Market Reform Issues, Including Public Option

Individual mandate

Should there be a law saying everybody has the responsibility to obtain health insurance?

Yes. After all, when people without insurance get sick, they still get care. That forces doctors and hospitals to shift the costs to the rest of us. And those costs are high: Because the uninsured generally do miss out on primary care, they enter the system sicker.
No. This is America, land of freedom of choice. Plus, since low-income people can't afford insurance, government would have to subsidize their coverage, which just shifts costs another way: to taxpayers. And it would be hard to enforce this mandate: Just ask the IRS how hard it is to track hundreds of millions of people.

Employer mandate

Should employers have to provide health insurance options?

Yes. We should build on the system we have. 60 percent of the public get our insurance through employers, which spreads the responsibility for health care between government, business and individuals. Plus, employers benefit when their employees are healthy.
No. A mandate would be a jobs killer, especially for small businesses. When the cost of hiring employees goes up, fewer employees are hired. And some small employers simply won't be able to stay in business if these costs are forced on them.
Maybe. Employers in some industries may want to continue to offer insurance benefits as a way to attract workers. But in other industries, a mandate would be a handicap to global competitiveness because the cost of health insurance significantly raises the cost of labor.

Guaranteed issue

Should health insurance companies have to accept every individual that wants coverage?

Yes. One reason there are so many uninsured people is that companies can pick and choose who they insure.
Yes, but. Guaranteed issue must be paired with an individual mandate. Otherwise there will be no incentive for people to buy insurance until they get sick. After all, if you could buy auto insurance after the crash, why buy it before? And without healthy people to subsidize the sick, costs would be out of reach.

Community rating

Should everyone pay the same price for the same coverage - in other words, should premium costs be averaged across the community and not be based on personal risk factors?

Yes. You shouldn't have to pay more because of your age, health, or where you live. The very purpose of insurance is to share the risk, and insurance becomes unaffordable if rates soar after you get sick, as you age, or if you move.
No. Costs should be based on a person's actual medical history and situation. Otherwise, young, healthy people have to pay more than they can afford, and people living healthy lifestyles end up subsidizing those who don't.
Strike a balance. Some kinds of personal information should be taken into account, but not others. This is called "modified community rating," where demographic information like age, geographic location and family size are fair game, but health history is not. That way, for example, the young don't subsidize the old; they subsidize unhealthy people in their own age group.

Public Option

Should the government offer a public option plan to compete with private health insurance companies?

Yes, a public option would create competition and force insurance rates down. It also would ensure everyone is able to get coverage.
No, a public option would create an unlevel playing field and would eventually force private plans out of business, which would reduce choice, innovation and access to doctors and hospitals. A public plan supported by taxpayers would have unfair advantages: It could use its size and clout to undercut private players, and could use tax money to absorb losses. As a result, the U.S. would slide into a single-payer, government-run system, limiting consumer options.
The public option's not necessary. If the rules are changed so that insurance companies must accept all comers and must charge the same rates regardless of health, and if there's a choice of plans in a geographic area, then there's no need for a public option.

Risk adjustment

Should payments be adjusted so that health plans, hospitals and doctors get more money for taking care of sicker people?

Yes. Otherwise they may not have enough money to meet their obligations. Also, you don't want to create a disincentive to serve sick people.
No. We may not yet have the data, technology or methods to make these kinds of adjustments fairly.

Reinsurance

Should there be a mechanism to make sure that no health plan is a big loser if the people they insure turn out to need more care than expected?

Yes. It needs to make business sense for insurance companies to take in sick people. The tab for high-cost individuals should be spread evenly.
No. It's not necessary. Risk adjustment is a better way to achieve the same goal.

Gateways/connectors/exchanges

Should there be a virtual shopping center for consumers to compare and choose health options?

Yes. People who don't get insurance coverage at work and aren't eligible for Medicaid need the equivalent of an Orbitz, Expedia or Travelocity so they can compare plan options and prices.
No. It's not necessary. Brokers already provide this important resource for making complicated insurance options.

Standardized plans

Should everybody have the same benefits?

Yes. Everyone should have access to the same basic benefits, although they should also have the ability to get more if they want more.
No. Health insurance should not be "one size fits all." People have different needs and should have a choice of different kinds and levels of coverage.

Prevention and wellness

Should health reform have a greater focus on prevention?

Yes. The long-term sustainability of our system depends on coming to grips with preventable disease. Right now, as much as 70 percent of health expenditures are for such preventable conditions as diabetes, heart disease and some cancers.
Yes but. While some studies show that people will respond to incentives and rewards for health behavior change, we need to be careful that efforts to reward positive behavior don't discriminate against people with disabilities.
No. The jury is still out on whether health behaviors can be changed. Paying for prevention doesn't necessarily save money, and people don't want to be told how to live and what to eat.

Health Care Reform: Delivery System Reform Issues

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