Health Care Freedom in Virginia

The Virginia house, with bipartisan support, passed Senate Bill 417 which legislatively pushes back against a federally instituted individual insurance mandate. It is legally protecting the right of Virginia residents from being forced to purchase health insurance.

You can find the text of the bill, which Governor McDonnell is now expected to sign into law here, and more about national efforts to protect health care freedom through states acting under the 10th amendment here.

At the Alliance of Health Care Sharing Ministries, we applaud these efforts because they will also protect our members’ right to use non-insurance options like health care sharing . Americans need to have freedom of choice in their health care solutions, rather than a one-size-fits-all approach that will limit innovation and liberty.

Somewhere Between Worried and Panicked in Virginia

A blog of the New York Times looks again at state-based moves to protect people from an individual mandate to buy insurance, either from state or national governments. It mentions that the latest state to take up legal language, Virginia, did so in the form of a statue, not a constitutional amendment. That should mean it becomes law much sooner–and could pave the way for a legal challenge, should Congress enact such a mandate.

Larry J. Sabato, a political scientist at the University of Virginia, comments on the movement, and specifically the vote of five Democrats in the Virginia Senate. He reads that as an attempt by the senators to buy political coverage, since “Democrats are somewhere between worried and panicked.”

We should do health care reform. But if what the House and Senate have produced constitutes reform, then reform ought to be dead, and we should start over.

Virginia Senate Says “No” to Mandatory Insurance

I love this lead paragraph from today’s Washington Post:

Virginia’s Democratic-controlled state Senate passed measures Monday that would make it illegal to require individuals to purchase health insurance, a direct challenge to the party’s efforts in Washington to reform health care.

An insurance mandate–a tax on breathing–is noxious. It isn’t the only bad thing about health “reform” being schemed in Washington, DC, but it’s perhaps the most visible. (OK, aside from “death panels,” that is.)

At least some elected officials are not on a political suicide mission: “five Democrats who represent swing areas of the state joined all 18 Republicans in the chamber in backing the legislation.” One of the give said of the requirement, “It’s un-American. And it might be unconstitutional.”

What are the broader implications? “But the action in Virginia, a state that backed Obama in 2008, could indicate that the president is failing to reassure members of his own party that current reform efforts remain worthwhile.” Reform efforts are good. The current reforms efforts? Not so much.

The bill is expected to be approved by the House of Delegates, the lower house in the state legislature.

Rent from a State Employee, Get Insurance

As I suggested in a post yesterday, Gov. Tom Kaine (D-Virginia) is throwing open the state employee insurance plan to anyone who lives with a state employee, not just domestic partners.

As the Washington Post put it, “Those adults could include heterosexual and homosexual partners, roommates, children and other family members, such as an aunt or grandfather.”

It may be true, as Kaine says, that the employee would have to pay the full premium of the add-on insured. But the idea doesn’t do much to address the problem of job lock, except perhaps make insurance a matter not of affordability but “who you know.”

Need Insurance? Move in with a Government Employee

Timothy M. Kaine, outgoing governor of Virginia, would like to expand health insurance coverage to more people. His idea: “adults without health benefits who share a home with an insured state worker would be eligible for coverage.”

The idea would effectively give spousal benefits to gay couples, which may end up drawing the most attention. But as I read the article in the Virginian Pilot, there’s nothing in the plan that requires any relationship other than living in the same house, as “adults without health benefits who share a home with an insured state worker would be eligible for coverage.” As the Pilot continues, it also “would apply to in-laws and to adult children who live with a parent who works for the state.”

How about brothers? Nieces? Ex-wives? The fraternity brother? There  might be no end.

Virginians Skeptical of Political Claims

Virginia has been trending toward a “blue” state of late, so a new poll on health reform among commonwealth residents is especially interesting.

Here are some highlights, according to the Hampton Roads Pilot:

Almost half of respondents (49%) oppose health reform structured along the lines of President Obama’s proposals.

Almost half (48%) oppose making people buy insurance.

A majority (57%) oppose a “public option” insurance company.

