As part of a very good (defined as substantive, open-minded, and comprehensive) discussion on health care reform options going on at TPMCafe, Jonathan Cohn notes:
“a lot of these people don’t understand how precarious their current situation is – because they don’t realize how easily they could lose coverage or the extent to which their insurance might not cover their bills.(emphasis is mine) (Indeed, that’s the whole point of my book.) But for now, anyway, that’s what they think. And if you start telling them you’re going to change their health insurance – even for an alternative as well-liked as Medicare – a lot of them will get skittish.”
That’s true. But at some point, enough of “those people” who lose coverage or go broke paying bills will decide to do something about it. And that “something” doesn’t have to be national; I’m of the opinion that there will be real reform in more than one state years before we do something nationally.
But which ones, and why them?
Massachusetts, Vermont, and Maine (let’s hear it for New England!) have already passed enabling legislation. California’s making a lot of progress, and recent reports indicate New Jersey might be next.
What’s interesting is that the New England states have a lower percentage of people without insurance (12.3%) than states such as Texas (24.6%) and Florida (18.5%) where there appears to be little momentum towards health care reform.
Why? I dunno. Perhaps its something cultural, maybe it has something to do with the Town Meeting form of government up here and/or greater involvement in government and elections. It could be that there is higher per-capita income, and therefore more disposable dollars available for health care.
While it is clear that there are factors that are pushing health care reform to the top of the agenda, it is also clear that different populations have different motivating factors. Politically, those factors will result in higher or lower levels of interest and motivation amongst Congresspeople and Senators.
And that’s what will ultimately determine when national health care reform comes to pass.
The most vulnerable segment of the uninsured, in my opinion, are the seven million early retirees in the 50-64 age group who are not yet eligible for Medicare. If they already have health problems, they either can’t buy insurance at any price or only at a prohibitively expensive price. It will be interesting to see how Aetna prices its AARP branded offering to this age group starting next year and how much more lenient its underwriting standards are compared to other insurers.
For younger people, they may well be able to easily pass an underwriting screen but still can’t afford coverage because they earn a low income. Or, they are young and healthy and believe they won’t need much healthcare. They think health insurance is a poor value and don’t buy it for that reason.
Massachusetts, for its part, has the advantages of a much lower than average rate of uninsured (about 8%) and much higher than average incomes among its workforce. Even so, they are finding that there are still a sizeable number of people who can’t afford coverage yet don’t qualify for subsidies. The Chief Medical Director of a large insurer told me recently that he thought Massachusetts might be able to drive its percentage of uninsured down to about 4% at best and will declare victory at that point (if it gets there).