Understanding Potential Changes to the Health Insurance Industry

There are potential changes to the health insurance industry that will affect all insured. There has been much speculation, both good and misleading, concerning what changes will take place.  It is almost universally agreed that the changes that do go forward will increase the number of individuals with insurance.  This will bring the number of insured up by some nearly 35 million previously uninsured Americans.

Public Option

Much discussion has focused on the attempts of Congress to include a public option.  A public option, as contemplated by the government, will be a program run in the same style as Medicare, which will allow Americans with little or no access to affordable health care to buy into a government run insurance program. 

The Pros of a Public Option

The feeling by some in Congress is that the industry does not want to see a substantive change in the way business is being done because such a change would result in lower profit margins for insurers. A public option will force competition in those areas of the country that has little or no competition. It will also ensure that all Americans can have access to affordable health care, regardless of their health conditions.

Arguments against a Public Option

Those opposed to a public option see it as government intruding on the lives of individuals.  They liken the public option and government run health insurance as socialism and a move to Soviet-style communism.  Although such rhetoric is inflammatory, the underlying fear that a government run program may not be the most efficient and could result in higher costs for some.  There may be some truths in the argument that the government should not be in the business of running heath care, accept for one fact.  The government has been in the business of running a pubic health care program for over 40 years.  These programs are called Medicare and Medicaid.

Pre-Existing Conditions

Another potential change that is being contemplated is the acceptance of all insured, regardless of pre-existing conditions. Changes were made to require the acceptance of individuals with a pre-existing condition into a group plan after 12 months of participation. This change was done through the Health Insurance Portability and Accountability Act of 1997 (HIPAA). HIPAA helped make it easier for individuals to transition from one employer-sponsored group to another with a pre-existing condition. Unfortunately this did not preclude insurers from denying benefits on the individual level for a pre-existing medical condition.

Arguments For and Against Covering Pre-Existing Conditions

The anticipated change to health insurance will allow all persons, regardless of any previous health condition, to participate in an insurance plan without regard to their pre-existing condition. The insurance industry and some in Congress see this as a restraint of trade and will force to increase dramatically to account for the increase risk. Other argue that refusing to cover certain individuals adds to the burden of rising health care costs, which eventually are borne by those that are insured as well as uninsured.

Regardless of what changes are contemplated and being debated, the ultimate change to the health insurance industry in this country should result in a positive impact for all Americans. No one should be allowed to press their nose to the glass of the best health care system in the world and be denied access because of their health.


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