You call for letting consumers buy insurance across state lines. Presumably that means if shoppers in Ohio don’t like the insurance selection in the Buckeye state and wanted to see what Indiana had to offer, they could ring up a carrier in Indianapolis and ask for a quote. The idea is they would shop for the lowest price and somehow the magic of the marketplace would make insurance cost less. Here, it seems important to remind you that it’s the doctors and hospitals that ultimately set the price of care, not the insurance companies.

Also, crossing state lines seems to open a regulatory free-for-all, and throws into question the role of the states in protecting healthcare consumers. Meanwhile, we have seen a great deal of consolidation in hospital systems, giving them market power to dictate price. It’s fair to note that big concentrations of economic power don’t necessarily mean lower costs. In fact, it could mean just the opposite, as The National Journal has shown.

One last point about states crafting their own plans: Your website advises that you want to “ensure flexibility to help the chronically ill,” and that effort includes high-risk pools for people with preexisting conditions. This is not a new idea. For several decades, states have offered high-risk pools for people who were uninsurable in the private insurance market—you know, the ones that Obamacare targeted for help. By any measure, they haven’t worked. Premiums are too high for most people, coverage too skimpy, and waiting periods before coverage kicks in too long.

In fact, when Congress passed Obamacare, it stuck a provision in the law that gave the states extra money to set up a sort of super high-risk pool to help people until 2014, when insurers are required to take all comers—s sort of a stopgap measure. These pools have not been successful either, and you don’t hear even the president talk about them on the stump. Federal officials estimated that 375,000 people would enroll by the end of 2010. But as of September of this year, less than 78,000 have. This effort, too, was plagued by the same deficiencies—high cost, for example. Yet you seem to say this “solution” is still a viable one.

So there you have it—even at this point in a long campaign, lots of questions and few answers about what you will do to replace Obamacare.

Related Stories:
Laurel to The National Journal: What we’er learning about hospitals

The Lowdown on High-Risk Pools

Climbing Medicaid Mountain




If you'd like to help CJR and win a chance at one of 10 free print subscriptions, take a brief survey for us here.

 

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.