States define health care

With the passage of health reform the cost containment battle shifts to the states.

Many people were surprised to learn, during the debate, that state insurance commissioners define what services health policies must contain. This has not changed.

Most states appoint insurance commissioners but some, like my own state of Georgia, elect theirs. Our current commissioner's gubernatorial campaign was scuttled by a tongue-in-cheek review of his ties to those he was regulating. (That's him, from Johnoxendine.com.)

In short there is a pressure point here ripe for exploiting.

A recent Los Angeles Times piece on this expressed hopelessness. Consumer advocates claimed regulatory capture, that insurers define through politicians whatever terms they wish and get rich in the process.

The focus was on the lack of prior approval authority for rate hikes, but commissioners can be challenged on other grounds, like what they're covering and not covering:

• Why are insurance contracts covering homeopathy, which doesn't work?
• Why are some covering prayer, which whether it works or not is not a medical procedure?
• Why aren't some states covering medical tourism, which can lower costs? Especially since companies that self-insure their risks can offer it.

Rather than creating non-insurance insurance, catastrophic plans that don't kick in until patients are broke, affordable policies can be created by beginning a dialogue on what should be covered and what should not.

Advocates could focus on one state, one that defines coverage in a way to make it unaffordable. Focus on what's covered that shouldn't be. Emphasize the savings and organize alongside business interests.

Such an alliance could, if successful, then take on the more contentious question of mandating cost-effective care, requiring the use of best practices, implementing the results of comparable effectiveness studies.

The power to say no is the only force we have to control health care costs. States have it, just as insurers have it. Insurers are starting to use their power. State regulators need to join them.

This post was originally published on Smartplanet.com