Tuesday, December 18, 2007

Throw Momma -- And Adopted Kids -- From The Train

This week's column suffered from editing. My proposed headline was even preferred by the editor, but he couldn't fit it into the allotted space (or get me more space for a good headline). I also came up with a better way to disclose my political contributions in the column tagline, but that joke got cut as well: "Coppersmith contributes to the campaign of John Shadegg's 2008 Democratic opponent every chance he gets." Instead, it was "Coppersmith has contributed to the campaign of Shadegg's 2008 Democratic opponent, Bob Lord." But they mentioned Bob's name, so we'll consider it a victory. Here's the newspaper version.

East Valley Tribune, Dec. 16, 2007

Rep. John Shadegg, defending his votes against providing insurance coverage to thousands of Arizona kids under SCHIP, said that nobody should vote for a bill because its name. That applies, in spades, to Shadegg's so-called "Health Care Choice Act."

The bill is designed, like most GOP policies, to help those who don't need it. It's not a "common sense" reform; it's about making life better for people who are healthy or rich, and preferably both. That's the role of "choice" in GOP health care plans -- choosing to make things better for insurance companies.

You immediately should be suspicious when Shadegg's bill gets lauded on The Wall Street Journal editorial page by the executive director of the Coalition for Affordable Insurance, whose Web site describes it as an "association of insurance companies, actuarial firms, legislative consultants, physicians, and insurance agents." You should expect CAI would endorse legislation that helps insurance companies, actuarial firms, legislative consultants, and the rest. You should not expect that they would endorse anything that would make your life better.

The concept is that people could choose to buy health insurance from anywhere. If they live in a state with lots of regulations and mandates, they could buy a cheaper policy from a low-regulation and no-mandate state. And if you were younger and healthier than average and didn't expect to need medical care, then you would buy a cheaper policy. And you'd be really happy, at least until you suffered some sort of medical problem. Then you'd be stuck, big time.

The sales pitch is "choice" for you, but the real purpose is letting insurance companies choose their customers. Instead of only cherry-picking customers in one state, Shadegg would let them pick cherries everywhere, insuring only those customers who won't need health care and dropping them as soon as they do, nationally.

Without state regulations, insurers could offer policies carefully constructed not to cover anything likely to happen. You'll have no coverage, but you'll get it really cheap! States trying to protect their citizens -- from fraudulent insurers, misleading advertising, and policies that don't cover vital health problems -- would be outflanked by low-regulation states.

Consider how the "expensive state mandate" works here. Arizona, according to CAI, is in the middle on mandates. One doesn't usually think of the Arizona Legislature as unfriendly to business or overbearing in consumer protection, but our legislators have seen fit to require health insurers to include certain benefits, certain types of health care providers, and cover certain types of persons in individual and small-business health policies (large employers are exempt under federal law).

Arizona requires insurers cover ambulatory surgery, breast reconstruction, clinical trials, contraceptives, diabetes self-management and supplies, emergency services, home health care, mammograms, maternity stays, mental health parity, off-label drug use, and PKU infant formula. Arizona mandates that policies cover medical treatment by chiropractors, dentists, nurse anesthetists, nurse midwives, nurse practitioners, occupational therapists, optometrists, podiatrists, psychologists, public or other facilities, and speech and hearing specialists. We also mandate coverage for adopted children, dependent continuation coverage, conversion to non-group, handicapped dependents, and newborns.

Sounds like a huge list, until you realize that according to the study relied on by CAI, the benefit mandates (like breast reconstruction and mammograms) don't cost all that much (comparatively speaking). The big dollars are in the access mandates -- the adopted children and newborns.

Say it costs more to insure adopted kids; they have more health problems than "regular" kids. Kentucky doesn't mandate adopted children coverage. Shadegg thinks you should be able to purchase a cheaper Kentucky policy without adoption coverage. It's cheaper for you, because you're not going to adopt. But if that means parents in Arizona with adopted kids then have to pay more, which leads some to drop coverage, which creates the "death spiral" where only the worst risks have to buy insurance -- well, that's not my department, says Rep. Shadegg.

Not everybody truly enjoys throwing kids from life rafts, but if that's the kind of world in which you want to live, John Shadegg's your guy.

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