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Health insurance bill a step backward

We all know that inadequate access to health insurance is one of Oklahoma's most urgent and troublesome problems. Almost 650,000 Oklahomans lack health insurance coverage, a situation which places great strains on our health care industry, endangers the health and financial well-being of the uninsured themselves, and drives up costs for everyone else.

While efforts to move us along the road to greater coverage are to be applauded, one approach under consideration which attempts to target uninsured young adults may not only fail to move us forward but may actually land us in the ditch.

While people of all ages are represented among the ranks of the uninsured, young adults between the ages of 19 and 34 are most likely to lack coverage. Oklahoma's uninsured rate for members of this age group, who are less likely to be employed in jobs that offer employer-sponsored coverage, is 35 percent, compared to 21 percent for the adult population for a whole.

A bill introduced this legislative session proposes to address the high incidence of uninsured among young adults by allowing insurers to offer health insurance coverage to adults under age 40 that is exempt from all state insurance benefit requirements, or mandates.

Oklahoma currently mandates coverage of 24 medical services, including mammograms, contraceptives, minimum maternity stays, diabetic supplies, ambulance services and mental health parity. Presumably, mandate-free policies would be offered at a lower cost and would appeal to younger individuals
in good health who do not anticipate needing many services.

Unfortunately, there are at least two major flaws to this approach. The first is that removing benefit mandates is unlikely to succeed in significantly lowering the cost of coverage. A significant body of research reveals that the net cost impact of mandates is modest only 3 to 4 percent of the total cost of insurance premiums in one state study.

The impact on premium costs of waiving mandates, therefore, is likely to be minimal. Moreover, in states that have actually experimented with waiving mandates, experience finds that most consumers are uninterested in purchasing bare-bones coverage. A Montana mandate-lite program managed to enroll only 53 individuals before it was discontinued due to low enrollment.

An even more problematic flaw with the proposal to allow bare-bones insurance is that it undermines the central premise of health insurance risk pools, that of spreading risk across a broad and diverse population. If mandate-free plans succeed in siphoning off the young and healthy, the inevitable impact will be to make insurance even more expensive for those who are left behind in the general coverage pool.

That will include not only those over 40, but also younger people most in need of comprehensive coverage: persons with chronic health conditions, such as diabetes or Crohn's disease, those with mental health problems, and women of child-bearing age, who would be denied assurances of contraceptive coverage and maternal health services that are currently protected under state law.

Ironically, expanding coverage for those least likely to need it could end up threatening coverage for the most vulnerable.

There are better alternatives for targeting the young uninsured, including allowing parents to claim their children as dependents in family coverage through age 25.

Ultimately, though, we are only going to steer our journey to the destination of affordable coverage for all if we recognize that we are all in this together.

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