Treat health plans like car insurance and people will cover themselves.
The good news is that we know a lot about who the uninsured are
-- and why they're uninsured.
They usually cannot, or do not, get health insurance through their
place of work. They are overwhelmingly low-income working people.
They tend to be young, are disproportionately minority and are
often concentrated in small businesses, particularly in retail
trade and service industries.
When they buy health insurance on their own, they get no federal
and state tax breaks for the purchase, unlike workers who get
coverage through their employers. This makes these workers' health
coverage far more expensive for them to buy. No wonder they don't,
or can't, purchase insurance.
The "hard core" uninsured -- those persistently uninsured over a
long period of time -- are, in fact, a relatively small part of the
problem. Based on the best evidence in the professional literature,
the vast majority of the uninsured are people who are in and out of
coverage, people who experience gaps or frequent changes in
coverage.
Normally, people own their own auto, life and homeowners insurance
policies. So when they change jobs or lose jobs, they don't lose
these insurance policies. But with health insurance, the employer
owns the policy; and because the employer owns it, the employee
can't take it from job to job. The best a departing employee can
do, under current law, is pay the full premium for an
often-unaffordable employer plan for a limited period of
time.
So the problem of the uninsured isn't simply getting access to
health insurance coverage, but keeping it once they have it.
The right policy, then, is to tie health insurance to the person,
not the job. That one, simple change would make a dramatic
difference in reducing the numbers of the uninsured.
What is to be done? First, create a new kind of health-insurance
market and allow individuals and families to pick and choose the
plan of their choice. Allow them to own it just as they own every
other type of policy, and permit them to take it with them from job
to job without losing any of the generous federal and state tax
breaks for health insurance.
Gov. Mitt Romney of Massachusetts has created just such a new,
consumer-driven market for workers and their families in the
small-business sector, guaranteeing them portability of affordable
health-care coverage.
Second, target assistance to uninsured individuals in the form of
health-care tax credits, enabling them to get the health insurance
they want without a tax penalty. For low-income people who don't
pay taxes, provide a voucher or "premium assistance," so that they
can afford coverage.
The problem of the uninsured is tough, but it is not insoluble. It
takes only political will, which is routinely in short
supply.
Robert E. Moffit,
Ph.D., is Director of the Center for Health
Policy Studies at The Heritage Foundation.
First appeared in The Press-Enterprise