The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

The Alfred E. Neuman Approach to Health Care Reform

Posted by Alan on December 20, 2007

The Los Angeles Times ran a surprising editorial in support of the health care reform package cobbled together by California Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. That the Times is supporting the reform package isn’t the surprise, it’s the reasoning.

The editorial, published on Wednesday and entitled simply “California’s healthcare plan” accurately noted that there is much to like in Assembly Bill X1-1, the Health Care Security and Cost Reduction Act. And they assume Governor Schwarzenegger will make “a reasonable case that there will be adequate funding [for the reform package] — and that there’s a backup plan in place should finances fall short ….”

So, there’s some good things in the bill. The Governor is bound to make a “reasonable” case it won’t bankrupt the state. That’s enough for an Alfred E. Neuman worthy endorsement by the Times: “Why not give it a chance?”

Well, gee. Let’s think.

First, the history of state health care reform is littered with the wreckage from “What, me worry? reforms. As described in one of yesterday’s post, Washington State and Tennessee had to roll back their reforms. New York and New Jersey consumers pay on average twice what Californians do for individual health insurance thanks to their reforms. In fact, there’s no example of state health care reform inspiring confidence that the challenges facing our health care system can be resolved at the state level.

Second, while there’s a lot to applaud about the compromise legislation, it may contain serious flaws, too.* The reality is the Health Care Security and Cost Reduction Act has not been thoroughly vetted. The bill that passed out of the Assembly Health Committee was far different than that put before the Assembly Appropriations Committee. And what the Appropriations Committee and the full Assembly passed was made available to them the day of the vote. There was no way this complex, 200+ page bill was thoroughly reviewed before its passage. The staffs of the Governor and the Speaker are very good. They are very well intentioned. And they are very human. The odds of the bill being ready for prime time are small.

Senate President Pro Temp Don Perata is to be commended for slowing down the reform juggernaut until the Legislative Analyst’s office can estimate the impact of ABX1-1 on the state’s rapidly worsening budget. The Senate should also use this time to thoroughly review details of the bill and fix what’s flawed.

Even Alfred E. Neuman should be worried about the impact of a defective health care reform package on California.

* Note: In the original post I outlined one such serious flaw, the lack of enforcement of the mandate for residents to have coverage. Mike Russo at CALPIRG posted a comment leeting me know I missed a provision that allows carriers to exclude coverage on existing health conditions for up to 12 months on “late enrollees.” In the interest of accuracy, and out of fear I missed something else, I deleted that discussion from this blog. As pennance for missing this major element of the bill the first time, I’m going to re-read the bill again to see what else I might have missed the first time. My thanks to Mike for the correction.
Alan – December 20th, noon.


3 Responses to “The Alfred E. Neuman Approach to Health Care Reform”

  1. Thank you Alan for providing an in-depth blog from an agent’s point of view. Being on the front of this healthcare crisis, we the agents and financial advisors see the issues from a much more practical position with more market-driven solutions than the legislators and politicians.

    Financial Planning by AEI Financial

  2. Mike Russo said

    Hi Alan —

    ABX1-1 in its current form actually does have pretty strong provisions for making guaranteed issue work, but most of the work isn’t done through direct fines or penalties for failure to comply with the mandate. Rather, it’s through not offering GI to those who don’t comply with the mandate — if you don’t have coverage and rush to get it as soon as you get sick, the insurance company doesn’t have to cover your pre-existing condition for up to a year’s worth of treatments. So waiting to buy coverage until you get sick won’t help at all, as the insurance will only kick in for future treatment.

    Obviously this isn’t as direct of a stick as more punitive fines would be, but at the very least it makes opportunistic violation of the mandate basically pointless, and creates a strong incentive to get coverage when you’re healthy (not to mention insulating insurers from the impact of sick people rushing to get coverage). Because it is a more indirect effect, though, outreach will be important so that people understand how the system works and the importance of getting coverage sooner rather than later.

    There are a few other GI modifications (those exempted from the mandate don’t get GI, for example), but this is the biggest one addressing the problem you outline, I think. The language is at p. 51 of the latest version of the bill (under section 28.5 of ABX1-1, in section 1399.831 of the Health and Safety Code).

    This is my first comment here, so I also wanted to say that I’ve found your blog to be a great resource — though I often disagree with your arguments, they’re uniformly thoughtful and informative. Thanks for all the work you put in!

    Michael Russo
    Health Care Advocate and Staff Attorney
    California Public Interest Research Group (CALPIRG)

  3. Ross Thornton said

    Yesterday a local Fresno radio station posed a survey question on its web site. The question was,”Would you vote for or against the health care proposition next November.” The results were 95% no, 5% yes.

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