Here’s a wake-up call for all of us who need health care services.
Washington state is on a collision course with socialized medicine and you,
the consumer, may become the victim!
One by one, private insurers have been forced out of the individual
marketplace. They have been unable to sustain heavy losses, which are
primarily the result of excessive government regulations and heavy-handed
decisions by Insurance Commissioner Deborah Senn.
The collapse of the individual insurance market
is creating a domino effect in the entire health
insurance market. Rates are increasing at an alarming rate
and becoming unaffordable for most. Individual
policyholders have been experiencing rate increases in the
30 to 60 percent range each year. Many people,
including children, senior citizens and individuals, are now being shifted to
government health care programs because they have no other choices.
It’s a harsh disaster in the making. Without private insurance
carriers, citizens lose on all fronts: choice of providers, services, treatments
and medicine. Government-run health care means escalating costs, lower
quality medical care and, finally, rationing.
Washington state first made this mistake when the
Democrat-controlled legislature passed the 1993 Health Services Act, which put a
government commission in charge of your health care. Although the 1995
legislature repealed this act, it maintained a provision implemented by
Commissioner Senn that is largely responsible for the collapse of the individual
market – the 90-day pre-existing conditions limitation. This limitation
mandates that insurers cover pre-existing conditions after only three months,
the shortest term in the nation.
This short waiting period provides no incentive for people to remain
insured. Many individual enrollees often carry insurance only when
they need it, and drop off as soon as insurers pay the bill. This unfairly
increases the premium rates for those enrollees and their families who
responsibly remain insured. Even with significant rate increases, carriers have been
unable to absorb the losses in this market. As a result, insurance carriers
– the latest being Group Health and Regence Blue Shield – have
dropped out of the individual market. There are only seven counties – out of 39 –
in Washington state where individual insurance is still available.
What’s the alternative for individuals and families in the remaining
32 counties? Government-dictated health care.
The state’s unsubsidized Basic Health Plan (BHP) is one option,
temporarily. But it is expensive. This year, BHP rates increased 65 percent,
and new enrollees will no longer be accepted after Jan. 1. For those who
are able to remain on the program, their rates will increase an additional
20 percent next year – unaffordable for the average family wage earner or
The second option shifts people to government-directed health
care through the state’s high-risk pool. This pool was originally created as a
last resort for people with serious medical problems who could not
otherwise purchase an individual policy. Rather than reducing regulations that
would provide more private insurance options, Commissioner Senn opened
this government-run pool in May to people in counties where individual
insurance is no longer available. Premiums are 150 percent of the small group rate
– in some cases as high as $660 per month.
Commissioner Senn is also expected to begin offering the
high-risk pool to more than 676,000 seniors on Medicare, with promises of a rich
benefit package. It’s tempting, especially for many of the 12,000 seniors in
rural Washington who have been told by Group Health and Pacificare
their Medicare-managed care plans will be closing Jan. 1.
At best, this offer is a leaky lifeboat, and it will not be
sustainable without extremely heavy government subsidy. Last year, with only
810 people enrolled, the pool lost $6 million. If only 200,000 seniors
enrolled, losses might easily exceed $1 billion in liability to the state. When
losses become too great, vulnerable seniors who were lured by political
promises of better benefits may be forced to pay much higher premiums or leave
the pool. At the very least, they can expect the rich benefits to be
sharply curtailed, leaving them paying much more for less.
Opening the high-risk pool may also result in group coverage
rates soaring sharply upward. Typically, premiums fall short of covering
costs in the high-risk pool, so insurance carriers are assessed fees for the
balance. Those fees are passed on through rates employers must pay for
employee coverage. As more people enter the high-risk pool, employers will
be forced to pay higher rates or drop coverage. It’s an unnecessary, but
premeditated disaster in the making with unconscionable social consequences.
What’s left when the individual and group markets collapse from
the strain? Government-sponsored socialized medicine.
It’s ironic that the commissioner who has used HMOs as a
whipping post is herself proposing a government-run HMO model as the
lifeboat. With government at the helm, we get the efficiency of faceless
bureaucrats, the compassion of the IRS, and the foresight of government
transportation planning. If we do nothing to stop
this crisis, it will be government – not your doctor and you – deciding what
surgery you need, what medicines you can take, and how much you will pay.
We can do better. We need policies that allow private companies
to compete and provide insurance that meets people’s varying needs at
prices they can afford. We need policies that restore choice to the marketplace,
and keep you and your doctor in control of your medical care.
The first place to begin is by extending the pre-existing condition
law to conform with the federal standards of 12 months. This will create an
incentive for people to maintain their insurance coverage, and it will
restore stability in the insurance pool. It will attract health care carriers back
into the individual insurance market, and in turn, relieve the state’s high-risk
insurance pool which is driving up rates.
The wake-up call is now. We cannot sleep through this
politically manufactured crisis and allow government to take over our health care
system. Government-run socialized medicine will never be able to
provide high-quality, personalized care at affordable rates. Will you trust
your family’s health care future to government bureaucrats? It’s time to
demand better choices from your legislators.
Rep. Cheryl Pflug, R-Maple Valley, serves the 5th
District and is vice-chair of the House Health Care Committee. She is also a
registered nurse with experience in family practice, critical care,
medical-surgical, operating room and school nursing. If you have comments about
this editorial, you may contact Rep. Pflug at (800) 562-6000.