More Medical Insurance Mandates on the Way

Kara Murdoch. Photo credit: The Virginia Mercury

Kara Murdock, 28, lost her right hand and forearm five years ago due to a blood clot, and she has been trying without success to get a prosthetic. Her health plan turned her down when she was covered by her parents’ insurance, and now that she’s on Medicaid under the Medicaid-expansion program, she wants to make sure that her new coverage will include prosthetic devices. So reports The Virginia Mercury in an article about proposed legislation to require all health plans operating in Virginia, including Medicaid, to cover prosthetics.

Murdock’s case is a tragic one — read the story for painful details — and I have no doubt that legislators will be moved by her plight. A bill to mandate prosthetics coverage has been forwarded to the Health Insurance reform Commission, where all new mandates must be studied before the General Asssembly can pass them.

But the argument for a mandate gets complicated.

Doug Gray, executive director with the Association of Health Plans, said that the Health Insurance Reform Commission needs to study the bill to determine “what’s appropriate and what’s not.”

“The shortfall with the prosthetics bill is it requires every prosthetic device to be covered regardless of cost,” he said. “So if someone wants the $150,000 computer-run prosthetic when a $50,000 one would do — that’s something that needs to be managed, you can’t just say ‘we’ll cover anything.’”

In related matters, the General Assembly has improved expanding the coverage for treating children with autism through their teenage years. Again, the arguments in favor of the mandated insurance coverage are powerful — and the expense is significant.

Any one mandate is insufficient to make insurance unaffordable, but a relentless expansion of coverage does drive the cost of insurance ever higher and out of reach for more people. Stripped down insurance policies, which arguably are better than no insurance at all, are not an option in Virginia.

What the General Assembly giveth with one hand, it taketh away with the other. We see the giving, but we don’t see the taking away — a multi-step process that occurs through opaque workings of the medical insurance system. And that’s just how politicians like it.

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5 responses to “More Medical Insurance Mandates on the Way

  1. And what this demonstrates is that virtually ALL Govt AND private insurance is… in effect… “rationed”.

    There is no way that they can cover “everything”.
    The only folks who get all they want – are the rich who pay for it themselves.

    All the rest of us in one fashion or another gets coverage that is “limited”, capped, “not covered”, etc. and, in effect, rationed.

    We talk about other countries Universal Coverage being “rationed” because they do not pay for any/all treatments – it’s TRUE .. but it’s ALSO true in this country where many people are denied coverage – even folks with employer-provided insurance or Medicare or MedicAid… or Obama_care.

  2. Jim, wrong! The new coverage for autism has no age attached at all. It works right up to Medicare…..the insurers proposed 18 as a compromise but it was rejected.

  3. No health insurance covers everything with no cap. It’s a balancing act in terms of what they can cover and for how much versus the cost of premiums to everyone.

    And I’d point out that Medicare provides insurance to everyone at one price and same coverage to all – for about what younger folks with employer-provided get.

    Part of the reason is that Medicare does not serve younger populations with diseases like autism. Part of it is that Medicare covers only 80% unless people buy additional “advantage” insurance and part of it is that Medicare severely limits what it will cover and how much. Medicare does not dental, nor optical nor hearing. They’ll cover cataracts but not LASIK, etc.

    But we still have this basic problem in this country where we say we want a “market” system which will keep rates low and instead we have a system where we pay twice as much for health care as other industrialized countries who do, in fact, cover everyone and we do not.

    So what do we do? We say if we offer “crap” insurance that is really not real insurance compared to even what Europeans, Australians, Japanese receive who all, by the way, not only pay less than us – they all live longer than us.

    In no small part, because we have people dying because they cannot get access to health care… People in NoVa live as long as Japanese do. People in RoVa have mortality rates like 3rd world countries.

  4. “we have a system where we pay twice as much for health care as other industrialized countries who do, in fact, cover everyone and we do not.”

    In order to do this, the United States would have to cut the compensation for specific procedures, regulate health care facilities and pharma like utilities are regulated (not the Dominion-style regulation), cut compensation and reduce jobs. Or we’d need to nationalize the entire system with all medical providers government employees. In order to have the same results as these other nations, the United States must replicate the same conditions under which they operate.

    I don’t think there is a desire in this nation to take the steps to produce the results Larry suggests could be achievable.

  5. All of the other nations ALSO have private insurance for those who prefer it and can afford it, just as, in this country, Medicare is voluntary and people can choose other insurance … if they want.

    In this country, the cost per subscriber is much lower for Medicare, MedicAid and the VA – all govt-operated insurance.

    It’s not like we are not doing it already.

    Anyone who gets Medicare can tell you that the reimbursement rates are pretty stingy – yet most doctors take Medicare anyhow.

    Standard Medicare requires people to pay 20% of the costs That 20% means that people have their own money in play and, in turn, do not expect “all you can eat for one low price” .

    So…. we say we CHOOSE to do what we are doing right now – even though the costs are killing us and it is driving us to essentially deny full insurance to those who have “conditions” – for those folks to buy “crap” insurance that will be capped and won’t pay much… that’s OUR “solution”? right?

    what else would we do? Just give insurance to some folks who are young and healthy and dump the others who are sick or old ? Is that the “better” system than the other industrialized countries?

    That’s the basic problems with Conservatives and health care Their “solutions” are not. and they have no other ideas other than “we can’t do anything else”.

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