Robb: 101 ensures right to buy health care
by Robert Robb on Oct. 22, 2008, under Elections, Opinion
A mandate to purchase health insurance can be seen as a self-responsibility requirement and an anti-free rider protection.
Proposition 101 stands for a simple and commendable principle: People should have the right to use their own money to purchase the health care they want.
How the proposition would affect Arizona’s health care system now and in the future isn’t quite so simple.
The proposition is intended to preclude the imposition of a government health care plan that would mandate that everyone participate and forbid the purchase of health care outside the plan.
It is also intended to preclude government mandates that individuals purchase health insurance or that employers provide health insurance or pay a fine.
These are not idle concerns. In 2006, Massachusetts passed a plan with both individual and employer mandates. Vermont adopted an employer mandate that same year.
New Jersey has adopted a requirement that all children be insured. California is considering a Massachusetts-styled proposal.
In Arizona, House Democratic Leader Phil Lopes has been touting a proposal in which a government commission would establish a standard benefit plan for the state and set reimbursement rates for health care facilities and practitioners. Private insurance would be forbidden for services covered by the government plan.
The opposition to Prop. 101 is claiming that it could dramatically increase costs for the state’s Medicaid plan, which is based on restricting choices regarding health care providers.
That’s nonsense. Proposition 101 confers a constitutional right on individuals to purchase health care services and coverage directly. It confers no rights on individuals with respect to health care purchased for them by others, either the government or employers.
If individuals decide to enroll in the state’s Medicaid plan, they have to abide by the rules of that plan. Proposition 101 doesn’t change that at all.
In reality, opponents of Proposition 101 want to preserve the option of mandated participation and a governmental system without opt outs.
If there is to be universal access, the health care of those sick, particularly those with chronic illnesses, has to be subsidized.
Universal access could be easily provided simply by allowing anyone to buy into the state’s Medicaid pool. In that way, however, the subsidy would be reasonably transparent and borne by taxes.
Many universal access advocates prefer to hide the subsidy through the premium mechanism. By mandating that individuals purchase insurance, particularly in a governmental system without opt outs, the young and healthy are subsidizing the chronically sick without knowing it.
An employer play-or-pay requirement also hides the cost of the government social welfare policy.
Universal access is a laudable policy. But the necessary subsidy should be provided transparently through the tax mechanism, not hidden through the premium mechanism or employer mandates.
To the extent Proposition 101 precludes more opaque options, it forces reform discussion in the right direction.
However, the claim by supporters that Proposition 101 is purely preventative is probably not true. Proposition 101 would also probably make fairly sweeping changes in the existing private health insurance market.
Arizona, like many states, imposes a variety of mandates on private health insurance plans. These mandates include various medical conditions, such as autism, and various health care procedures, such as breast reconstruction in cancer cases.
There also are mandates that various health care professionals, such as chiropractors, be covered if the medical condition being treated falls within their scope of practice.
Proposition 101 says that no law can be passed that restricts an individual’s freedom of choice regarding “private plans of any type.” That presumably would include plans free of the mandates the state currently imposes.
Now, I happened to think that this is a good thing. Government shouldn’t be dictating the terms of insurance contracts. And these mandates are widely thought to drive up the cost of health insurance. People should have the right to purchase stripped-down insurance policies if they want.
But it does mean that the impact of Proposition 101 is probably far broader than proponents are admitting.
I certainly agree with Proposition 101′s goals of protecting the right of individuals to purchase health care services directly and to preclude employer play-or-pay provisions.
I’m more ambivalent about precluding a government mandate that people purchase health insurance. After all, if people get sick, they get taken care off. And if they don’t have insurance, often the rest of us are stuck with the bill one way or another.
A mandate to purchase health insurance can be seen as a self-responsibility requirement and an anti-free rider protection.
In the final analysis, however, it’s better to have the right to purchase health care independent of government constitutionally protected than not.
Robert Robb, an Arizona Republic columnist, writes about public policy and politics in Arizona. E-mail: robert.robb@arizonarepublic.com
