I had a brief debate via Twitter (I guess it is impossible to have anything but a brief debate on Twitter) with a staffer for the Pennsylvania House Democrats over health care policy. At the source of contention was HB 1(see a previous critique of this bill) - he claims it proves that Democrats care more because it "will help the uninsured". I suggested our proposals for health care reform - specifically allowing individuals and families to shop across state lines for insured - would help both the uninsured and insured.
His rebuttal was that a) HB 1 would help the uninsured, and the insured by lowering the "cost of the uninsured" and b) Buying across state lines, or other reforms to lower the cost of insurance or of health care, wouldn't help. Here are some reasons he is wrong:
- Like previous versions, HB 1 would only serve a fraction of the uninsured, for hundreds of millions of dollars passed on to taxpayers.
- HB 1 is similar in many regards previous failures like RomneyCare in Massachusetts - where a large number remain uninsured, program costs have skyrocketed, and insurance premiums have continued to escalate - or Dirigo in Maine - which has not reduced the uninsured or the cost of insurance, but has resulted in a tax on those with coverage.
- HB 1 doesn't address the root cause of why people are uninsured.
- HB 1 would expand the AdultBasic program, which is basically an extension of Medicaid. Yet cost-shifting from Medicaid far exceeds the "cost of the uninsured" and drives up private insurance rates. Worse yet, Medicaid is a very poor quality provider of medical care - in fact, Medicaid recipients do worse than the uninsured.
- One estimate suggests interstate competition would reduce the number of uninsured for 25% to 33% for no cost.
- We have called for an overhaul of the Pennsylvania's Medicaid system, similar to the reforms of Florida, that would help recipients by private insurance. This would improve quality, save costs to taxpayers, and reduce the cost of private insurance by eliminating cost shifting. I'm not sure where the House Democrats (or Republicans for that matter) are on this issue, if they've even thought about it.
- State mandates drive up cost of coverage; Pennsylvania had 38 mandates at last count, but enacted a few more since then. A recent study finds that each mandate results in about a 0.25% increase in the number of uninsured - which would account for a large chunk of Pennsylvania's uninsured population.
- State laws drive up cost of prescription drugs, requiring higher prices than places like Wal-Mart would otherwise charge. Patients with insurance might be ok with this, if their coverage includes prescription drugs. For the uninsured, it means more money out of their pocket.