to a population. Unfortunately, the mechanism used is of questionable legality and ethical backing and the Act itself is packed with so many other "solutions" to problems that don't exist (mandating coverage to age 26, tens or hundreds of billions in taxes, removal of essential benefit monetary caps, etc) that any societal gains realized through expanded health insurance coverage may likely be trumped by the deleterious economic effects of all the rest of it.

I'd conclude by saying that a 90-day pre-existing condition exclusion might work in theory but not in practice. The reality is that any exclusion would need to be much longer, similar to how individual policies today often exclude maternity for the first year of coverage. In the world of health care and health insurance 90 days really just isn't enough time to deter adverse selection. Emergency care just isn't that big of a driver of health costs. Most cost drivers are conditions that can have treatment postponed for at least a brief period of time (like during a 90 day exclusion window) so a relatively short delay between diagnosis and treatment won't abate the adverse selection. Longer periods would alleviate the issue somewhat, since having to wait a year to treat your cancer would be a deterrent, but some people would still "gamble" and lose.