NCPA - National Center for Policy Analysis


February 11, 2010

Most proposals for dealing with the problems of pre-existing health conditions would completely divorce health insurance premiums from expected health care costs, requiring health plans to enroll individuals regardless of their health status.  Yet a policy of trying to force health plans to take enrollees they do not want risks jeopardizing the quality of care they receive, says John C. Goodman, President, CEO and the Kellye Wright Fellow with the National Center for Policy Analysis. 

Instead of suppressing the price system, following are 10 ways of dealing with this problem that make greater use of it.  In a reformed health care system, the chronically ill -- along with their doctors, employers and insurers -- should find lower-cost, higher-quality, more-accessible care in their economic self-interest, says Goodman: 

  • Encourage portable insurance.
  • Allow special health savings accounts for the chronically ill.
  • Allow special needs health insurance.
  • Allow health status insurance.
  • Allow self-insurance for changes in health status. 


  • Give people on their own the same tax break employees get.
  • Allow providers to repackage and reprice their services under Medicare and Medicaid.
  • Allow access to mandate-free insurance.
  • Create a national market for health insurance.
  • Encourage post-retirement health insurance.  

These 10 reforms would encourage insurers to compete to cover patients with chronic illnesses, rather than trying to avoid them.  They would give doctors and other health care providers incentives to innovate, and to use technology in order to improve quality and reduce costs, says Goodman. 

Source: John C. Goodman, "Ten Small-Scale Reforms for Pre-Existing Conditions," National Center for Policy Analysis, Brief Analysis No. 691, February 11, 2010. 

For text:  


Browse more articles on Health Issues