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HEALTH PLANS SHOULDN'T COST AN ARM AND A LEG

Even amid the justified cheers that greeted its passage, it was predictable that the 1996 Kassebaum-Kennedy health-insurance law would still let many working Americans fall through the health-care cracks.

The euphoria greeting the law was justified because of the difficulty of winning any health-care improvements following the failure of a comprehensive reform effort in 1994.

But the problems were predictable for precisely the same reason that the law was needed in the first place: the insurance industry's singular focus on minimizing risks by excluding those customers who most need coverage.

Without some controls on price -- which the bill lacked -- it was inevitable that the industry would get around a mandate to offer coverage by making that coverage so expensive that few Americans would be able to afford it.

That's exactly what has happened, according to an analysis by the General Accounting Office, the investigative arm of Congress.

The GAO found that working Americans who need health insurance and try to take advantage of the law to get it often are being charged exorbitant prices of up to 600 percent more than the standard rate.

GAO probers also uncovered evidence that some companies are discouraging agents from selling policies to people with medical problems -- the very citizens who were supposed to benefit from the new law.

The 1996 reform measure was supposed to fill a gap in the health-insurance market by making insurance "portable" so that workers could maintain their coverage when they change or lose jobs. Workers who had insurance on their old jobs were supposed to be able to buy a policy to replace the group insurance they lost if they couldn't find a new job or if their new employer didn't offer coverage.

It sounded like a splendid idea. But the federal law said nothing about the price of the new coverage. Congress left that up to the states. Now it appears that many states have been lax in preventing insurance companies from pricing individuals out of the market, despite a law that technically gives them access.

If families can't afford to buy the coverage, the law making that coverage available is little more than a cruel joke on those who need it most.

Sen. Edward Kennedy, the Massachusetts Democrat who co-sponsored the bill, says that federal action to limit "excessive premiums" now may be needed.

He's right. An industry in which competitors win by insuring only the healthiest people is one that is ripe for federal intervention. That's particularly true after the industry was given two years to see how it would behave, and after the GAO found that it has behaved rather badly.

If the market and the market alone rules, even insurers who would like to provide the transitional coverage may feel that doing it is impossible. Federal rules would level the playing field and lower the competitive penalties for doing the right thing.

Americans increasingly are viewing health insurance as a right, and justifiably so. Everyone has the right to pursue good health, and insurance is a prerequisite. Such coverage is taken for granted in most other industrialized countries.

Here, unfortunately, it still is parceled out in a piecemeal fashion that misses far too many working Americans.

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