The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

The Misguided Health Care Reform Surcharge

Posted by Alan on March 10, 2007


The last couple of posts have dealt with the guarantee issue requirements in the individual health insurance market, a central component of several health care reform proposals. What I’ve suggested is that guarantee issue, which simply means health insurance carriers have to accept all applicants regardless of their health risk, if done right can lead to universal coverage, but if done wrong can lead to disaster.

The line between right and wrong in this context concerns requiring consumers to be insured. If it’s required, and that requirement is effective, guarantee issue can work. In systems where consumers can wait until after a need for insurance develops you wind up with a mess. The poster children for disaster are New York and New Jersey. Consider the results of a 2005 study conducted by the America’s Health Insurance Plans (AHIP):

Average Annual Individual Health Insurance Premiums:
                                          New Jersey        New York      California
Single Coverage:                $  6,048               $ 3,743         $ 1,885
Family Coverage:                $14,403               $ 9,696         $ 3,972

New Jersey and New York have guarantee issue (and community rating) without a mandate to purchase coverage. California does not — at least, not yet. The result: a consumer in New Jersey buying coverage just for herself pays surcharge for the state’s misguided health care reform of over $4,100. If she moves to New York, the surcharge falls to approximately $1,850.

Families suffer more when health care reform goes bad. A family in New Jersey buying their own coverage pays over $10,400 more than a California family; New Yorkers pay over $5,700 more.

Think of the impact of a 350% surcharge on a family’s budget — or on a state’s economy. Promoting guarantee issue in the individual market as a key to achieving universal health care coverage is both noble and reasonable — if it’s done right. If done wrong, the state and its citizens will pay the price.

2 Responses to “The Misguided Health Care Reform Surcharge”

  1. James Kallman said

    Alan —

    I am intrigued by the observations above. As a small business owner (I run a medical practice with 15 employees) and a head of household, I am astounded at my family premiums that are $17-$20K per year. That’s with a $3000 family deductible. We shell out $20K before we get help from our health insurer.

    How could we as a nation go about requiring individuals and families to buy insurance? How do they do it in California? How would we enforce such laws and what would be the consequences to those who refused to buy insurance? How do other nations do this?

  2. […] One of the problems with the health care reform debate this time around is how little real dialogue there has been. Most of the time the debate seems to be about what legislation can pass, not what legislation should pass. To their credit, the Administration and the Legislative Leadership have met with a number of people, but I don’t see much of what they’re hearing being incorporated into any proposals. It’s as if ideas not generated within the State Capitol aren’t given credence.  How else do you explain AB 8’s inclusion of a mandate for carriers to accept virtually all applicants without a requirement for all individuals to be insured? I don’t know anyone who has studied the issue who believes this won’t raise premiums as it has done in New York and New Jersey.  […]

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