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.

Sometimes having the wrong health insurance is even worse than being uninsured. An recent article in Chester County’s Daily Local News made that clear. After becoming unemployed, many people are left in dire straits once their employer’s COBRA coverage expires. With little money, most are only able to buy inferior health insurance plans. At that point, millions of individuals and families become underinsured. Imagine if your insurer refused to cover even one emergency room visit! No wonder some people decide to go uninsured instead; they’d still have to pay for their medical care, but at least wouldn’t still be paying premiums.

Unfortunately, some people doesn’t find out what their health insurance plan does and doesn’t cover until it’s too late.  Avoid the underinsurance trap by reviewing your plan and talking with an insurance agent. The best solution is to find a plan that suits your needs and provides the most value. It’s important to save money on insurance, but don’t forget your health. If you are currently underinsured, you can get an affordable health insurance quote for a better plan.

(Image: Commonwealth Fund)

So far, Republicans in Congress have mainly expressed opposition to the healthcare reform plans proposed by the Democrats. They haven’t offered many solutions of their own, but that’s about to change.  John Boehner, the most powerful member of the minority party in the House of Representatives, has promised that the GOP will present an alternative bill that doesn’t entail major government involvement or adding to the national debt. Obviously, there will be no public option in this version.

Boehner acknowledges that the current system isn’t ideal. How does he plan to give more Americans access to health insurance? These are several things Republican healthcare reform bill would do:

• Severely decreasing the number of medical malpractice lawsuits. This would lower health care costs through a reduction in the unnecessary tests given by overly cautious doctors. Malpractice insurance can also cost doctors millions of dollars per year. As a bonus, it doesn’t hurt that trial lawyers tend to support and contribute to Democratic politicians; this measure wouldn’t affect many GOP supporters.
• Creating a pool that allows small businesses and individuals to buy affordable health insurance in large groups. That proposal is similar to part of the Democrats’ healthcare plan. It’s pretty noncontroversial.
• Repealing the regulations that prevent people from going across state lines to buy health insurance plans. Some states, such as New York, regulate the industry more than others. These regulations include prohibitions on denying insurance to people with pre-existing conditions, for example. While these measures allow more people to be insured, they also result in higher health insurance premiums. Boehner believes that creating a nationwide free market will be more effective in lowering healthcare costs than a public option.

A Republican plan wouldn’t include a health insurance mandate, and would avoid tax increases. It sounds nice, but would it actually be successful? Even party leaders admit that their proposals wouldn’t come close to covering most of America’s uninsured.

Following her Senate counterpart’s reveal of his healthcare reform plan earlier this week, Speaker of the House of Representatives Nancy Pelosi has now unveiled her chamber’s proposal for expanding affordable health insurance coverage. As expected, the House’s plan is farther-reaching than the Senate’s and more similar to the one outlined by President Obama during his campaign.  Here’s a quick Q&A on Pelosi’s plan:

Q: How much is this going to cost?

A: It’s projected to cost a whopping $894 billion over ten years.

Q: How is the government planning to pay for reform?

A: It will raise income taxes on couples making over $1 million and individuals making over $500,000 yearly. In addition, Medicare spending will be cut by an unknown amount.  Liberal representatives also floated the idea of having the government dictate the rates paid to health care providers by the public option, but moderates managed to strip out that provision. (The government, as well as private insurers, will instead negotiate payment rates with hospitals and doctors.)

Q: Is a public option included?

A: Yes. Unlike the Senate version, the House’s bill doesn’t allow states to opt out of it. So far, it doesn’t include a so-called “trigger” either.

Q: Will illegal immigrants be covered by the public option?

A: As of now, it’s unclear. That’s one of the main sticking points preventing the House bill from reaching a vote. However, remember that illegal immigrants are already receiving a form of public healthcare: hospital emergency rooms are required to serve everyone who comes in.

Q: What about abortion? Will it be covered?

A: That’s another controversial topic that will see much debate before the bill hits the House floor. A handful of pro-life Democrats will probably try to have abortion coverage removed from the public option in order for it to receive their votes. Meanwhile, some pro-choice representatives oppose a bill that doesn’t include abortion services. Either way, the Democrats have a solid majority in the House and can afford to lose some votes in either direction.

Q: What if I have a pre-existing condition and can’t get insurance?

A: These reforms are supposed to change that. Health insurers will no longer be allowed to deny coverage to people with pre-existing conditions. They won’t be able to charge those with pre-existing conditions significantly more, either.

Q: When will healthcare reform take effect?

A: It’s hard to believe, but the bill won’t fully kick in until 2013. By then, a mandate will require everyone who can afford it to buy health insurance. They can be insured via the newly created exchange (consisting of private insurers, in addition to the public option), by their employer, or an existing government program such as Medicare or Medicaid.

Q: But I need health insurance now! What can I do in the meantime?

A: The government is putting together a temporary program to insure individuals and families that have been rejected by private insurers. Otherwise, do you really want to wait for the government’s health insurance plan? Keep in mind that the House bill needs to be reconciled with the Senate bill before there’s a final vote, and that could take months.

(Image: U.S. House of Representatives Portrait)