It could not escape notice this week that the Virginia state Senate passed legislation that would make it illegal for any government body to require individuals to purchase health insurance.  The bill is expected to be passed by the state’s House of Delegates and then signed into law by Governor Bob McDonnell.

Virginia is one of the first states to take such action, but it almost certainly won’t be the last.  According to the American Legislative Exchange Council, legislative measures or proposed constitutional amendments have been filed in 35 states to challenge the idea of health insurance mandates.

This is a significant problem for the future of health reform.  One of the most popular components of the health reform bills that have passed both houses of Congress is the provision that removes pre-existing health conditions as a barrier to purchasing health coverage.  Even in our fractious society, there is virtual unanimity around the idea that having an illness shouldn’t leave individuals and families without health insurance and subject to financial ruin.

But we can’t enact that essential reform unless we also take steps to ensure that there is an individual responsibility to have health coverage.  Just as our property insurance system would collapse if individuals could wait until their house is on fire to buy a homeowners’ policy, so would our health insurance system be unsustainable if the healthiest among us could opt out until we became ill and needed an insurance plan to cover their expenses.

Understandably, lawmakers, in a challenging political environment, would love to pass laws making insurance companies issue policies to all comers, but they’re reluctant to impose health insurance mandates on their constituents. This, however, is a case where you genuinely can’t have the dessert without the vegetables.

In a judicial sense, these state laws probably aren’t a barrier to health reform.  Federal insurance reforms would almost certainly pre-empt state statutes.  Politically, though, having several states (and, keep in mind, the Virginia state senate is controlled by Democrats) take official positions opposing one of the centerpieces of health reform legislation could be devastating.

I can’t help but believe that a valuable opportunity was squandered during the health reform legislative process.  This was a time for a dialogue between political leaders and the American people on the steps necessary to achieve accessible, affordable health insurance for all.  A couple of years ago, the Healthcare Leadership Council commissioned focus groups and simulation exercises to better understand attitudes among the uninsured.  There is active initial resistance among healthy Americans toward the idea of buying health coverage they don’t believe they need.  We also found, though, that they are open and responsive to compelling arguments on the value of having coverage.  Unfortunately, that dialogue hasn’t happened.

Instead, we spent valuable months arguing over whether government should take the unprecedented step of creating a health insurance entity to “compete” in the private marketplace.  The disproportionate focus on the government plan option undoubtedly helped fuel fear of expanded federal influence over healthcare and, subsequently, to the anti-mandate legislative measures we’re seeing today.

I sincerely hope we can resurrect the drive toward health reform.  This effort has come too far to let it slip through our fingers.  There is a desperate need, though, for leaders in both Congress and the White House to have a candid conversation with the American people on what it will take to make our health insurance system work optimally for everyone.  This needs to happen soon, because if more states follow Virginia’s lead, the goal of achieving affordable health insurance for every American will be facing a very steep mountain to climb.

This entry was posted on Friday, February 5th, 2010 at 8:01 am and is filed under Health Reform, Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.