The more they stay the same.
I’ve been researching the state health insurance exchanges that are part of the health “reform” law, and am struck by how little they may end up doing, and how much furor they are causing. Republican state lawmakers in more than half the states are scaring their governors away from participating in setting up exchanges, on the theory that insurance exchanges are part of an unconstitutional health reform law.
But let’s look at this from the typical consumer’s point of view. A majority of Americans get their health coverage from an employer or from Medicare or Medicaid. A large fraction buy health plans on their own from insurance companies and another big chunk go without.
So the exchanges, in an ideal world, would make it easier for the people buying on their own or remaining uninsured to buy insurance from private insurance companies, and some with lower incomes would qualify for financial help to pay for the premiums.
So what is so threatening about an expansion of the private marketplace? The problem, of course, is that the marketplace might actually come with some consumer-friendly rules that make insurers (and their friends in state legislatures) uncomfortable. So we have the typical dynamic of insurers resisting rules that might make it easier for consumers to have health coverage that actually pays their bills and is reliable. Same old, same old.
Call me cynical, but I’ve been struck from the beginning of the health “reform” debate by the unwarranted optimism of those who think that dynamic will somehow be overwhelmed by Congress’ desire to reduce the number of uninsured. We can see already how the Affordable Care Act’s provisions are being eroded by legal challenges, failure to appropriate money to carry them out, and out-and-out refusal to play along in the states.
It would be great if we got some real consumer-friendly insurance rules, and the law has actually put a few of those in place. But by setting up the exchanges on a state-by-state basis, Congress has simply allowed the debate to continue in every state capitol rather than resolving it once and for all at a national level. Oh well.