Questions for Congressman Ryan
Monday, July 13 2009
Putting Patients First doesn’t happen until Friday, but already I’m thinking about questions I could ask. The problem is, I’ll have way more questions than time to ask them – so I thought I might as well ask the questions here, first.
I plan to do this again each day until Friday – one for the policy expert, one for the first panel, and another for the second panel. But today, I want to ask Congressman Paul Ryan some questions about the Patient Choice Act,the Republican version of health care reform.
(1) In my experience, high premiums and pre-existing condition exclusions are just some of the many ways insurance companies scare off sick customers. In fact, we now know the industry as a whole has developed a range of tricks and tactics to avoid paying for the sickest patients. Can you explain how your bill puts a stop to those practices, other than the promise of competition?
(2) Your bill includes three possible mechanisms for states to limit exorbitant premiums (ie. on those with pre-existing conditions; Sec. 202.d2), including (1) independent risk adjustment, (2) high-risk pools, and (3) reinsurance. Of course, several states already operate high-risk pools, with varying degrees of success. For the mechanisms you propose, can you offer an lessons from the successes and failures of actual implementation in states or other markets? Why is this best left to states, if they have already tried these practices without much success?
(3) Most health insurance analysts have concluded that if health insurance is available to everyone – healthy or sick – then everyone has to buy in for the market to work. If healthy people bail, the remaining sick people will see their premiums go up, leading to more bailing, leading to the collapse of the market – in econo-jargon, this the problem of “adverse selection”. Even the insurance industry supports a mandate, in part because of the threat of adverse selection. Your bill has no such requirement, but it does guarantee access to anyone who wants insurance. How does it prevent a collapse of the insurance market?
I don’t expect Congressman Ryan to answer the questions here, so anyone else is welcome to take a shot in the comments section.
