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Required Insurance Coverage The Right Issue at the Right Time
By Jack Lewin and Ronald A. Williams

August 19, 2005

The following text first appeared as an op-ed in the Wall Street Journal.

With 45 million Americans uninsured, achieving universal access to health care may seem daunting, but it's not impossible. Encouraging work is underway in California to aid employers who don't provide insurance to voluntarily expand primary and preventive care, and the innovative coverage options targeting groups such as students and part-time employees show great promise.

There is, however, a more comprehensive approach under consideration in California and elsewhere -- an individual-coverage requirement. The stakes are high. People with little or no health coverage most often don't receive preventive care, and they usually seek emergency care only after medical conditions become acute. Absorbing the uncompensated costs of services for the uninsured has taken a financial toll on many health-care facilities and resulted in cost shifting to those who have insurance.

This changing environment has made the concept of requiring individual coverage attractive. An individual-coverage requirement encourages personal responsibility by recognizing that those who can afford health coverage should purchase it, and it acknowledges the social responsibility to subsidize coverage for those who cannot. If properly structured, an individual-coverage requirement not only would provide access to quality health care, but also would ease the financial crisis facing health care. This would be an enormous accomplishment.

Employer-based coverage is beneficial and should be preserved. But the environment is changing and costs are crippling the system. Under an individual-coverage requirement, many more Americans would benefit from the private-sector health care that most enjoy currently in our employer-based system. This would foster the adoption of consumer-directed health plans, which typically include high-deductible plan features. These new plans create greater awareness of health-care costs by providing consumers with better information about available treatment options, including the cost of these services. Consumers then can make the treatment choices that are right for them without the third-party disconnect that divorces the consumer from costs. And, consumer-directed health coverage could be portable from workplace to workplace!

With an individual-coverage requirement, people who want more comprehensive coverage and can afford the higher premiums could choose to buy it. Those who could not afford even the most basic plan would receive subsidized coverage. The focus should be to get uninsured families covered without destabilizing the coverage of those already insured.

As it is, state legislatures are still mandating costly new benefits for insured persons, destabilizing employer coverage and, as a result, increasing the number of uninsured. Instead, we need more affordable insurance options that increase coverage of low-income workers, and reduce the numbers of the uninsured who threaten the viability of ERs, physician practices, and the safety net.

We urge the state legislatures and Congress to approach this debate with an open mind as the access to care debate intensifies. At the very least, let's study and analyze this concept to determine whether its practical application can work to unite us in our quest to solve the persistent problem of the uninsured.

The status quo is the worst possible strategy. We need a new approach to financing universal access that is more practical and affordable, while still socially responsible and ethical.

Though many details remain to be worked out, the goal of instituting an individual health-insurance requirement to cover all Americans is admirable. Nothing could be more critically important for business and medical professionals in every state to consider.


Dr. Lewin is CEO of the California Medical Association. Mr. Williams is president of Aetna.
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