On July 2, 2015, Governor Jeremiah “Jay” Nixon signed Missouri House Bill 769 “relating to direct health care services” into law (PDF).
MO HB 769 makes Missouri the twelfth state in the Union to enact such a law recognizing the legitimacy of direct-pay medical practices and defending the model against regulation by the state department of insurance.
The most outspoken opponent of this bill was the insurance lobby. Now, why would that be? The direct health care services model is ideal for those who are uninsured—those who either can’t afford insurance, feel they don’t need it or for those with high deductible health insurance coverage, which is designed to help with burdensome, bankruptcy-causing medical bills. It stands to reason that insurance companies don’t make much, if any, money on these folks. And, if those who are fully insured choose to utilize a direct pay practice for their primary care, it is out of the insured’s own pocket, not at cost to the insurance companies. So, how could this be of any potential concern or harm to the Insurers?
Since there is now a national “law” that states all must have health insurance, one might wonder why an enterprise such as a cash-pay model of primary care is necessary, or at the very least important enough to warrant a state law. How can there be any uninsured patients? If you don’t have insurance, aren’t you now breaking the “law”?
Let’s use an example of a healthy 30-year-old woman. She is single and makes three times the poverty level. She received an exemption this year, because she doesn’t make enough to afford any policies on the exchange. Yet, she also can’t afford any high deductible insurance. So she just hopes life doesn’t deal her a bad hand. Is she a law-breaker? If so, this criminal element is perfect for a direct pay model of medical care. She needs “maintenance” to make sure she doesn’t break down alongside the road, and to keep an eye on anything that might run in her family. Is it reasonable to require her to pay for a product or service solely to compensate for those who receive the subsidies and get the bargains? So much for being affordable for all.
What about the “underinsured? The underinsured are those who have a high-deductible health insurance plan. Some deductibles may be affordable for one, but not for another. Most of these plans pay for very little until the deductible is met for the year. These consumers must pay for primary care and medications out of pocket. The model of direct-pay primary care provides affordable office visits, labs and even some medications for patients. It takes up the slack so the uninsured and underinsured do not have to wait until a problem becomes urgent or emergent, which will inevitably cost more than the original preventative measure or early detection.
So back to the question: why would the insurance lobby be opposed to this bill? Their overwhelming presence was felt at the committee hearings in both the state House and Senate. I believe the answer is a concern for public understanding. The American people have been fed a great lie. Insurance is insurance and nothing more. Insurance cannot get to know you. It cannot hold your hand or give you a hug. It cannot know that because of your anxiety a different type of inhaler would help you more than another. It cannot know that your living situation may preclude therapy effectiveness. It cannot guarantee you a same day office visit. It cannot promise, “If you like your doctor, you can keep your doctor.” Or if you like your nurse, or if you like your receptionist, or if you like your clinic, you can keep any of them. It cannot place sutures in a laceration. It cannot stop bleeding. In other words, it is insurance, but it is NOT care and it is NOT access. You can have the best insurance plan on the planet, but if no one bills it, of what worth is it? If the public were aware of this, that the mandate to have an insurance plan to cover “healthcare” will not make you healthier, or more wealthy or happier, We The People might consider taking a closer look at a the national “law.” We might then find some problems in the “law.” We might start looking back at who supported it and how they benefitted from its passage. We might also find at whose expense the entire system has been shifted.