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Streamlined medical plans are better than none

Rocky Mountain News

Published February 20, 2009 at 12:05 a.m.

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Sweeping changes in health-care delivery by the federal government would not be cheap, so they have apparently been shelved for now, due to the recession.

But the economic slump should not preclude incremental improvements at the state level, as exemplified by House Bill 1143.

The measure, by Rep. Spencer Swalm, R-Centennial, would allow health-maintenance organizations to market limited-benefit plans to Coloradans who don't have insurance and earn too much money to qualify for Medicaid. The measure passed the House earlier this month by a 40-25 vote and is now in the Senate. It deserves to become law.

The legislature would let HMOs cap the amount of benefits they provide in these low-cost, employer-provided plans - annual limits ranging between $30,000 and $100,000 are the amounts often discussed. They would cover doctors' visits, prescription drugs and most routine care, including cancer screenings and other basic diagnostic tests.

Because the plans would not pay for catastrophic illnesses, Swalm estimates the premiums could run between 20 percent and 35 percent lower than what HMOs typically charge.

Residents in areas with large numbers of lower-income working families stand to gain a lot. Their employers typically don't offer medical coverage, or they do and workers still can't afford the premiums. Indeed, Swalm told us that officials at San Luis Valley HMO say some 12,000 residents of the San Luis Valley alone who aren't on public assistance could qualify for low-cost plans under this bill.

Much of the opposition comes from advocates of a full government takeover of health care through a single-payer mechanism. They argue that any reforms falling short of comprehensive, universal coverage are inadequate.

More to the point, they say capping benefits would not help people who suffer major, debilitating medical conditions.

But these folks can't afford to buy insurance now anyway, and aren't likely to get medical coverage until Washington agrees on significant changes in health policy (whether it's a single-payer plan or some other mandate). Ongoing medical costs can now drive these families into poverty, forcing them to enroll in Medicaid.

The goal should not be to encourage the collapse of private health care, or push more families into destitution, but to make medical coverage affordable for many more working Coloradans. Parents should be able to make sure their kids get regular checkups. Out-of-pocket costs should not prevent families from purchasing prescription drugs when they're needed.

HB 1143 isn't a panacea for the health-care system's ills. But it was never intended to be. And if it can bring the cost of medical coverage within the reach of a lot more Coloradans who can't now afford it, then this minor fix could provide major benefits.

Comments

  • February 20, 2009

    7:48 a.m.

    Suggest removal

    DougH writes:

    This idea sounds like a wonderful way to help the folks in San Luis Valley. But here is what will happen:
    Many companies, especially struggling small businesses will us t his plan to reduce their employer paid insurance costs by the 25 to 30% figure.
    Then as soon as this is announced, companies like Colonial and others will come in and offer catastrophic health coverage that the employee can purchase themselves, out of their own pocket. Of course, providing they do not have some preexisting condition or life style variance that would raise their risk.
    So, while this sounds like a good idea on the outside, it is just a cost shifting device to a move a large part of the cost of insurance back to the employee.
    As long as everyone understands this, then they should pass the law.

  • February 20, 2009

    9:23 a.m.

    Suggest removal

    mytwosense writes:

    The RMN writes: "More to the point, they say capping benefits would not help people who suffer major, debilitating medical conditions. But these folks can't afford to buy insurance now anyway, and aren't likely to get medical coverage until Washington agrees on significant changes in health policy (whether it's a single-payer plan or some other mandate). Ongoing medical costs can now drive these families into poverty, forcing them to enroll in Medicaid."

    I don't see how these kinds of plans would prevent the above scenario, either. I imagine the kind of medical costs that drive families into poverty are associated with just the kinds of serious illnesses and accidents these plans don't cover.

    Also, I thought lower-priced catastrophic insurance, associated with HSA accounts, was supposed to solve the solution of families going broke when a serious accident or illness occurs. Apparently, San Luis families can't afford them, based on this article's inference they're not able to pay for insurance. If they can't afford those plans, how will they afford these?

    That being said, I don't have any real opposition to the creation of these plans. I just don't think they should be touted as a specific solution that they clearly are not. In this case, the RMN is inferring they can prevent families from getting overwhelmed by medical costs to the point they're driven into poverty. It's not those sorts of costs this particular plan will even pay for.