Improving Private Health Coverage
The Need for Health Care Reform
Hardworking Texans pay more money each year for health insurance but often receive less coverage in return. One in four Texans has no health insurance at all. A chronic disease such as MS means extra reliance on health care services to maintain or cope with the effects of a progressive condition.
Accessibility of Coverage
The reasons for the high number of people without health insurance are most often related to two factors: 1) the high cost of coverage and 2) medical underwriting, or the process by which many people are legally denied coverage due to their health status.
Affordable Health Care
People with chronic illness or disability are especially likely to be underinsured. This includes people with plans that have high premiums, high deductibles, limited coverage for needed health services, and plans with excessive co-pays, co-insurance and pre-existing condition exclusions.
In a 2007 random survey of people with MS, 21% reported spending less on food, heat and other necessities to pay for health care needs, and 22% did not fill prescriptions or skipped doses of medicine despite having insurance coverage.
Recommendations:
- Standardize and enforce guidelines for reasonable medical loss ratios on health plans
- Tighten rate bands or implement community rating to decrease premium variation in the small group and individual market
- Facilitate the broad dissemination of risk through re-insurance methods
- Give TDI the authority to review and approve or reject rates in the small group and individual market
- Monitor the effect of Consumer Choice Benefit Plans on selection and pricing of standard benefit policies
- Minimize or eliminate pre-existing condition exclusion periods designed to prevent consumers from participating in insurance
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