Tuesday, December 21, 2010

America’s Health Insurance Plans spokesperson comments on pre-existing conditions and the “individual mandate”

The recent decision by a Federal judge in Virginia declaring the “individual mandate” provision of the new health reform act unconstitutional makes it more likely that the question of that law’s constitutionality will ultimately be decided by the U.S. Supreme Court.

While waiting for this development to unfold, Etopia News contacted the industry group America’s Health Insurance Plans (AHIP) and asked them about the insurability of persons with pre-existing conditions if the individual mandate were finally declared unconstitutional.

Robert Zirkelbach, their press secretary, promptly replied, providing a link to, and summary of, some background information on the subject, along with a statement, to be attributed to him, from the AHIP on this subject.

The background report, from Milliman, Inc., can be accessed here. Here’s the report’s summary:

“Guarantee issue requires insurers to sell an individual health insurance policy without regard to a person’s health. Community rating requires that all consumers pay the same or similar premiums without regard to age, gender or health status. According to the report, these initiatives have the potential to cause individuals to wait until they have health problems to buy insurance. This could cause premiums to increase for all policyholders, increasing the likelihood that lower-risk individuals leave the market, which could lead to further rate increases. If this continues, the pool or market could essentially collapse or shrink to include only the high-risk population.”

Here’s what Mr. Zirkelbach said, on behalf of AHIP:

“Throughout the health care reform debate there was broad agreement that enacting guarantee issue and community rating would cause significant disruption and skyrocketing costs unless all Americans have coverage. States that have implemented these laws without covering everyone have seen a rise in insurance premiums, a reduction of individual insurance enrollment and no significant decrease in the number of uninsured.”

We’ll need to wait for a while for a final resolution of the constitutionality of the individual mandate, but it appears clear already that if it is determined to be in violation of the Constitution, there will be some serious problems for the overall viability of the health care reform law and its implementation.

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