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Andy Harris learns a lesson

Andy Harris probably learned a lesson from the flap caused by his questions about the health care benefits he'll enjoy as a congressman in a supposedly confidential briefing — but likely not the right one. Mr. Harris, a Republican and a physician who was elected this month to represent Maryland's 1st District, will surely chalk this one up as a painful object lesson in the "gotcha" culture of Washington, where reporters were eager to pounce on the health care reform opponent's apparent dismay that his new benefits wouldn't kick in until he'd been on the job for a month. But here's hoping that instead, Mr. Harris takes away a lesson in the problems millions of Americans face in getting and keeping health insurance, and uses that experience to inform his lawmaking.

Mr. Harris has backpedaled from initial reports about the incident on Politico and insisted that when he started asking incredulous questions about the fact that his congressional health benefit plan wouldn't kick in on the day he's inaugurated, he was really concerned about others in the House's freshman class who might not have the options he does. Or maybe that he was trying to make some point about the irony of the federal government requiring individuals to have health insurance but making them wait a month before its own benefit policy kicks in. For the sake of argument, let's take him at his word on that. Either way, it points to a disconnect between Mr. Harris' opposition to the president's national health care reform law and his personal understanding of the health care system.

Critics of the health care law often lampoon congressmen as having a gold-plated health care system that is unavailable to the average citizen. But what we learn here is that the gold-plated system is actually the one offered by Mr. Harris' current private-sector employer, Johns Hopkins Hospital. It covers new employees on day one, whereas the congressional system — which is really just the same system that all federal employees are eligible for — doesn't kick in for a month.

It's also worth noting that the federal system isn't particularly a sweetheart deal; it is a BlueCross BlueShield plan, and once Mr. Harris does enroll, assuming he takes the standard plan and not the cheaper basic option, premiums will cost him $199.20 every two weeks. He'll have a $700 annual deductible and a $250 co-payment for admission to preferred hospitals, more for others. Non-unionized, full-time Johns Hopkins staff members will pay $138.20 every two weeks in 2011, and unionized employees will pay $103.65. Hopkins employees will see no increase in health insurance costs next year, and dental insurance will actually get cheaper.

Mr. Harris has been working for Hopkins his entire professional career, so it may have been a very long time since he had to grapple with the reality of new insurance when switching jobs, but that's actually a huge part of the problem of the uninsured. Many of those who lack insurance at any given time are experiencing a gap in care, not a chronic lack of coverage. There's actually a mechanism in the health care reform law that could fix that, and it's a version of an idea that conservatives have long championed. The law requires states to set up health insurance exchanges, which are marketplace in which individuals can select coverage among a number of private providers. The purpose of the exchange is to allow the unemployed or self-employed, or those who work for small firms that don't offer insurance, to buy policies on the private market but get the cost savings usually associated with purchasing insurance through a large employer.

It also could help make sure that individuals don't experience gaps in coverage while temporarily unemployed or switching jobs. In fact, Mr. Harris noted this benefit in a 2009 op-ed, calling the exchange "one of the better ideas" in the health care reform legislation. He wrote in The Daily Times of Salisbury that "people would have a health care insurance policy they can call their own. They could choose one that exactly fits their families' needs and their budgets, be able to take that coverage with them from job to job and be able to 'fire' their insurance company if it doesn't treat them well."

But the idea was watered down in the legislation that passed Congress, and it won't be of any use to Mr. Harris or others like him. The exchanges don't start until 2014, and the legislation was set up to exclude those who work for large employers (like, say, Hopkins or the federal government) from participating. If Mr. Harris wanted to make a constructive contribution to health care reform, perhaps he could advocate for opening the exchanges to all.

More fundamentally, though, Mr. Harris' remark betrays a belief that when it comes to him (or the other members of Congress he was apparently so concerned about), going a single day without health insurance coverage is unacceptable. When he takes his seat in Congress in January, Mr. Harris might do well to think about his reaction to that possibility, and of the fact that, according to the Census Bureau, 50.7 million Americans lack health insurance coverage, an all-time high. Say what he will about the health insurance reform law, but "Obamacare" makes a serious effort at ensuring that everyone will have health insurance — the Congressional Budget Office estimates it will more than cut the number of uninsured in half.

When it comes to health care, Mr. Harris has expressed a lot of concern about reining in medical malpractice judgments and limiting the work that can be done by nurse anesthetists (in favor of physician anesthesiologists like himself) but less about expanding access to health care. Now that he's experienced the fear of being uninsured, perhaps he can persuade his GOP colleagues to stop talking about repealing the health care reform act and instead improve it so it covers the 23 million Americans that even it would leave behind.

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