Healthcare wake-up call

Guest Column

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legislature repealed this act, it maintained a provision implemented by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.