McCain says he wants families to make more decisions about their health insurance, availing themselves of the new competition he believes market forces will bring. But Hall is already making his own decisions. There’s nothing in that rhetoric for him. Because of his health problems, he has no choice, and that likely won’t change under McCain’s health reform solutions. Carriers would not be required to insure people with preexisting health conditions, and McCain’s fix for dealing with the so-called uninsurables probably won’t be relevant for Hall.
If McCain is elected, and if some sort of high risk pool for sick people emerges, Hall probably wouldn’t even be eligible, since he already has insurance. In sum, McCain’s proposal won’t do much for Hall. McCain’s approach to reform would let insurers like Arkansas Blue Cross Blue Shield conduct business as usual. Carriers could continue to use exclusions on policies, effectively de-insuring people, or charge them higher prices, effectively putting the policies out of reach for many. That would be especially true in the “individual” market, where self-employed people like Glenn Hall must turn to buy their coverage.
How Hall would do under Barack Obama’s proposals
It’s hard to say exactly what Obama’s plan would do for Hall, either. In his early speeches, Obama talked of regulating insurance companies, and one of those regs would affect whether insurers could exclude sick people from coverage. Companies would have to cover people like Hall with multiple pre-existing conditions. But would they actually cover those people, or would there be strings attached? Will insurance carriers, whose bottom lines depend on shielding themselves from expensive claims, really cede their ability to pick and choose the people they want to insure? That is the sine qua non of American insurance.
When health reform was debated last year in California, some insurers said they were willing to take everyone, even those in bad health. But they insisted on conditions, such as limiting someone’s ability to switch to more comprehensive plans. They also said that all citizens—sick and well—would have to be in the so-called risk pool; that is, everyone would have to be covered in order for companies to gamble on those in poor health. Covering everybody with a mandate means that the losses from sick people would be offset by the new profits from those who are well. Such a mandate doesn’t square with Obama’s statements that only children would be required to have health insurance.
Since he already has coverage, it’s also unclear whether Hall would be eligible for Obama’s proposed public plan option, which would ostensibly be cheaper and more inclusive than the private alternatives. He certainly wouldn’t be eligible for subsidies. The extent to which he would be helped by Obama’s still-vague proposal will be determined by how the preexisting conditions issue plays out. For the time being, people like Hall should hang on to any coverage they’ve got, and not count on much help from Obama.