Waterloo-Cedar Falls Courier (Iowa)

An estimated 45.8 million Americans don’t have health insurance, often because their employers don’t offer it, sometimes due to the high sticker price, but in many cases they are rejected because of one or more common ailments.

In California, Gov. Arnold Schwarzenegger has proposed requiring all California residents to carry health insurance, but many can’t get it because the insurance companies have narrowed their risks to people without any pre-existing conditions.

According to the Los Angeles Times, applicants were rejected because of: allergies, arthritis, asthma, attention deficit disorder, autism, bed-wetting, breast implants, cancer, cerebral palsy, chronic bronchitis, chronic fatigue syndrome, chronic sinusitis, cirrhosis, cystitis, diabetes, ear infections, epilepsy, heart disease, hepatitis, herpes, high blood pressure, impotence, infertility, irritable bowel syndrome, joint sprain, kidney infections, lupus, mild depression, muscular dystrophy, migraines, miscarriage, pregnancy, “expectant fatherhood,” planned adoption, psoriasis, recurrent tonsillitis, renal failure, ringworm, sleep apnea, stroke, ulcers and varicose veins.

Occupations also could prompt rejection. Some insurers reject police officers and firefighters, making it difficult to recruit self-employed police reservists or volunteer firefighters.

“This isn’t cherry picking; this is ignoring whole orchards of people,” said Jamie Court, president of the Foundation for Consumer and Taxpayer Rights.

The federal government is looking at the states as incubators for health-care management, just as they were for welfare reform.

In Massachusetts, where 515,000 people were uninsured, liberals and conservatives put ideologies aside to develop a health-insurance program for all residents, recognizing that medical facilities were providing $1 billion in “free” health care to those who couldn’t pay — costs passed on to consumers and taxpayers.

Its plan mixes state subsidies, existing programs such as Medicaid as well as employer-paid premiums and those paid by individuals.

As with auto insurance, all Massachusetts residents must show proof of health insurance. Tax penalties will be incurred by those who can afford to pay, but don’t. A sliding scale determines the ability to pay.

Private companies get subsidies to help cover the working poor and children. Small businesses not offering health insurance are required to pay an annual $295 fee per employee.

Businesses with 50 or fewer employees can purchase coverage with pretax dollars. Families will cover children, possibly up to age 25.

Policies can be tailored to fit needs — such as a less comprehensive, less expensive ones for young people.

The estimated cost is $1.2 billion over three years, but only $125 million is new state money. The rest comes from existing state and federal programs.

Illinois’ All Kids program covers all children with premiums and co-payments based on a family’s income. Wisconsin is considering a similar BadgerCare program.

To encourage small businesses to cover their workers, West Virginia allows private insurers access to rates negotiated by the West Virginia Public Employees Insurance Agency with health-care providers. Employers must split the cost of premiums with workers for employee-only coverage.

New York and Vermont offer subsidies for companies providing insurance for low-wage workers Oregon, North Carolina and Missouri stress disease managementand preventive care to save money on Medicaid. Missouri wants to use the money saved — as well as price competition — to provide subsidies to help small businesses offer health insurance.

When it comes to competition, the Federal Employee Health Benefits Program –with premiums up only 1.8 percent this year compared to 7.7 percent nationally — has kept its costs down by providing access to 284 plans.

In Iowa, Democrats want to dramatically expand access to health-care coverage and quality child-care programs. Republicans want to make it more feasible for small businesses to offer health insurance.

It should be a top priority, given the staggering potential medical and financial impact on residents who cannot afford or obtain policies. Legislators would do well to study the initiatives of other states and pursue the most pragmatic course.