1. People in US cannot buy health insurance across the state border. The population size for each pool is very limited. This will increase the premium.
This is just an adminstration issue. Insurance companies can sell insurance in other states, as long as they are approved by the regulators. Almost all physicians have contracts with insurance providers. Imagine the overhead if you have 60 different insurers selling insurance in one city. How many different claim systems do you need? At the end, a doctor would only pick a couple insurers to work with. This limits your accessibility as a patient. Consolidations might happen over the long run, leading to a few major players dominating the entire country. However, this is not what the government wants and I am not sure if it's really good for the consumers.
2. Health insurance plans have to include clinical care. As the expected claim number increases, the premium will increase too.
What exactly do you mean by clinical care? You mean regular office visits and preventive care? It's inpatient stays in hospitals that are driving medical costs up. You talked about utilizations going up but didn't talk about the cost side. You could have a lot of office visits but each only costs $100 - $150 where as a hospital stay can cost you $100K. |