Insurers must renew all group and individual health policies on request. Wise states will show restraint in meeting these goals. For example, states need not force small-group insurers to offer all types of insurance to all comers. Virginia is moving to require guaranteed issue of a single policy, one based on the NAIC's '93 model plan. Oklahoma, Georgia, Idaho, Utah and South Dakota are following suit.
States can also guarantee individual coverage without sweeping reform.
One way is to set up a high-risk pool for those who can't get other insurance. States with high-risk pools can continue this proven approach and apply for a waiver from the new law's rules. Another way to expand access to health insurance is to let people open medical savings accounts in conjunction with high-deductible health policies. The lower cost of these policies' premiums brings the price of insurance within reach of people who are now priced out of the marketplace, while the MSA provides cash for first-dollar coverage of small medical expenses. State legislators will decide in the next few weeks to make health insurance more or less expensive and more or less secure.