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Well-designed coverage access guarantees help industry

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Last week during a Senate hearing, Janet Trautwein talked about what sounds like a great starting point for overhauling the current guaranteed-issue health coverage system.

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Trautwein described a proposal, which has come up before, that would let people who get and keep a minimum level of health coverage continue to be major medical coverage policyholders without worrying about medical underwriting affecting their access to coverage, or doing much to affect the cost of their coverage.

The government would set up risk pools, or special insurance plans for high-risk people, but only for people who failed to maintain continuous coverage, according to a written version of her remarks posted on the hearing website.

The continuous coverage rules would, presumably, be less complicated than the Health Insurance Portability and Accountability Act of 1996 continuous coverage requirements. The HIPAA continuous coverage requirements seemed to give continuous coverage credit only to consumers who had been enrolled in group major medical coverage for all of their 100 lives.

The HIPAA credit seemed to give the eligible consumers access to affordable coverage only if they could figure out how to travel faster than light, back through time, to a special health insurance agency in another, nicer universe than this one.

And, of course, the devil is in the details. It’s hard to know in health insurance what will really protect health insurers against plan-killing antiselection pressure. The continuous coverage requirements Trautwein described might be too weak to help health insurers much.

But what’s nice about the version of the requirement that Trautwein described is that it lets people be honest.

Health insurers and employers now have all sorts of wellness and chronic condition management programs that hinge on a health plan having complete information about an employee's health. (Photo: iStock)Health insurers and employers now have all sorts of wellness and chronic condition management programs that hinge on a health plan having complete information about an employee’s health. (Photo: iStock)

The sorts of people who have no idea what a deductible is might blithely give the programs complete information in exchange for a $20 gift card, no matter how health insurance rules change.

If Congress returns us to where we were in 2008, and many states impose no medical underwriting restrictions on health insurers whatsoever, then people who have manageable near-term health costs have a huge incentive to hide health risk from insurers and employers.

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People who have had a full-blown stroke may have no alternative to filing a big catastrophic claim.

But people who understand how the system works, know they have high blood pressure and high cholesterol, and know they are at relatively high risk for having a stroke may try to get all the tests and pay for all care out-of-pocket, to avoid creating a paper trail showing they have health problems. They might choose cheap drugs they could afford to pay for out-of-pocket, or do without necessary care, to keep their health record as clean as possible.

Even if health insurers start requiring applicants to go through blood pressure checks and cholesterol tests, consumers might do everything they can to hide the health indicators that they can hide.

Before the Affordable Care Act started coming to life, consumers were isolated. They may have had no way to learn about how medical underwriting works, or how to fool medical underwriting programs. Today, if the ACA went away and full major medical insurance medical underwriting returned, they would probably set up websites and Facebook pages just to share medical underwriting tips.

Designing medical underwriting standards that discourage irresponsible grasshoppers from going without coverage in the summer of their lives is an important goal.

But I think keeping consumers from feeling as if health insurance wellness program managers are out to get them is also a goal worth considering. 

Allison Bell is a senior editor at


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