Given the recent coverage of Rep. Marsha Blackburn's health care repeal-and-replace measure, you'd think you were hearing the thundering hooves of an approaching GOP thought-leader — echoes of Paul Ryan and his Medicare-privatization proposal. According to a report last week in The Tennessean, the legislation — billed as the free-market solution for millions of uninsured Americans and metastasizing health care costs, in retort to the 2010 health care law — "represents another advance in Blackburn's profile as a policymaker in Congress."
But if originality is any measure of thought leading, Blackburn's bill gets a big goose egg. The bill's central idea — allowing insurance to be sold across state lines — has already been recycled several times; a variant even appears in the health reform act mocked as Obamacare. And if the nonpartisan Congressional Budget Office's assessment of an earlier version is to be believed, it hasn't gotten fresher.
This GOP default position last cropped up in the House in 2005, sponsored by Arizona Republican John Shadegg. What's new? Blackburn spokesman Claude Chafin says Blackburn's bill contains vital consumer protections the Shadegg bill lacks. In response to a Scene request, Chafin sent an email identifying the sections and subsections containing these extra protections.
Aside from the repeal measure and a few "findings" of fact, a side-by-side, line-by-line comparison shows that the bills — including their consumer protections — are utterly identical. They even have the same name: The Health Care Choice Act. And because the bills are doppelgangers, the budget office's analysis of the 2005 bill applies here — flaws and all.
The budget office predicts that if citizens can purchase insurance across state lines, insurers headquartered in states with few regulations will have a workplace advantage over competitors based in states with stronger protections. Why? The competitor will be bound by the demands of its home state, which might include mandates such as cervical cancer screenings and treatment for autism that raise insurance costs. Meanwhile, the out-of-state rival, which only has to meet its own state's standards, can poach desirable (read: not sick) clients with cheaper individual plans.
Who can argue with cheaper insurance, right? At first glance, this reads like the marketplace ideal — and so it is, if you aren't sick and don't need insurance. In a press release, Blackburn says there are too many mandates, even if the National Association of Insurance Commissioners estimates they add, at most, 5 percent to the cost of a policy. But mandates aren't the only reason policies in some states cost more. Some have rate-setting rules that prevent wild fluctuation in prices.
This is where the Blackburn bill's consumer protections prove to be anything but. The out-of-state insurer isn't subject to the laws of the state with more stringent regulation. NAIC fears this would spark an exodus to the states with the weakest regulatory regimes. A 2010 Kaiser Family Foundation study found that 14 states require no review of individual market-rate increases.
It's worth noting that the 2010 health care law Blackburn would repeal and replace also allows for the interstate sale of insurance — but only through compacts, meaning there must be an agreement between the states. On top of that, the insurer in one compact state must be licensed to sell its policies in the others, placing it within the jurisdiction of the insurance commissioner in the policyholder's state.
Not so with Blackburn's bill. "[Consumers] will have to hope that the regulator in a distant jurisdiction has the ability and resources to assist consumers nationwide," a NAIC report says. Failing that, a consumer's only other recourse is a third-party medical reviewer.
Arizona Gov. Jan Brewer may not be known as an exemplar of progressive thought. But even she vetoed a similar measure, saying she's "concerned about risks to our citizens who may be subject to other states' regulatory procedures that could leave them with little recourse in the event of mistreatment."
In terms of its anemic consumer protections — not to mention the ideological impurity of its resemblance to a provision in the Affordable Care Act — Blackburn's bill would seem to earn yet another zero on its scorecard. But there's yet another metric to be considered here: the staggering number of uninsured Americans, now totaling some 50 million. Here, the budget office has more bad news for the Blackburn/Shadegg bill.
Right off the bat, the budget office estimated that a million people with employer-provided insurance would lose their coverage. As healthy co-workers opt for cheaper out-of-state policies, employee plans would sag under the weight of their less vigorous ranks while per-person rates rose. Small business owners — the Republican touchstone — might find they couldn't afford it, the budget office concluded.
Worse, it predicted the trend would spread nationwide. Out-of-state insurers would entice and cherry-pick the healthy, removing the essential counterbalance that is supposed to stabilize prices — by no means a perfect system even now. Prices for those with higher health care costs would rise to the point that they became unaffordable. The insurance pool would grow lopsided. The budget office predicts a net increase in the number of insured healthy people and a decrease in the number of insured among the patients who need insurance most. It should be no surprise this bill keeps reappearing. It's an insurance company's wet dream.
In all, the budget office found the bill Blackburn copied would have a "negligible" effect on the number of uninsured. Meanwhile, it estimates that some 30 million currently uninsured Americans will be able to obtain insurance under the health care law Obama signed. For reducing uninsured rates, the Health Care Choice Act comes up empty once again.
To be fair, criticizing legislation is much easier than creating it. And writing a sound, innovative bill is a bit like songwriting — if everyone could do it, there would be no cover bands. Perhaps it's a wonder, then, that there aren't more musical equivalents of the Health Care Choice Act — a cover version that faithfully reproduces all the original's sour notes.