GUEST OPINION: Barrasso, Enzi health insurance ‘solutions’ are weak

By on March 25, 2015
PHOTO CUTLINE: Sen. John Barrasso

Sen. John Barrasso

Jackson Hole, Wyoming – A news release from Wyoming’s two U.S. senators announced they were co-sponsoring a bill “to allow consumers more healthcare choices and freedom” – something much better than the despised Obamacare. But their bill seems to offer little to the 21,000 Wyoming residents who have health insurance plans purchased on the federal exchange, and who could lose the subsidies that make that insurance affordable.

The bill is the Health Care Choice Act of 2015, written by U.S. Sen. Ted Cruz, R-Texas. It doesn’t have a bill number or information about co-sponsors, but the news release says they include Sens. John Barrasso and Mike Enzi of Wyoming, Mike Crapo of Indiana, Marco Rubio of Florida and David Vitter of Louisiana. But the proposed legislation is not new; Rep. Marsha Blackburn of Tennessee introduced the same bill in the U.S. House in January 2011.

As of last May, Wyoming residents were paying an average of $113 per month for individual insurance plans purchased on the federally facilitated exchange. That price tag is a 79 percent savings from the $536 average premium before subsidies, which is the highest in the nation. The King v. Burwell case being decided by the U.S. Supreme Court could remove premium subsidies from Wyoming and 35 other states on the federally facilitated exchange. That decision would sink the Affordable Care Act and consumer-friendly requirements that include affordability, guaranteed issue, minimum insurance coverage and provider network adequacy. Premiums would be unaffordable and only the sickest people would seek insurance. It would devastate the insurance industry, which relies on broad sharing of risk.

Risk pools must include healthy people who pay premiums but don’t file claims. Pooled risk is why insurance companies can pay for a $40,000 knee replacement or a $500,000 cancer treatment.

Congress could respond to a ruling in favor of King with corrective legislation to ensure subsidies in federally facilitated exchange states. However, most people consider that unlikely. Instead, Republican lawmakers are refreshing legislation to repeal and replace the Affordable Care Act.

Barrasso has put his name on the Health Care Choice Act, but he continues to entertain ideas to protect Americans he says have been harmed by the Obama administration. He co-authored an opinion piece, “We Have a Plan for Fixing Healthcare,” in the Washington Post on March 1 with Sens. Orrin Hatch of Utah and Lamar Alexander of Tennessee. The piece lacks specifics about the plan, but it makes reference to temporary financial assistance, creation of “competitive health insurance markets” by individual states and other ideas from their colleagues. Those ideas are still at the 50,000-foot level and not pinned down to legislative language and details.

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Sen. Mike Enzi

We can, however, take a closer look at the Health Care Choice Act of 2015. It seems to offer little to people in Wyoming. The two features highlighted in the news release are repeal of the insurance mandate in the Affordable Care Act and allowing insurance policies approved and sold in one state to be sold in another state and still comply with the state’s basic requirement.

The belief that interstate sales of insurance will result in availability of better and cheaper plans is touted periodically in Wyoming, but the National Association of Insurance Commissioners published a report correcting that “myth.” Interstate health insurance sales would “make insurance less available, make insurers less accountable and prevent regulators from assisting consumers in their states,” NAIC writes.

The bill includes no definition of “insurance,” which is held to high standards of quality and coverage in the Affordable Care Act, prompting insurance companies to drop the minimal plans that provided little or no benefits. They are likely to return.

There are no subsidies or mandates. The bill does not help the estimated 8 million people who will be unable to afford insurance if the Supreme Court rules against the subsidies, nor does it impose requirements on insurers to provide coverage. In fact, it seems to just roll back the Affordable Care Act without addressing the problems that created the most expensive health care system in the world with mediocre health outcomes among industrial nations.

Cruz issued a statement about his Health Care Choice Act of 2015: “The administration has done absolutely nothing to prepare for an upcoming Supreme Court decision that could leave millions of Americans unable to afford insurance thanks to this failed law.”

There’s not much in this bill, either, aside from cutting states loose to fend for themselves. What’s the Wyoming Legislature going to do with that?

Whatever the Supreme Court does with King v. Burwell, I look forward to seeing more of the ideas to “fix” healthcare from Barrasso and other federal lawmakers take concrete shape in legislation.

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