Gene Meyer, president and CEO of Lawrence Memorial Hospital, foreground left, and Sandy Praeger, Kansas insurance commissioner, visit before Praeger addressed an audience on health care reform during an event sponsored by the Lawrence Chamber of Commerce and LMH in September 2009 at the hospital.

Kansas Insurance Commissioner Sandy Praeger remains hopeful that some of the nation’s health problems will be fixed at the federal level.

She talked about health care reform during a breakfast Wednesday morning at Lawrence Memorial Hospital, which about 140 people attended. The event was sponsored by LMH and the Lawrence Chamber of Commerce.

Praeger reviewed three major proposals that are being considered in Congress. They all get rid of pre-existing conditions, but then the debate begins.

Among the issues: Whether to mandate coverage, whether to offer subsidies, whether to tax expensive health plans, who will oversee regulations and how to pay for reform.

Praeger said these four key elements should be addressed for successful health care reform:

• Getting rid of pre-existing condition exclusions.

She said her department receives calls every day from people who have been denied health insurance coverage or even lost coverage because insurance companies claim they lied about a pre-existing condition — even in cases when they didn’t know they had one at the time.

“It will just take away a huge, huge disagreement that crops up between insurance companies and individuals,” Praeger said.

• Mandating that everyone has health insurance.

She said the nation can’t get rid of the pre-existing condition exclusion unless it mandates that everyone be covered.

“If we don’t require people to buy coverage, then they will just wait until they need it and then they can’t be excluded, and it will just drive up the cost for everybody,” she said.

She said it is similar to buying car and home insurance.

“You can’t buy home owners insurance after your home is on fire,” she said.

• Offering subsidies to make insurance affordable for low-income residents.

“You can’t tell somebody that they have to buy something if they can’t afford it, so we are going to have to step up to the plate and find ways to make it affordable,” Praeger said.

• Keeping regulations mostly at the state level, and offering some flexibility in those regulations.

Praeger said consumers have unique problems that aren’t necessarily going to be covered under one standard.

The insurance commissioner said if Congress doesn’t pass health reform, it likely will be due to bipartisan battles. But, she thinks Tuesday’s vote by a Senate panel to reject a government-run option — which she thinks is off the table for good — will bring the sides closer together.

“At least, I hope so,” she said.

If the federal government fails to pass health care reform, Praeger expects the state to pick up the issue. But, she said, some issues such as pre-existing condition exclusions need to happen at the federal level.

“I will be very disappointed if we don’t get some of them passed,” she said.