With the public option shelved and the hysteria over nonexistent "death panels" exhausted, opponents of health care reform have zeroed in on the notion that everyone must buy insurance.
Tyranny! The protests ring from state legislatures, tea party meetings and from Congress, where Republicans will seize any cause to stop Democrats from securing a major legislative accomplishment.
Sandy Praeger is one Republican who refuses to join the opposition.
“We need to create an expectation that everybody needs to be insured for medical care, just as we have an expectation that we have to buy auto insurance," the Kansas insurance commissioner said.
Praeger knows health insurance. She spent three terms in the Kansas Senate working on patient protection laws. As the state's elected insurance commissioner since 2003, she regulates all insurance sold in Kansas. She also is the head of the health insurance and managed care committee for the National Association of Insurance Commissioners.
Praeger has no objection to government requiring people to buy health insurance. The individual insurance mandate, she noted, began as a Republican idea. Some of the GOP senators who are driving the opposition supported it during the Clinton administration.
But the political winds are blowing with a fury. And so, like a good Kansas politician, Praeger has come up with another approach for getting healthy people in the insurance pool — a must if insurers are expected to cover chronically or severely ill people at a reasonable price.
Praeger's idea: People under a certain age — say, 25 — would be eligible for insurance without having their health status evaluated. Once consumers reached the designated age threshold, their continuous coverage would be guaranteed without medical underwriting as long as they paid into a policy. If they dropped their coverage they would have to pay a penalty and have their medical history evaluated — at the risk of being charged a higher rate — before getting reinstated.
Praeger's idea would leave some people uninsured — at least at first. Government subsidies would still be required to help low-income people buy policies.
But it seems that it would create a powerful incentive for people to maintain insurance policies, without being required to do so by Washington.
And, it's a thoughtful detour around the gridlock that we're seeing in Congress.
Praeger has floated her idea to some congressional staffers. She's received interest but so far no traction.
Why is that? If all ideas are back on the table, this one seems worthy of being in the mix.
Because of her leadership role with the National Association of Insurance Commissioners, Praeger is often tapped as a resource by Capital Hill staffers. So far, she said, nearly all the inquiries have come from Democrats.
If Republicans would ask, Praeger would tell them that her years in the trenches have convinced her that insurance reform can't be accomplished by small fixes or by deregulation.
Unfettered selling of insurance across state lines would spell the death of regional insurance firms and quickly result in a market dominated by a handful of national companies that offer minimal policies at low premiums, she said. Sick people would be left in the lurch.
Praeger doesn't reject all Republican ideas. She favors medical malpractice reform and sees it as a bargaining chip the Democrats could use.
She thinks the tax break handed to people with employer-provided health care plans should be extended to the individual market.
She thinks any bill that's passed needs to do more to curb soaring costs.
And, like others who have devoted their professional careers to the quest for a saner form of health care in the United States, Praeger decries the triumph of politics over the greater good.
"They're always running," she said of Washington's politicians. "We never get a grace period, where they're focused on public service."