John McCain and The Politics of The Uninsured

John McCain spoke about health care in Tampa on Tuesday and tried to
answer many of the questions that have been raised about his health
care reform plan.

The most pressing question is how would people with preexisting
conditions get health care coverage in his plan? The worry is that his
plan emphasizes tax incentives for consumers to purchase coverage in
the individual health insurance market that relies so heavily on
upfront medical underwriting.

Here is how his website explained his answer to that question:

McCain Will Work With States To Establish A Guaranteed Access Plan. As
President, John McCain will work with governors to develop a best
practice model that states can follow – a Guaranteed Access Plan or GAP
– that would reflect the best experience of the states to ensure these
patients have access to health coverage. One approach would establish a
nonprofit corporation that would contract with insurers to cover
patients who have been denied insurance and could join with other state
plans to enlarge pools and lower overhead costs. There would be
reasonable limits on premiums, and assistance would be available for
Americans below a certain income level.

I am frankly amazed he offered this as a "solution."

First, he is simply shunting the problem off to the states.

Second, he implies that one or more states have figured out what to do
with people who can’t get health insurance because of preexisting
conditions. Just which state is that? I don’t know of a single state
that has been able to provide widely available access to health
insurance for people who cannot get it.

Third, just who would finance this pool? States have tried so called
high risk pools before. Time and again they are swamped by people
trying to get in and there is never enough money. Since they have never
worked before, how would they work this time?

At the risk of taking sides here, what I find most frustrating is that I think this problem is solvable for McCain.

As consumers left an existing employer or individual plan for any
reason they could be guaranteed access into their new individual plan
within a certain time limit–just as we have "creditable coverage"
provisions today under HIPAA when people move between employer plans.

For those who are not insured today and want to purchase an individual
policy in the new McCain health plan, I think he can guarantee access
by telling people that his plan would be "guarantee issue" at a first
open enrollment. The high cost people could then be carved out by the
insurers and put into a risk pool that was reinsured across all market
players. This would be a structure that consumers would never see–it
would only be a behind the scenes risk transfer system between insurers.

There are a number of different mechanisms for the insurers to identify
and pool these "high risks" and spread their cost across the entire
individual market. The program would also be self-financing because the
high risk costs would be spread across the entire pool.

With this structure, Senator McCain could simply look everyone in the
eye and say his plan will guarantee access to everyone–even those with
a pre-existing condition.

But he didn’t propose anything like this. McCain simply took one of the
biggest problems his plan has–and one of the most legitimate
criticisms Democrats can levy against his plan–and said there really
isn’t a problem. From his own website:

      MYTH: Some Claim That Under John McCain’s Plan, Those With Pre-Existing Conditions Would Be Denied Insurance.

        * FACT: John McCain Supported The Health Insurance Portability
And Accountability Act In 1996 That Took The Important Step Of
Providing Some Protection Against Exclusion Of Pre-Existing Conditions.

        * FACT: Nothing In John McCain’s Plan Changes The Fact That If
You Are Employed And Insured You Will Build Protection Against The Cost
Of Any Pre-Existing Condition.

        * FACT: As President, John McCain Would Work With Governors To
Find The Solutions Necessary To Ensure Those With Pre-Existing
Conditions Are Able To Easily Access Care.

So people would not be denied insurance just as soon as he and the governors find a solution?

Senator, health care plans are supposed to be about your telling us how you are going to do it before you are elected.

McCain also vaguely talked about premium assistance for those who
cannot afford coverage even after his $2,500 individual/$5,000 family
tax credit but he also gave no details on how much would be available
and who would pay for it. I would suggest he means test his tax credit
just has he recently proposed doing for seniors in the Medicare Part D
program and use that money to help subsidize low income folks. In his
own terms, why is he giving a tax credit to Bill Gates and Warren
Buffet when there are people who legitimately can’t afford health
insurance coverage?

Senator McCain, you had better get your health care act together before
the Dems make their choice. At this rate, they’re going to cut you to
ribbons on this issue.

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7 replies »

  1. I could not agree with Mr Laszewski more. I’ve enjoyed his critiques of the presidential candidates’ health plans. Basiclly none of them will work and as in most aspects of medicine, several have the abilty to do more harm than good. But then the plans aren’t written to solve the problem but to get their canididate elected and are addressed to each one’s core constituency. The discussion on the direction this country should go in providing healthcare to all its citizens long ago took leave of reality. Can anyone tell theses candidates what the capacity of the current health care industry is to provide care? They can’t even come to an agreement on what the mission is, let alone how to get there. Yor right Mr L. The Democrats will wip Mr McCain to death with his present plan and the Republicans will wip right back. Both will be half right and half wrong. There will be nothing left for the voters but fear for their and their families health care. Some choice, and I’m a McCain supporter.

  2. Medical tourism is getting much more expensive because our great politicians have inspired such confidence in the U.S. dollar that it’s getting to look like Zimbabwe
    currency. If we’re not careful we’ll get to their inflation rate too. Isn’t it nice to know we have competent leaders looking after the store.

  3. “Medical tourism” is probably my favorite example of doublespeak right now in healthcare. What a marketing term. More like “Last Resort Sightseeing” or “Desperate Traveling.”

  4. Perhaps Mr. McCain needs to also look into the medical tourism industry to solve a portion of the problem.

  5. Perhaps Mr. McCain needs to also look into the medical tourism industry to solve a portion of the problem.

  6. Why is the pre-existing condition group not wanted by anyone – because we are trying to solve healthcare with an insurance mindset. In universal, single-pay, government run countries a pre-exisitng condition is NOT an issue, either for coverage or funding. Congress just passed legislation to prohibit denial of health insurance because of genetic factors – isn’t that a pre-existing condition? Why don’t we just include them in that great equalizer – community rating. I think because people don’t want to taint their “community rating” and pay more. Let someone else look after them.

  7. People need to hammer McCain on this point. It is just a flat out lie to say that state high-risk pools have worked. According to just about any metric (cost or access), state high-risk pools have repeatedly failed. This is not political spin, it is reality.