Thursday, December 18, 2014

Live free or die uninsured

New Hampshire wants to go further than some other states in turning its back on federally mandated insurance exchange. Not content to merely passively object, the Granite State has a bill prohibiting any action - even time - being spent on such a plan.

Live free or die uninsured

New Hampshire’s oft-quoted motto may soon take on a new meaning. Last week, the legislature took the first steps to help residents live free of health insurance.

The lawmakers were trying to make a statement about Obama’s health reform law, the Affordable Care Act, but their actions went beyond that. They seem intent on standing in the way of free-market health insurance in any form.

The action in question is a bill that was overwhelmingly approved by the state house to prevent New Hampshire from creating its own insurance exchange. Exchanges are a key element in the federal health reform law. If states don’t create their own, the federal government will do it for them.

But the bill goes further than just blocking the state’s compliance with health reform, a tactic being used in some other states. New Hampshire's bill specifically prohibits the state from taking any steps - spending time or money, for instance - to create any kind of insurance exchange, even one that has nothing to do with the Affordable Care Act. (Click here to see the bill.)

Legislatures in other states have blocked the creation of exchanges under health reform. But New Hampshire’s proposed law is especially far-reaching.

Insurance exchanges are one of the least controversial aspects of health reform. They enjoy support from across the political spectrum.

In an exchange, individuals and small businesses can comparison shop for policies from multiple companies. Policy terms and rates are clearly displayed, and the purchasing process is greatly simplified.

This exemplifies the free market in action. Exchanges end the complexity and confusion that makes it difficult for many people to purchase health insurance in the private market today.

The main point of contention in health reform debates is the mandate that requires every individual to have health insurance. It is the chief focus of the case challenging the law that is pending before the Supreme Court. Not even the most passionate opponents of the law find fault with the exchanges through which insurance would be sold.

In fact, the legislature of Utah, the most heavily Republican state in the nation, created an exchange several years ago independently of health reform, and it is in operation today.

Who stands behind efforts to create an insurance exchange in the Granite State? Among the strongest advocates are small businesses and health insurers. They seem to understand the value of the free market better than the legislators who voted for the bill.

Opponents of the bill see it as a political maneuver to express opposition to health reform. The bill’s sponsor, Republican Representative Andrew Manuse, has acknowledged as much. He calls it “the state’s best response to the President’s federal act” and boasts that it will promote the law’s repeal.

But what would the bill accomplish if it became law? It would block the state’s best path to making private insurance easily accessible.

Even if the Affordable Care Act were struck down by the Supreme Court or repealed by Congress, an insurance exchange could turn a chaotic market into a smoothly functioning one. But this law would prevent even that.

The bill makes it more likely that many uninsured New Hampshire residents will continue to live free of health insurance. And also that some of them could die from lack of access to health care.



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About this blog
Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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