New Era for Healthcare Solutions


She’s not exactly Employer Driven but certainly adorable.

January, 3rd 2017

We have seen Healthcare Reform, now we must fix the Reformed

Today, we start a new ERA in the life of this Blog. The intent has always been to help brokers and employers understand the changing healthcare market but now we have a renewed sense of excitement, direction and energy.
BTW, you have a new email at which to reach me-

We know that with a new administration there will be changes to healthcare and we all remember how confusing and unsettling the years 2010-2014 were for everyone. Over the coming months we will address dozens of issues and ideas related to fixing healthcare and its financing. Since we know the ACA is in for some modification, if not repeal, then the discussion will center on its replacement.

In the coming weeks we will discuss replacement issues such as:

  • Plan designs
  • Premiums & pricing
  • Pay or Play mandates
  • Taxes & fees
  • Exchanges
  • PPOs
  • Transparency
  • Cross state plans
  • Pre-ex conditions
  • Group plans
  • GI for Individual Plans “IFPs
  • and much more

Today let’s address a topic that will be used or rather misused by some to make headlines, scare the public, and complicate any changes. It is the topic of “Guarantee Issue (GI) and pre-existing conditions” for IFPs (Individual & Family Plans). The ACA provided for GI but relied on the mandate for enrollment.

The mandate for citizens to get covered was supposed to push everyone into healthcare coverage which would theoretically make it easier for insurers to price and profit from their plans.  As you know, not only did premiums increase astronomically to the average person on IFPs, (and small employers too) but plans were built with “skinny” PPOs and benefit designs that left members with a lot of out of pocket.
Resulting in the opinion – “why pay for insurance that doesn’t pay anything?”

Plus, reports show that 20-25 million citizens still don’t buy health insurance. So, the individual mandate did little to help.

So, let’s agree that GI is absolutely required for IFPs. That means there are two ways to address affordability:

  1. Make the penalty for not being covered substantial such as $3000/yr or 9.5% of gross annual income. Would that be sufficient to drive citizens to buy a health plan?
  2.  Allow a common sense and reasonable Pre-ex condition. We can look back 25 years to see a model that can accommodate this goal. It’s simple and it’s defendable. Here it is:
  • Make all IFPs be GI, but with a reasonable pre-ex period for late enrollees.
  • First to clarify, if a citizen has coverage but changes to another plan there is no pre-ex period. As long as coverage has no gap longer than 60 days – No Pre-ex.
  • But for late enrollees, a one year pre-ex period which will allow insurers to stabilize premiums yet guarantee access to anyone wanting to buy a plan. Call it a 12/6 pre-ex.
  • If a citizen does not buy their own plan when first eligible s/he could still get GI at a later time but with a one year Pre-ex for illness treated during the previous 6 months. The illnesses would be defined so no carrier shenanigans can occur.
  • This is the way it was addressed before HCR in the 1990s. If those IFPs had been GI then the issue of access would never have been brought up.
  • This would address the human nature tendency to “buy insurance after your house is on fire”. It would also allow insurers to develop competitive pricing.
  • Last and maybe most important. It’s a defendable common sense approach. All Americans could support this approach as fair, especially when premiums are reduced and stabilized! Americans would get behind a policy that had teeth in it for to penalize those trying to slide by. It would also be a good talking point on TV News.

As we discuss these issues in the coming weeks I look forward to your feedback and your ideas. Please send me your ideas! We can’t trust Republicans to get it right any more than we trusted the Democrats in 2009 and 2010. Let’s make sure that the wisdom and working knowledge of brokers and employers is heard.

I look forward to starting up our discussions again.
And remember, we are all in this together.

Mark Reynolds, RHU                                                                                                                                                        559-250-2000

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2 Responses to “New Era for Healthcare Solutions”

  1. Mark Rogerson Says:

    Makes perfect sense, we should make Mark Reynolds Trump’s Health Care Czar!

  2. Mark Reynolds, RHU Says:

    Thanks but I’m not sure Mr. Trump needs anymore problems. I’ll stay where I am.

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