That may also be good short-term politics  there are a lot more healthy people than chronically ill people  but it shortchanges those who most need help. And until the problem of rising medical costs is addressed, the government will never solve its deficit problem.

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Here is a look at the main “fixes” contained in Republican reform bills. They primarily affect people who buy their own policies or work for small businesses, not the vast majority who get their insurance through larger employers.

INSURANCE IN ANY STATE The cost of insurance for individual buyers varies considerably by state. In New York, for example, the premiums are high because insurers are required by law to accept all applicants without regard to their health status and provide a wide array of benefits.

Under federal laws, health insurers can sell policies only to individuals in the states where they are licensed to do business. The Republican proposals would allow insurers to designate any state as their primary place of business and then sell policies to residents of any other state. Most insurers would probably choose a state with few requirements, enabling them to offer skimpy policies, shun the sickest applicants and keep premiums low.

The Congressional Budget Office expects that young and healthy individuals would flock to the lower-benefit/lower-premium states while the older and sicker would flock to the states where they are guaranteed coverage, causing premiums to rise even higher there.

The Republicans are also calling for federal bonus payments to states that reduce the number of uninsured or states where insurers lower their average premiums for individual and small group insurance. The idea has some merit as an add-on to more comprehensive national reforms, but leaving the states to solve such major problems is unlikely to have much success.

ASSOCIATION HEALTH PLANS The Republicans would allow individuals or small businesses to buy group coverage through various business, professional or civic associations. The notion, a good one, is that a broader pool should enable the group to get lower rates than an individual could. The downside is that these associations could also tailor their policies to attract the healthy, leaving the sicker out of luck or in small group coverage where they would drive up the average premiums.