Say no to public plan

At Anthem Blue Cross and Blue Shield in Missouri, we support comprehensive health-care reform that will rein in the cost of health care for everyone, improve the quality and safety of care and ensure all Americans have health insurance.

We've been on the front lines of promoting quality, affordable health care in Missouri for more than 72 years. We want to help people stay healthy, get better sooner and keep costs down while ensuring that everyone has access to coverage and the care they need.

Legislation being considered by Congress addresses many critical steps needed for reform. However, we have significant concerns that some specific provisions will have unintended consequences and undermine the goals of reform. We believe the most effective way to improve our health-care system is to build on the employer-based system. Currently, 160 million Americans -- or more than one in two citizens -- receive their health-care coverage through their workplace.

A new government-run health insurance plan to compete with private insurers through exchanges would have tremendous advantages over private plans in the marketplace and would put the coverage and access to care that millions of Americans currently enjoy at risk.

The government-run health plan is unnecessary to achieve universal coverage and would be problematic.

Researchers at the Lewin Group estimate that roughly 114 million people would shift to the government plan almost overnight. With the 95 million people already enrolled in Medicare and Medicaid, two out of every three people in America would have government health coverage. Simply put, this would exacerbate that cost-shifting in the health-care system caused by the government's underpayment for medical care.

What that shift means is less choice in providers for those in the government plan and higher costs for those who want to keep the private health insurance they currently enjoy.

Because Medicare and Medicaid already underpay physicians and hospitals by 20 to 30 percent, more and more doctors are unwilling to accept new patients in these government health programs. The situation is so dire in many parts of the country that a recent Medicare Payment Advisory Commission report, for example, found that as much as 28 percent of Medicare patients could not find a primary-care doctor willing to accept new Medicare patients.

Providers testified in recent congressional hearings that their long-term viability would be at risk if a new government plan is created with payments based on Medicare rates. They even warned that declining revenue from lower government payment rates could force facilities to furlough doctors, staff and close facilities -- reducing patient access to care.

Who is going to provide care for all of these people in the new government plan? Wasn't health reform supposed to be about "choice"? And what about those Americans who want to keep the private health coverage they currently have?

Because Medicare and Medicaid do not pay the full cost of medial procedures, somebody has to pay. These costs are passed along to patients, employers and private insurers -- with the average American family paying an extra $1,700 a year in premiums. This cost-shift will only worsen for those who choose private insurance, particularly as struggling doctors and hospitals look for ways to make up for these losses.

These higher costs will potentially force employers to drop coverage and eliminate their employee's ability to choose what type of health-care coverage is best for them and their families -- meaning even less choice.

The government plan would also have many advantages over private plans. While private plans can be sued in state courts for punitive, compensatory, or other damages provided for under state law, the government plan as proposed could only be sued in federal court.

The government plan would also be exempt from the many state taxes, assessments and regulations that private plans must follow. While private plans must maintain stringent state-mandated contingency reserves, the government plan would be exempt from solvency requirements and would enjoy at least $2 billion in startup money from taxpayers. Big changes are on the horizon in health care -- changes that will affect each and every American in a personal way. We agree we urgently need to reform our health-care system. Our goal should be to build on what works and make it better.

Dennis Matheis is the president of Anthem Blue Cross and Blue Shield in Missouri.