The trials and tribulations of insuring the sick and small businesses

A new report from St. Luke's Health Initiatives, a health care think tank in Phoenix, says that 94 percent of the state's businesses are small businesses - with less than 50 employees - and that among those small businesses, only 30% provide health insurance as a benefit to employees. Meanwhile, an article in the Tucson Weekly chronicles the roller coaster ride of Healthcare Group, a state program administered through AHCCCS, that provides health insurance coverage to small businesses, most of whom are sole proprietors. Healthcare Group has raised its premiums significantly in the past year or two, even while the state has provided subsidies for the program, because, well, when most of the people you insure are too sick to get private health insurance coverage, it costs a lot of money that the sick don't have. The reason so many people stick with Healthcare Group is that they will insure you regardless of your pre-existing conditions.

Of course, one of the best ways to make health insurance affordable - even to the sick - is to spread out the risk among many people. Healthcare Group could take in more people, healthy people, and that would lower the premiums that people in it would have to pay, while reducing the amount of tax money the state would have to use to subsidize it. But private insurance companies don't like that. They have no problem with taxpayers subsidizing, or the government completely taking over, insuring the sick. But it's cheap - and profitable - to insure the healthy, and private insurance companies don't want to let some of them join Healthcare Group just so sick people can better afford insurance and the taxpayers can save a few dollars.

So what are we to do? Well, the uninsured drive up health care costs for the rest of us when they don't see primary care physicians, and wait until they end up in the ER, can't pay, and the hospital passes on the loss it incurs to the rest of us. So for those who truly need help paying for their health insurance, let's expand outreach for KidsCare, our state children's health insurance program (SCHIP), which provides low-cost health insurance for qualifying low-income children (citizens or five year legal residents). Let's allow families that are just above the income limit for KidsCare to buy into it. It won't be cheap, but it will cover their children regardless of pre-existing conditions, and private insurers just won't insure some kids for pre-existing conditions as common as asthma. Young adults, age 18 to 29 or so, are among the least likely to have health insurance, because they are off their parents' insurance and are working in entry level jobs that don't provide health insurance. This is a healthy, cheap group to insure, but occasionally they do get sick, let things slide until they end up in an ER, and can't pay. So Arizona should do as other states and require insurance companies to cover young adults up through at least age 25. Again, it's a profitable group, so it doesn't hurt insurance companies' bottom lines. The catch, if you voluntarily decide to drop health insurance and go uninsured, your parents' insurance company doesn't have to take you back, because you're probably coming back due to an illness you just found out about. Even when you're young, you're not invincible, and it's your responsibility to get health insurance if anything reasonable comes your way.

When the Wall Street Journal sounds like Michael Moore, something is up

The Wall Street Journal did a story and posted a blog recently about a patient in Texas who has leukemia and was asked for $45,000 up front before even being seen by the M.D. Anderson Cancer Center, and then another $60,000 up front to begin chemotherapy treatment. And the patient had insurance. But unfortunately, the patient's limited-benefit plan, underwritten by United Health and marketed by AARP, only covers $37,000 a year in benefits, so the hospital refused to bill the insurance company and demanded payment up front. This is part of an increasing trend of hospitals demanding cash up front for treatment, as they are swimming in rising mountains of bad debt.

Senator Charles Grassley (R-IA) is usually a pretty practical guy, but has a temper and gets frustrated when he hears about such things. When this patient appeared via video link before the Senate Finance Committee, Grassley seemed to suggest that hospitals such as M.D. Anderson, which receive some government funding, should provide more charity care. I am glad Senator Grassley shares America's frustrations, but don't we need some more comprehensive solution to America's health care problems than saying hospitals should just provide more charity care?