Let’s Prepare Now for Healthcare Reform Decisions

Is it time to discuss Repeal and Replace?

In the next six weeks, the discussions will once again return to the Supreme Court’s decision on PPACA.  Therefore, we need to prepare now for what our industry’s realistic and common sense approach to SCOTUS’ decision can be.  If the law is upheld we must go one direction but if it is struck down in all or in part then we must go another.  Currently the media is focused on the GSA and Secret Service scandals; and therefore not giving healthcare much attention, but that will change.

Therefore let’s focus on “repeal & replace” for a moment, since that is the Republican motto, for now.  One way or another during this coming summer and fall, we will need to address “repeal & replace” so let’s assume we must replace the law because the citizens will not stand for the status quo.

Here are 10 ideas to include in a bill to repeal and replace:

  1. Make health insurance premium tax deductible for anyone who pays it.
  2. Make all Fully-Insured plans Guarantee Issue to 1 EE Business with a reasonable Pre-ex period.  Pre-ex period 6 months.
  3. Allow Carriers a reasonable corridor for Risk Adjustment Factors (30%).
  4. Tort reform: Loser Pays or Fixed Attorneys at 15%.
  5. Allow carriers and plans to sell across state lines.
  6. No new benefit mandates for 5 years.
  7. HRAs and MERPs to be permissible and available to implement on all plans.
  8. All providers and insurers to publish outcome statistics and experience data.
  9. Universal Enrollment forms for Employer/Employees, Individuals/Families.
  10. Health plan commission set at level 7% and does not increase as premium does.

I also think wellness, pooling for individuals and families, and a traditional approach to underwriting will be important.  Certainly, if we want to bend the cost curve downward we must address behavior and expectations through real wellness and benefit structure.

I will expand on these ideas over the coming months but let’s make no mistake; the issue is access and affordability.  The industry and those of us who make our living in it must drive this discussion.  We can not sit back to let any Congress, Republican or Democrat, develop the solutions because that will provide no solutions.

I suggest that every carrier executive involved in plan design and pricing go to the field and meet with small employers.  Just a few conversations will make it clear that employers are willing to provide their health plans in new and better ways if someone will just show them how.

We need to show them how.  More about that later.

Some may think that I am premature in discussing this matter or that it will never come to pass.  Well, that is what we, as an industry, did from 2002-2009 and look what happened.

This time, let’s plan to be ready!

Let me know what you think and give me your ideas to improve my Basic 10.

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One Response to “Let’s Prepare Now for Healthcare Reform Decisions”

  1. Leroy Says:

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