The Press reports that replacing the ACA will stretch into 2018. That’s OK! Let’s identify what can be done first to achieve the best results and give relief to our citizens quickly.

Everyone understands that press reports coming out of Washington DC should be met with skepticism and that Repealing and Replacing (R&R) the ACA is always a meaty subject for which pundits often jump ahead of the facts. But, the current reports from politicians, including the President and Republican leaders, are saying that R&R of the ACA will stretch into 2018 should not be viewed as necessarily bad news.

Every Republican as well as the President have made it abundantly clear that the R&R of the ACA is the top priority on their legislative action list. So, they know that they must do something and the folks are getting restless.

But, it would be wise for the Republicans to support the timeline that replacing the “failing” ACA properly, so that no one falls through the cracks, should be accomplished step by step in a well planned and thoroughly disclosed process.

Many are properly reporting that the ACA, while destined to fail on its own, is actually hundreds of independent provisions or regulations which need to be addressed. Many of those provisions will be easily addressed as the replacement occurs but no one wants to make a mistake on the fix, right? Plus politicians know that if they move forward with R&R then the Democrats will willingly grant ownership of Healthcare Reform back to the Republicans.

So, let’s assume that the Leadership agrees that something needs to be done quickly but that slow and steady wins the race.  They should create a public game plan with a step by step timeline for the changes and processes. The public can then have realistic expectations and not fall victim to dishonest reporting about the replacement plans. We all know that the scare tacticians will declare that tens of millions will be losing their plans, and pre-existing conditions will not be covered, that our kids will not get their teeth cleaned, and so forth.

Remember, the R&R plan will be better received if the folks are told up front and ahead of implementation what benefits or provisions are safe and how the timeline will unfold.

 Let’s identify 12 issues or actions that could be quickly addressed and immediately improve the results. Some of these may sound too simplistic but please note that your humble author is in the unique position to see just what it takes to deliver a good plan as well as using a great plan.

The first five are easy and will eliminate fodder for the scare tacticians:

*Kids to 26 – immediately explain that this provision is safe. Insurers have priced for it,   these members are the best risk, generally, to include in a pool, and important at least until the economy improves so these kids can get jobs with benefits.

*EHBs – maintain the provision for the 10 Essential Health Benefits except that the extra burdensome portions, added by special interests, can be omitted.

*GI – for IFPs(Individual Family Plans) which as we said in an earlier post was a mistake omitted from being a part of the HSA/HRA bills in 2002. GI already existed for group plans.

*No Pre-ex – until the legislature address the “failed” individual mandate we must provide for Pre-ex. Leaving Pre-ex as is initially won’t gain us as much rate relief as desired but it will help citizens with serious ailments from worry. That’s good!

*Medicare expansion – leave this up to the states for now to avoid the outcry from the scare tacticians. However, the funding of this expansion certainly needs addressed quickly. It did give the ACA proponents talking points about the millions added to the rolls of coverage even though no one explained that these members pay nothing to get the coverage. Medicare expansion is a single payer plan for the poor which while help is needed it also drives dependence.

The next seven will help gain rate stability and actually lower member costs:

*Metallic Levels – Immediately eliminate all restraints that prohibit insurers from offering plans designed to be competitive and appealing. This means no restrictive actuarial value structure so insurers can actually provide more choice.

*MLRs – we mentioned this one before but we should not require insurers to price to an artificial actuarial line or rebate to members should the carrier have the good fortune to be profitable.

*3:1 pricing – this was a pricing mandate that caused premiums to increase simply because of its ill conceived structure. Allow insurers to price their plans based on the risk or lower risk inherit in younger ages.

*Waiting periods –  allow employers to select a waiting period for eligibility that best suits the employer’s needs.

*Language-English – this may seem simplistic but the folks should know that it is costly for plans to make plan materials available in an almost countless number of languages.
This language requirement is mandated and wasteful. if an insurer chooses to make materials available in multiple languages, for competitive reasons, then go for it. For the record, citizens should also be outraged that their local, state, and federal government make materials, such a driver’s test, available in languages other than English.

*Lifetime limit –  historically lifetime limits were set at various levels determined by insurers. Insurers would determine their plan’s lifetime level based on costs, competition, and reasonableness. Setting the lifetime limit at $10 million would be a suitable and defendable level. It won’t impact premiums initially but over time it will. Mandating unlimited lifetime limits become a target more than a limit.

*Eliminate any ACA Fees or Tax  included in or charged to plans – the benefit of eliminating these costs would be hard to actually see because they have been “baked” into the plans actuarially. But, if eliminated, it would take away another excuse for actuaries and over the next couple rating cycles would deliver lower increases on premiums.

That’s twelve simple steps which will help citizens understand that they will lose nothing and give them the peace of mind to know that rational realistic steps can be taken to increase access to providers, lower cost for member’s out of pocket as well as stabilize and lower premium costs. Our citizens will see that it can be done quickly without loss of benefit.
Finally, it is an easy way to start and it will show folks that they have nothing to fear.

Let me know what you think.

We’re all in this together.

Mark Reynolds, RHU
(559)-250-2000
mark@reynolds.wtf

 

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