No Harry and Louise This Time

Les Masterson, for HealthLeaders Media, December 10, 2008

When most Americans think about the healthcare reform debate of the mid-1990s, they picture two "ordinary" people at the kitchen table.

Forever known as Harry and Louise, the dynamic duo killed President Bill Clinton's dreams of healthcare reform and are now in the pantheon of political advertisements alongside LBJ's daisy girl and George H.W. Bush's Willie Horton ad against Michael Dukakis.

Harry and Louise returned to TV briefly this summer in an ad that promoted making healthcare a top priority, but thankfully, as we gear up for another healthcare reform battle in 2009, the couple is not headed back to the dinner table. They have been replaced with stakeholders actually working together to come up with potential solutions to the country's healthcare problems.

America's Health Insurance Plans (AHIP) last week joined a growing list of stakeholders by presenting a plan to fix the system. In their proposal, health insurance plans said they are willing to accept all customers regardless of illness or disability, but they want something in return—a mandate that requires all Americans to have health insurance.

In a four-point plan, AHIP said its proposal would control costs, help consumers and purchasers, achieve universal coverage, and add value to healthcare.

AHIP's proposal includes the major piece of the Massachusetts reform: the individual mandate. Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, told me recently that the individual mandate was the most important part of the Bay State's initiative. Without requiring the young and healthy to get insurance (and pay into the system), insurers would not have the money necessary to pay for the sickest.

Unlike Massachusetts, however, AHIP includes a proposal to limit healthcare cost increases and a public-private advisory group to provide specific policy recommendations. There is also a plea for universal quality, reporting, and information technology standards, as well as prevention programs.

Most healthcare stakeholders support those ideas, but AHIP's fourth idea is a nonstarter—insurance portability. A new "portable health plan" would allow federal law to trump state minimum coverage standards.

AHIP has been outspoken in its opposition to state mandates that require insurers to offer specific services and coverage. Mandate foes point to services like hair and limb prostheses and requirements to cover non-custodial children and dependent adult students, which they say increase healthcare costs for everyone.

Those who oppose mandates also complain about the confusion raised by myriad mandates, especially for companies operating in multiple states.

AHIP says its portable health plan idea would reduce regulations, satisfy multi-state businesses, and cut costs because of fewer mandates—but it's not going to happen. Barack Obama will soon enter the White House, and the Democrats control Congress and will be nearly filibuster-proof in the Senate. This means portable health plans are DOA. There is no way the Democrats are going to implement a national program that limits state coverage requirements. Heavily-mandated states and Democrats will defeat a federal program that supersedes more expansive state regulations and removes service and coverage guarantees.

AHIP's proposal received sharp rebuttals from groups that support a single-payer system like Health Care For America Now and the California Nurses Association. Despite that criticism, AHIP's proposal is a step forward from the healthcare debate of the 1990s.

Whether major healthcare reforms happen in 2009 is questionable, but at least this time around, healthcare stakeholders are working together—rather than spending millions on advertisements that don't offer solutions.

Les Masterson is senior editor of Health Plan Insider. He can be reached at
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