Past efforts by the federal government to reform the health care system offer instructive guidance about future prospects for meaningful reform.
Lesson learned – why go for the simple fix when the Rube Goldberg fix will do. Limit the fix to only a small hole in the system. Make sure it has a good story line. Congress gets some political mileage with little down side. In addition, it keeps bureaucrats and lawyers busy figuring out what Congress intended.
Let me illustrate with two examples.
Thirty state legislatures have attempted to address a real problem – health care coverage for young adults. Young adults generally lose coverage as dependents on their parents’ plan when they turn 19. The technical term we in the benefits profession use is “age off.” Young adults who continue as full time students can generally continue on their parents’ plan if they and their college or university jump through some administrative hoops.
These ideas evolved in a quainter world when young people could find jobs at 18 or 19 that offered health insurance. Rarely true today.
How have these 30 state legislatures addressed the problem? Most are requiring plans they regulate to cover dependents until age 25. New Jersey uses age 30. The focus is on dependents.
No more student certification forms to hassle students, parents, and university administrators. Just cover everyone under a certain age. Simple in concept, simple in execution. Unfortunately, it only covers those insured plans regulated by state insurance departments.
That’s why a federal approach to reform is so essential. The concept may be simple at the state level, but a multi-state business trying to conform to different state requirements will not find it simple at all.
So how does Congress approach the problem?
They don’t see a problem with coverage for all young adults. But thanks to an impassionate plea and effective lobbying from the mother of one young adult, congress was able to focus on a problem for a very small percentage of young adults. A very very small percentage.
The result was Michelle’s Law.
The story is a heartbreaker. We see similar stories in our plan often enough. A college student get ill. In the case of Michelle Morse, she was unable to continue as a full time student as a result of the illness. But if a student is not a full time, she loses her health care coverage under her parents’ plan. A tragic enough story.
Let’s look at the fix.
According to the Michelle’s Law web page, it affects only .0058% of students. Even if you assume the decimal point is in the wrong place, it is still a very small number. And it is only the percentage of students affected, not the percentage of young adults.
And the law only gives the student one year to get better and return to full time status. What if the student had an illness that took longer than a year to recover from? Forgeddaboutit!
The law only affects young adults who are students and covered under their parents’ plan. What if the young person was working and the illness caused them to lose their job? Forgeddaboutit!
What if the young person had purchased a plan offered by the college – as is often the case? Can the student continue if she is not a student?
The law does not extend student eligibility, which frequently ends at age 22. What if the illness extends past the plan’s age limit for student coverage? Forgeddaboutit?
And the law certainly does not simplify anything. Instead of a process that involves just the student, parents, university, plan sponsor and carriers, you now need to add the physician into the mix.
Is this a model for health care reform? Forgeddaboutit!
Next up – the portability provisions of HIPAA.