I think I will continue my inadvertent yet somewhat purposeful avoidance of discussing the presidential debates. There are plenty of other people out there who are writing pretty much what I would say, and I don’t want to post what would essentially be a “me, too.”
But I do want to note something John McCain said tonight that resonated with me. Mind you, little he says ever does, but at one point he expressed something cogently that tracked to a frustration I’d already experienced: that it is so difficult to transport one’s health coverage across state lines.
I don’t know what proportion of Americans find themselves needing to, but I’m sure I’m not the only one who potentially might. Perhaps I wouldn’t find it as much an issue if I had an employer-sponsored policy, but I have my own individual one. It’s a policy that I’ve maintained for about seven years, ever since I got laid off during the last recession and discovered I did not want to be dependent on an employer for my health insurance. It’s a policy I’m afraid to ever give up, for fear I might never get underwritten ever again. (Note: my health is fine, but if such healthiness could be perpetually guaranteed, then why would we need health insurance in the first place?)
The problem is that it’s a California policy, and if I were to move to another state, I would need a new one. I suppose it’s possible that certain national insurance brands might allow for policy transfers from state to state without requiring new underwriting, but the impression I’ve gotten from mine is that I would indeed need to be newly underwritten by the corporate arm in that new state in order to get a valid local policy.
In other words, heaven forbid should I end up diagnosed with some lingering condition, because it would mean I would be forced to stay in California in order to continue to have health insurance. I’d never be able to get a new policy elsewhere because of the pre-existing condition, but at the same time, my current policy would cease to cover me if I became a resident of another state. So much then for American citizens’ constitutional right to travel and establish residency in new states. While there may be no formal legal barrier prohibiting such movement, if moving results in losing one’s health insurance, then for all intents and purposes, that’s a real barrier.
The point of having states regulate health insurance is because they may be in the best position to toggle their levels of regulation to local circumstances. Many, particularly many on the Republican side of the aisle, believe strongly that, more often than not, local regulation is better than federal regulation. But the byproduct of that localization is that health insurance policies are not portable across state lines. I think McCain is right in saying that they need to be, and that interstate commerce is sufficiently implicated to permit the federal government to act in a way that ensures that they are. On the other hand, I also think Barack Obama correctly points out a danger of federal preemption of state regulation: that important consumer protections certain states have implemented will be avoided as insurance companies race to the bottom and set up shop in whatever state has the least burdensome (or most profitable) requirements.
Still, I’m not sure that federal regulation necessarily precludes having consumer protections. A preemptive federal law could require them. Or, as Obama’s plan seems to call for, if insurance companies were to be federally barred from refusing to underwrite policies due to preexisting conditions, then the functional problem of not being able to port a policy across state lines would essentially become moot because a new local policy could so easily be acquired once the move was complete.
Thus I don’t necessarily see a defect in Obama’s plan and still believe his to be superior to McCain’s. Nonetheless, at least on this issue — the need to ensure interstate portability of health insurance — I do believe McCain is absolutely right, and that it’s something everyone’s healthcare plan should specifically address.