In the news

CALPIRG Education Fund
|
Sacramento Bee
By
Austin Price, CALPIRG

A year after the passage of the federal health reform, the debate over the law continues to rage on the cable news shows and in Washington. Unfortunately, these fights have given off far more heat than light, with the inside-the-Beltway squabbles being mostly focused on scoring political points and not on assessing what the law is actually doing for real people.

There are concrete ways the law has made things better. This spring, when California college seniors graduate and begin new jobs or the next stage in their education, they'll be able to stay on their parents' insurance plan, instead of being thrown off. California patients can now get preventive care without co-payments and deductibles, which will keep them healthier and will lower costs for everyone. And even more significant changes, like eliminating pre-existing condition denials, will come into effect in the next few years.

At the same time, there's a lot more that needs to be done to get costs under control and give consumers better choices. Just ask Lauren Michele, the principal/owner of Policy in Motion, a small business in Sacramento focused on designing sustainable communities.

Lauren received her master's degree from the University of California, Davis, last March and decided to begin a career as a small and disadvantaged business enterprise in California – the same week the federal health care bill passed. However, like 6.5 million Californians, Lauren has a pre-existing health condition, and is therefore ineligible for coverage as a sole proprietor. While COBRA was a temporary option, Lauren was unable to afford the 102 percent premium charged – or $598 a month to continue coverage.

After debating whether or not she should pursue work elsewhere, she decided not to abandon her business endeavors because of insurance policies. Lauren has been building her business the past year while concurrently working for UC Davis in order to keep her health care coverage. Lauren considers herself fortunate to be able to have this option; however, this is not the case for many sole proprietors like her sister who, prior to a major accident last fall, was not only uninsured but ineligible for state disability and unemployment benefits because our health care laws do not support emerging businesses and independent contractors the way they do employees of large companies.

Even without a pre-existing condition, the cost of premiums for small businesses and sole proprietors can lower job mobility and force employers to choose between expanding their business and providing health care to their employees.

Fortunately for people like Lauren, the California Legislature became the first state in the country to pass legislation establishing a new competitive health insurance marketplace, or exchange, where small businesses, the self-employed, and individual consumers can pool their bargaining power and make insurers compete for their business. However, there remains a great deal of work to be done and individuals on the board that oversees the exchange, and the decisions they make, will determine how well the exchange achieves its goals and serves consumers.

Designed correctly, the exchange will be a powerful advocate for small businesses and consumers. By setting strong standards, it can push insurers to adopt quality-enhancing, cost-lowering reforms that will reward higher-value care and improve patient health. Consumers will be able to rely on clear rankings on plan quality and standardized, clear information on costs so that consumers no longer need be surprised by insurer fine print.

When you look past the politicized national debate, you can see we have actually taken some of the first steps on the road toward delivering lower costs and better choices. But if the insurance industry lobbyists get their way and manage to cripple the new exchange in Sacramento, we will just get more of the same skyrocketing premiums and low-quality coverage we've had in years past. So for people like Lauren Michele, what happens this year in California will be even more important than what happened last year in Washington.

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