Last time I made my case that having a health insurance mandate up front in the reform process actually gives you the upper hand in future debate. It can also accelerate real change by exposing market dysfunction as the real driver behind exorbitant costs. As in, “Hey, we’re all in the insurance pool now but costs keep rising. Do something about it, Congress.” But you don’t need to take my word for it. Maine has already been down that path. Follow along as we trace the state’s experience in avoiding a health insurance mandate.

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Have I got a deal for you. It’s an Exchange within an Exchange, featuring non-profits as equivalent to public plans and even bearing a strange resemblance to co-ops. Pretty soon, if Olympia Snowe has her way, I bet it will be triggered too. Even better, it’s been proven – not just once, not twice, but three times – to be ineffective at holding down costs. Are you in?

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In Part 1 we looked at how HR 3590 can bend the US healthcare cost curve, and found some expected and some surprising answers. While deficit neutrality is a healthcare reform Holy Grail, from a personal perspective my first question is “It’s deficit-neutral for whom?” The answer to that, of course, is for the government, not you.

Yes, the bill includes some good subsidies for the poorest among us, and subsidizes even those up to 400% of the poverty level. That still doesn’t prevent over-sized US healthcare costs from continuing to bankrupt the majority of Americans, as we saw explicitly in an earlier post. So beyond subsidies, what does HR 3590 do to bend your healthcare cost curve?

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Well at least one of the two manager’s amendments to the final version of HR 3962 could be useful. It addresses the “Wall Street Effect”, most obviously in a section entitled Sunshine on Price Gouging by Health Insurance Issuers. The Wall Street Effect was observed when banks and credit card companies were told regulations would be tightened the beginning of 2010 – they promptly raised rates and found all sorts of fees and penalties they could assess customers prior to that.

Expecting private insurers to do the same thing when faced with health reform legislation, John Dingell created preemptive strikes to ward off predatory rate spikes. Then the GOP made itself look really silly when the CBO scored its amendment, billed as an alternative “plan”.

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Tell your Congressional representatives that being a woman is not a pre-existing condition. No, we’re not kidding … more and more insurers base coverage and premium decisions on your gender. Click below to find out more and sign the petition at Change.org!                                  blogsurfer.us