By: Troy Singleton
With Congress moving full-steam ahead with the dubious "repeal and replace" strategy for the Affordable Care Act, voters would be wise to remember that many times when something seems too good to be true, it usually is.
For those who are insured under the ACA, and even sympathetic voters who aren't, the right to affordable health care should be a clarion call to pay attention to the details and let your congressional representatives know that you don't want Congress dismantling critical components that have provided millions of the newly insured with peace of mind.
As we saw recently when the House tried to quietly gut its independent ethics office, outcry from the public forced lawmakers to abandon this maneuver. Phone calls and emails work, and when it comes to dismantling the ACA, there are many reasons voters should consider doing the same.
A number of replacement proposals being touted by President Donald Trump and Republicans in Congress might seem appealing in a sound bite, but once you peel back the layers, they are fraught with concerns.
One such idea is to allow health insurance to be sold across state lines. While this regurgitated proposal seems like it would enable consumers to save money by purchasing coverage from another state where the policy may be cheaper, it would leave consumers vulnerable to a host of pitfalls.
A Kaiser Health News report on the five states that already allow this practice found that "not a single insurance company has offered" to sell a policy approved in one of those states to consumers in another.
Why is that? Network adequacy for one is a major concern.
For example, a person who lives in New Jersey and wants to buy a plan sold in Maine is going to have a problem finding health care providers that are in-network in their state because the network was designed for the unique needs of Maine residents, and building a robust network in New Jersey to meet the newfound consumer demand will be quite expensive. So, unless you don't mind taking flights to Portland, your choice of in-network doctors and hospitals under this new multistate plan would be severely limited.
There is also the very real possibility that out-of-state insurance policies could discriminate against women. Prior to the ACA, 37 states permitted gender rating of health plans -- the unethical practice of charging men and women different rates for identical health services. This usually resulted in higher insurance premiums for women, with studies conducted before the enactment of the ACA showing that women in the individual market could pay up to 1.5 times more than men for health insurance, costing women in the United States approximately $1 billion annually.
Additionally, the universally celebrated ACA provision that ensures access to coverage for people with pre-existing conditions could be at risk. Prior to the ACA, New Jersey was one of only five states that required health plans to do so. Allowing insurers to sell across state lines could create a dynamic where everyone but the healthiest may see higher premiums and reduced coverage options. So anyone with a worrisome health history should beware.
Finally, if you have a problem with one of those out-of-state policies ... good luck! If an unscrupulous out-of-state insurance company were to take advantage of you through a potentially discriminatory policy with limited consumer protections, the New Jersey Department of Banking & Insurance would have no jurisdiction to assist you with any problems associated with a policy sold in another state.
Striking the proper balance between cost containment and consumer protection in health insurance is something that should be undertaken carefully. Therefore, I strongly believe that allowing out-of-state health insurers to sell policies here in New Jersey is the wrong prescription to fix the problem of providing affordable health insurance in our state.
Those who feel the same way should take up the call for action and contact their representatives in Congress to tell them to guard against governing by sound bite and take the time to mold a national health care policy that puts consumers first.