If you watched HBO’s Real Time with Bill Maher on November 12th, you heard Mike Huckabee propose a public option as part of a health reform fix. With “repeal, revise, and replace” stories in the news every day, shouldn’t this be worth at least one national headline?
Governor Huckabee didn’t just flirt with the public option; he married it to his opposition to requiring insurers to cover people with pre-existing conditions.
Defending his position, Huckabee argued “when you buy insurance you’re buying something in the private sector. Now maybe there’s a place to say if you’re really, really sick and you can’t access a traditional marketplace then should we have some form of safety net? Yeah. I’ve said that; I did that when I was Governor.”
He called for “a partnership between government and the private sector” to insure people with pre-existing conditions. So what did Mr. Huckabee propose?
He cited the Arkansas TEFRA program he started for families of children with serious chronic conditions as the model safety net program he would favor for people with serious illnesses. In that program, Arkansas allowed families earning between $25,000 and $200,000 per year the option of buying into the state’s Medicaid program by paying annual premiums of between $504 and $5,500. After the family paid the premium, the state and federal government paid the cost of the care.
If you expand the Medicaid program and use means testing to include people with serious illnesses, this is about as public an option as you can get – even if you pass it off as just a “safety net.”
How Many People Have Serious Chronic Conditions?
I’m one of them. Like 55 million other adults, I suffer from chronic back pain. In the past twenty years, I’ve been to doctors, hospitals, and physical therapists for it, and taken prescriptions and over-the-counter pain medications.
Back pain is inconvenient, but hardly life-threatening. It could be different for me. I could be one of the almost 75 million Americans with hypertension. They may not have outward symptoms like I do. But if they don’t manage their condition, it could lead to serious health consequences for them.
Or things could be worse. My condition could be serious and costly. I could be one of the 100 million or so Americans with at least one serious and even life-threatening condition who need ongoing treatment.
I could be one of the 34 million with asthma, the 30 million with heart disease, the 24 million with diabetes, the 14 million with serious mental illness, or the 12 million with cancer.
Death Sentences?
When insurance companies refuse to insure these people because of their conditions, they give some of them a death sentence.
This isn’t an exaggeration. Without insurance, many people can’t even afford the tests for their chronic conditions, much less the treatment.
Consider this: A member of my family had a bout with cancer a few years ago, and the treatment cost well over $100,000. She now has annual diagnostic tests to make sure the cancer hasn’t returned. The price of this year’s tests was exactly $3,171.20.
If she were uninsured, she would have had to find the money for the treatment and the tests. If she couldn’t afford the treatment, why do the tests? If she couldn’t even afford the tests, then she would be gambling with her life.
Why Sick People Need Insurance the Most
Insurance does two things for us when we’re sick, and this is why the sickest people need insurance.
It doesn’t just pay most of the cost; it also negotiates down the price for tests and treatment. My family member’s insurer negotiated the price of this year’s tests down from over $3,100 to just over $1,400.
Taking on both roles costs insurers money. That’s why requiring insurers to cover people with chronic conditions draws opposition from Mr. Huckabee. He prefers a publicly-funded safety net.
This past summer, insurance commissioners in Florida, California, Michigan, Virginia, and Nebraska all said that they did not have the authority to enforce the consumer protection provisions of the health reform law.
If they don’t enforce these protections, or if Mr. Huckabee were to convince Congress to repeal some of them, then what will people with pre-existing conditions do? Their only alternative would be something like Mr. Huckabee’s public option. As a credible conservative voice and leading Republican Presidential candidate, will he be willing to sell this public option to a broad national audience, or was this just a one-night stand for him?
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