A recent New York Times highlighted Maine’s attempts at comprehensive healthcare reform. Their experiences serve as a cautionary tale for Congress.   The state established a public health insurance plan, expanded Medicare and Medicaid eligibility, and banned insurers from refusing to cover people with pre-existing conditions, but those actions have done  little to insure more of its residents.  Contrary to the promises of public option supporters, health care costs have only continued to rise in the state.

Reasons for the high health care costs range from the state-specific to the general. Unlike the bill that recently passed the House of Representatives, Maine’s healthcare reform legislation didn’t include a mandate to buy health insurance plans. It’s a vicious cycle: forcing health insurance companies to offer policies to unhealthy people with pre-existing conditions raises the rates for younger people; young adults will be even less likely to buy health insurance if their premiums go up, which results in the insurer’s risk being spread among less people. In the end, the older, unhealthier population remains in the pool and must contend with less affordable health insurance. Therefore, there is a larger uninsured population.

Granted, Maine is a market dominated by just one private health insurance company (which, with its effective monopoly, can increase premiums to their liking); and its population is older, sicker, and poorer than the U.S. in general. Senator Olympia Snowe points to her state as a cautionary tale of what may happen if drastic changes are made too fast. Snowe is a Republican that supports healthcare reform but is against the public option. Budgeting problems have caused Maine to cap enrollment of its own public option health insurance plan at under 9,000. The federal government, unlike most states, is allowed to run a deficit. However, it isn’t exactly rolling in the money right now either.

Although it seems like the Democrats’ healthcare reform bills have been zooming through Congress, Senate Majority Leader Harry Reid predicts that there will soon be roadblocks.  To the chagrin of the Obama administration, Reid believes that a final bill won’t pass before the ball drops on Times Square and 2009 draws to a close. The White House wanted a bill passed prior to Ryan Seacrest’s countdown to the new year. Why is that so important? Well, 2010 is an election year; the entire Congress will be up for re-election. Judging from the few elections held yesterday, things don’t look good for the Democrats. Their prospects will be even worse if the fight to reform the health insurance industry continues to drag on, instead of  allowing the public’s memory to fade.

Unlike the House of Representatives, which is already close to voting on its bill, the Senate may not begin debate until December. There is some speculation that Reid is waiting for the final cost analysis from the Congressional Budget Office. He commented publicly that he doesn’t want to rush such an important bill. However, he is still striving to pass Obama’s top domestic priority by years’ end. They may be worried that waiting too long will make more likely that this administration’s attempt at providing more affordable health insurance will follow the failing path of Clinton’s.

This new development is just another example of why you shouldn’t wait for the public option if you can afford a health insurance plan now.

The medical device industry, which manufactures and sells items such as heart stents and artificial hips, has kept a low profile during the healthcare reform debate. However, that doesn’t mean that they won’t be affected. Their products are very important to many patients, but help drive up the cost of your health insurance plan. That’s probably why the House of Representatives’ healthcare reform proposal includes $20 million in taxes–coming from a 2.5% sales tax. AdvaMed, the industry’s lobbying group, is obviously unhappy with this and believes that the tax will be detrimental to the American economy.

What would medical device makers consider a more acceptable bill? One that:

• Exempt small companies, defined at those making less than $100 million
• Would be tied to specific products, presumably with more profitable products being taxed a higher rate
• Was at least partly deductible as an expense and,
• Doesn’t take effect until 2013.

As it turns out, the medical device industry was lucky. An initial Senate proposal doubled the fee to $40 million, so AdvaMed has expressed its gratefulness for the reprieve. Such a break was probably going to happen anyway, in exchange for moderate Democratic Senator’s Evan Bayh’s support. Bayh represents Indiana, a state that is the headquarters to many medical device companies. Will the goal of affordable health insurance still be achieved with this corporate giveaway?

(Image: stevendamron under CC 2.0)

Over the past week or so, the public option has been on a roll. Democratic leaders of Congress have insisted that some form of a public option be included in their healthcare reform bill, considering it an essential step in providing the nation with more affordable health insurance. It wasn’t going to be an easy battle. Senator Joe Lieberman has expressed his opposition to such a government-run plan. The independent senator–who used to be a Democrat and still caucuses with the party–cites budget concerns as his primary reason for rejecting it, and believes it isn’t the right time to go into even deeper debt. A less charitable view is that he wants to continue receiving funds for his re-election from major health insurance companies, many of which are headquartered in his home state of Connecticut. Only Lieberman himself knows his motivations for sure.

Lieberman has stated that he will vote with Harry Reid in the initial procedural vote that allows the bill on the full Senate floor for further debate, but vows to be part of the inevitable Republican filibuster against any final bill that includes the public option health insurance plan. Leaders should take him seriously, since he’s well-known for switching sides: he even campaigned for John McCain during last year’s presidential campaign. Nobody said getting 60 votes in the Senate would be easy; don’t be stuck without a health insurance plan in the meantime.

(Image: Official U.S. Senate Portrait)

Senate Majority Leader Harry Reid has joined the strong push for a public option in Congress’ healthcare reform bill, but its inclusion is not guaranteed. The provision’s fate is in the hands of moderate Democrats. Despite the ability for individual states to opt out of the government-run health insurance plan, centrist Democrats like Senators Ben Nelson and Max Baucus are still leery of voting for it. You should get a health insurance quote while you wait for the endless wrangling of votes to finish, since garnering 60 Senate votes to pass this bill will no doubt take awhile. The fact that several politicians in the party have received large campaign contributions from the health insurance industry doesn’t help.

