Reform won't stop health plans from avoiding the sick, analysts say

One of the linchpins of health reform is making it possible for anyone who wants to buy health insurance to do so. This involves not only subsidies that help to pay for coverage, but also rules banning plans from rejecting sick applicants or charging them higher premiums.

While this sounds like a major game changer, the truth is that health insurers will find ways around these limitations, instituting less direct mechanisms that discourage the sick from buying coverage, researchers say. After all, the free market will still penalize those who take excellent care of sick patients by throttling profits, they note.

One tactic health insurers might use is to drag their feet on paying claims filed by the chronically ill. This would chase away sick patients while keeping healthier ones who don't require much care, they say. Another approach might be to build networks that include relatively few doctors caring for patients with expensive-to-treat chronic conditions.

To avoid this outcome, legislators are working on provisions that level the playing field. For example, the Baucus bill draft moving through the Senate Finance Committee calls for mechanisms that raise or lower pay to health plans depending on how sick their patients are.

Another way to avoid health plan gamesmanship on covering the sick, analysts say, would be to create a national standard benefit package, though such a step would require lawmakers to make some tough choices on how much leeway insurers would have.

To learn more about health plan reforms:
- read this Washington Post article

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