Health insurance issues

One way to try start an argument with someone these days is to talk about health insurance, because we are in a transition as there have been issues over the Affordable Care Act’s implementation. But what are the key health insurance questions today? N.C. State University economist Mike Walden answers.

“I know that a lot of the attention on the Affordable Care Act has been on problems with the rollout of the computer system. But, really, I think that the disagreements that you mention over the Affordable Care Act and health insurance really stem from some fundamental disagreements that people have about the role of the state and the federal government in health care.

“Let me just talk about, briefly, a couple of those: One, I think people still disagree on whether the government should require people to have health insurance. Some people say, ‘No, it’s their right. If they don’t want to have insurance, they shouldn’t have to … .’ Then you have others say, ‘Yes, they should have health insurance, because if they don’t pay, someone else will pay when they are hurt or injured.’

“Another issue has to do with whether insurance rates should rise with risk. Now that’s a standard insurance practice — (with) any kind of insurance, the more risk you carry, the higher your rates. But the Affordable Care Act does impose limits on that. It imposes in terms of people with pre-existing conditions, (and) it imposes limits in terms of how fast those rates can go up with age.

“And, actually, if you look at the Affordable Care Act, younger people are paying higher risk-adjusted rates than they actually would under a standard insurance policy.

“Third issue: Can competition control health insurance costs? Again, many say, ‘Yes, that’s what we need to solve the problem.’ Others say, ‘No, health insurance is too complicated. We need the government in there regulating the market.’

“And then, on that note, I think there’s a big disagreement on what should be the role of the government in health insurance. On the one end people say, “Hey, all the government should do is to help people who can’t afford to buy health insurance — help them afford that, then get out of the way.’ Others say, ‘No, we need government in there specifying policy provisions, limiting price increases and evaluating practices and procedures.

“I think all of these and more … are why we have a lot of arguments about health insurance.”