Why the delay? The Senate and the House of Representatives have to debate exactly what form the public option will take, and moderates hold its fate in their hands. They need to compromise between comprehensive health coverage and cost. Gaining Republican votes is a lost cause at this point, so party leaders will be forced to exert their power. For example, Reid may try to convince a swing vote with a seat on a prestigious Senate committee–that a Senator will only get if he or she votes with him on healthcare reform. The more liberal House has a more comprehensive public option proposal included in its bill, and it must be combined with the bill in the generally more conservative Senate prior. Afterward, it’ll see even further amendments by the rest of Congress before a final vote. There is also the possibility, albeit less likely, that some liberal politicians will vote against the bill because it doesn’t do enough to reform our health insurance system. However, centrist politicians receive more attention from leaders because they are the wild card. Can you wait for Washington to decide, or would you prefer to be safe and get health insurance quotes from multiple insurers now? If, years from now, you like what the public option shaped up to be better than your existing health insurance plan, you’ll be able to switch–but if you’re caught uninsured before then, you’ll wish you hadn’t waited.

Recent studies have found that women under the age of 55 are more expensive to insure than their male counterparts. Why are their health insurance costs higher? A lot of it seems to come from the unfairness of biology:

• Most women need maternity care at some point in their lives, while men don’t. (Still, women who choose not to have children don’t get discounted health insurance quotes.)
• Although this disparity reverses in old age, cancers that almost exclusively affect women (e.g. breast and ovarian cancer) tend to strike at a younger age than exclusively male diseases like prostate cancer. In addition to the high cost associated with cancer treatment, health insurers must also cover preventative measures, such as Pap smears and mammograms.
• On average, women visit the doctor more regularly and use more prescription medication than men. This is most likely primarily due to a higher tendency for women to be proactive when it comes to their well-being, rather than a case of the female gender being sicker.

All of these factors cause insurance providers to consider women’s health insurance policies higher risk, and they charge more as a result.

Many consider the practice of gender rating discriminatory and counter intuitive, as it penalizes women for using greater quantities of preventative care–even though prevention is a proven way of reducing health care costs by a far larger sum.  Health insurance companies are willing to eliminate gender rating in certain instances. The Senate Finance Committee’s healthcare reform bill bans insurers from giving individuals and small groups a different health insurance quote based on their gender, but the definition of a small group is arbitrary. It could be as small as 50 or 100 employees. A firm with just 51 employees and a predominately female workforce could pay up to 20% more than the national average to insure its employees–and employees will have to cover more of that cost themselves.

Democratic Senator Barbara Mikulski is calling for the end of this practice altogether, including in large corporations. While she has been gathering support from other congresspersons in her quest, the health insurance industry’s lobby has been fighting to retain the exception that would allow gender rating to continue in the large group market. Their argument is that some businesses will decide to offer their own insurance (as opposed to buying it in the group market) after seeing their premiums increase. It’ll be extremely interesting to see how this plays out. Will Congress give into the insurers, believing that their support in eliminating gender rating for individual and small business health insurance is more urgent? After all, at least those working for large companies tend to have at least some form of employer-sponsored health insurance plan.

(Image: jfrancis under CC 2.0)

Finally, we get some more concrete information about the proposed government-run health insurance plan, otherwise known as the public option. It’s already in the House of Representatives healthcare reform bill, but the Senate’s version goes into more detail on what a public option for America would look like. First off, it wouldn’t take effect until 2013; after which it would be included in an exchange (think the Dow Jones or NASDAQ for health insurance), along with private insurers. Small businesses and individuals will be able to take part in the exchange and pool their buying power to buy their health insurance plans at a lower group rate. The idea behind the public option is that, with the government’s negotiating muscle and lack of profit motive, the competition will make healthcare costs lower across the board.  Opponents are skeptical, and believe that there is no way other health insurance providers can compete against governmental subsidies.

Even though the federal government doesn’t need to maximize profits for its shareholders, it still intends to cover most of its costs through the insurance premiums paid by its participants. The Obama administration plans to increase the federal deficit in order to provide initial funding, but hopes to repay the debt through those premiums. However, those revenues may end up smaller than anticipated; the Senate bill also allows states to individually opt out of the public option portion of reform, beginning in 2014. The program will be nationwide by default, but each state can pass legislation excluding itself from it. Further details are unknown; would those states have to pay the portion of federal taxes that goes to cover the public option, or will that money be refunded to their residents so they can buy one of the existing private health insurance plans? It remains to be seen how many state governments would actually take up that offer when all is said and done, but the choice allows some halfhearted “Blue Dog” Democratic politicians from conservative regions to vote for some form of healthcare reform without arising the ire of their constituents.

(Image: Andrew Aliferis under CC 2.0)

As it stands, the health insurance industry is one of the few that is exempt from federal antitrust regulation. Democratic Senator Patrick Leahy called a meeting of the Judiciary Committee to consider revoking the exemption, which would allow for greater oversight of health insurers. Democrats have criticized insurers for being a monopoly that keep rates high and cherry-picks the healthiest potential clients while leaving those who need it most uninsured. This view has been one of the main drivers of political support for the public option, which would allow the government to directly compete with private companies by selling its own health insurance.

However, a representative from America’s Health Insurance Plans, which represents the health care industry, told the Associated Press that healthcare reform doesn’t need to go that far. Despite being exempt from antitrust laws, it’s still one of the most highly regulated industries in the U.S. Some believe that insurance companies have become a scapegoat in the health debate. There are many reasons for skyrocketing medical costs, and for-profit insurers are only one.