Jan. 15--Millions of working Americans don't get health insurance through their employer. How they can access affordable, quality insurance is at the core of final discussions over a federal health care reform bill.
Both the House and Senate bills include insurance "exchanges" that would allow individuals to compare and shop between different plans. But the differences between the two bills are enormous.
The Senate version creates 50 separate state exchanges -- a patchwork of varying quality and affordability.
The House version sets up a national federal exchange, with an opt-out for states able and willing to meet certain standards.
Massachusetts, for example, already has a well-functioning exchange. Other large states, such as California, also might want to manage insurance on their own with tough national standards for insurance companies that participate.
On this score, the House bill is far better than the Senate version. That's why California's congressional delegation should fight for a national health insurance exchange. Fortunately, according to a report in the Wall Street Journal on Wednesday, the White House wants a national exchange in the bill that goes to the president's desk.
A national exchange, as many experts have pointed out, would reduce insurers' ability to game the system. If they want to compete for the estimated 30 million new customers who would come to the exchange, insurers would have to follow certain standards.
A national exchange also would create a sizable risk pool for small states that would have little negotiating power with insurers in a state exchange (bringing down premium costs for individuals).
A national exchange also would add "another cop on the beat" to make sure that insurers do as they say in providing coverage and ending discriminatory practices (such as denial of coverage for pre-existing conditions).
Equally important, a national exchange can provide a forum for standardized information about insurance plans, including complaints and satisfaction, so individuals can make informed choices. Individuals would have a choice among several national insurers as well as the local insurers.
Such a function wouldn't be new for the federal government, which already successfully runs exchanges like the Federal Employees Health Benefits Program.
If the Senate version were to prevail, states would be authorized to create their own exchanges. Some would likely take the job seriously, some won't. The Senate version would allow the federal government to step in if states failed to meet their obligations. But this would create a crazy quilt of health care coverage, with very different results for individuals depending upon the state in which they reside.
California is key to the outcome. House Speaker Nancy Pelosi and committee chairmen George Miller and Henry Waxman, on the team negotiating with the White House, still have some heavy lifting to do to ensure a national exchange makes it into the final bill.A 50-state patchwork, without some meaningful national benchmark, doesn't provide the choice and competition Americans deserve in a major reform package.
Editorials are the opinion of the Merced Sun-Star editorial board. Members of the editorial board include Publisher Debra Kuykendall, Executive Editor Mike Tharp, Editorial Page Editor Keith Jones, Copy Desk Chief Jesse Chenault and Online Editor Brandon Bowers.
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