There’s also a fair amount of skepticism about political promises, with respondents believing that health reform as now constituted will lead to rationing, cuts in Medicare, and higher taxes.

Not included in the story (and and perhaps the poll) were questions about guaranteed issue and community rating regulations. These regulations, which sound desirable in the abstract (”no discrimination against sick people!”) would, if imposed, make insurance unaffordable across the board.

The poll of 625 likely voters was conducted on October 6 through 8 by  Mason-Dixon Polling & Research Inc.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

State Officials–and Now, Hackers–Watch Your Prescription Drug Use

In the name of combating the abuse of prescription drugs, the Commonwealth of Virginia instituted an electronic database of everyone's prescription drugs. (At one point, it looked like Iowa was going to include people who buy non-prescription drugs allergy medications in a similar database.)

Guess what happened. Yep. A hacker broke into the system.

The possible breach of a state electronic prescription drug data-base could have an ironic effect: promotion of prescription drug fraud and abuse, the very thing the system was set up to deter.

That suggestion came from outside experts Thursday as the FBI and State Police continued investigating last week's unauthorized intrusion on the Web site of the Virginia Prescription Monitoring Program.

Among other ramifications, people whose names were in the database could find it more difficult to get legitimate prescriptions.

Using the Private Sector to Rescue Mental Health Care

States would do well to make more use of public-private partnerships in providing mental health treatment, says Leonard C. Gilroy, a senior fellow at the Thomas Jefferson Institute.

In a commentary (Windows Word file) entitled "A New Wind is Transforming Psychiatric Services," Gilroy praises the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services for drawing on private sector parties to revamp the Eastern State Hospital, which was founded in 1773. (That's right; before the United States was even an independent country!) The renovations, he says, will save money and improve patient care.

Gilroy then encourages the commonwealth to go beyond using the private sector for one-time fixes to using it to run mental health treatment programs. He draws on the experiences of Florida and Georgia.

Take the case of one hospital in Florida:

Florida's efforts began in November 1998 when it contracted with a private company to operate South Florida State Hospital, an aging facility which had never been accredited in its history and which was facing a major class action lawsuit concerning patient abuse and poor conditions. Within two years, the private operator was able to achieve accreditation for the existing facility (removing the lawsuit), while at the same time financing and building a new, modern facility to replace it. No capital dollars were involved and the state will own the new facility when the debt is retired.

To paraphrase Gilroy's conclusion, it's one thing to say that government ought, in some instances, fund mental health services. It's another entirely to say that government agencies are the proper organizations to deliver those services.

When Forced to Pay More, Fewer Can Afford to Pay at All

The March 1 issue of The Undercurrent has an excellent discussion of Virginia's proposed autism-coverage mandate by Rituparna Basu.

Here's an excerpt:

…Insurance companies' costs will obviously increase if they are forced to pay for the treatment of autistic children. To offset this additional cost, insurance companies will do one of two things: they will either offer fewer medical services to maintain the current premiums or increase the premiums for everyone. In the former case, vital medical services will no longer be covered, and patients who rely on these services will have to pay more for them. In the latter case, all insured individuals will be charged a higher premium, which means that some people who have health insurance will no longer be able to afford it and fewer employers will be able to offer health insurance to their employees.

…People work hard to earn money in order to attain those goods and services that make their lives enjoyable and worth living. Consider what this bill means to those who do not have autistic children: instead of spending their money on that which they value, now they will be forced to spend that money on other people's autistic kids. Many families who already find health insurance difficult to afford will now be forced to decide whether they want to spend more for their health insurance or instead use this money for other important expenses, such as investing it towards a college education for their children or paying their rent or mortgage. If it is unfair for parents of autistic children to have to pay their children's medical bills, how much more unfair is it for other parents to have to pay the same bills? Demanding that people hand over their hard-earned money without regard for the consequences such an action will inflict on their lives is unjust.

Read the whole thing here.

I especially like the fact that Ms. Basu integrates the economic and moral arguments against insurance mandates. IMHO, we badly need more such health policy analysis along these lines.