Small changes and good communication could lead to a successful Healthcare Bill to replace the ACA. Let’s discuss:

Last week I promised to continue analyzing the key components of the AHCA 2.0 and we’ll do that. But based on the Press’s over-reporting on President Trump’s meeting in the Oval Office with the Russians, Former Director Comey, the so-called Russian conspiracy, the appointment of Robert Mueller as Special Counsel as well as the President’s historic trip to the Middle East I thought we could take a different path.

The reasoning is that while the Press is focused on trying to bring down President Trump it has taken the focus away from the House/Senate’s work on the ACHA 2.0 and has allowed the “Senate 14” to work on their health plan virtually unmolested by the press. BTW, the Senate 14 is a name I’m attaching to the 14 old white guys in the Senate assigned to produce a fix for the House bill.

As we discussed in past weeks, the initial actions related to replacing the Affordable Care Act do not need to be earth shattering, controversial or bad for the environment. There are a number of changes that could make plans easier to understand for members, make it easier to choose the plan best suited for your needs, provide better value and not stir up political upheaval.

I know its naïve to hope that some common sense changes to the ACA can be embraced and that it is not necessary to go to war on every suggested action. Here are just a couple of thoughts to help the Senate “save the day”:

  1. Address the issue of Medicare Expansion first – make it known that the AHCA 2.0 will not affect members covered under the current guidelines for 2 years. Also make it clear that during that period rules will be enacted to do two things:
    * One is explain how and make it clear that the truly needful enrollees will lose nothing. The method by which their premium payments may be different such as Pre-fundable tax credits but that this method will create more choices, more plans available and more doctors who accept the plans.
    *Two is enact and explain how able bodied employable people (probably younger) will be reduced from Medicare Expansion because it just isn’t designed for the current young and/or able-bodied working folks. But more plans with lower premiums will be available which will be more beneficial to them.
  2. Plainly spell out that plans will be “guarantee issue” and no “pre-ex” for those that stay covered. Explain that more plan choices with lower premiums that are GI will be better than the ACA for folks that don’t try to game the system by going without coverage.
  3. Address the need, make that requirement, to have coverage using one of the following methods.
    * Keep a “Mandate”  similar to what is currently in code but with real penalties for non-compliance. For instance: individuals should a graded penalty that is increased by age as well as income with a minimum of a $2,500 penalty per year. If someone making $25,000 year does not have coverage then the penalty would be the minimum but a person making $100,000 per year might pay as much as $5000 per year for non-compliance.
    * For employers the current mandate for employers with 50+ employees is adequate however the penalty should be at least double what the current ACA statute dictates.
  4. Eliminate plan benefit requirements in excess of the Essential Health Benefit categories of coverage. Don’t dictate deductibles or plan characteristics except for the benefit category of the EHBs. in other words, plans can include limits on certain benefits to help bring premiums lower and to make more selections available.
    * I recognize that this one is controversial because people fear that insurers will strip out benefits and offer really “crappy” health plans. Plans may differ by region but if plans are more plentiful offering rich as well as less rich and crappy plans which are more affordable with more doctors and hospitals then people are free to buy what fits their need.

I realize that this is only 4 categories from the multitude of issues for the Senate to address. But, starting with these basics as a guide will build a foundation for the entire package.

There are two things which are more important than anything.

  1. Make the plans authentic. Don’t call it Repeal & Replace if it does not strike down the entire ACA. The AHCA 2.0 must include most of the provisions of the ACA to have a foundation but the components of the ACA, which we all hate and know create higher premium and lower quality, must be stricken. Things like the Cadillac tax, all of the taxes really, the State Exchanges, rating restrictions such as Minimum Loss Ratios are just a few.
  2. The second “must do” is communicated to the public in a manner than over-comes what we know will be attacks from the liberal press and politicians as well as special interests. We know that they will be predicting thousands will die and babies will go without care so the communication must be of a “positive shock & awe” manner.
    If the end-product is good & honest then all it will take is mass communication and education.

Next week, depending on the outcome of the President’s trip let’s expand on the idea of Federal Invisible Risk Reinsurance that is included in the AHCA 2.0. This could very well be a means to replace the insurer subsidies but do so in an intelligent actuarial process.

Until then, let’s keep our eye on the fact that employers and their employees as well as individuals not on employer sponsored plans need our help.
They know that we’re all in this together.

Talk then

Mark Reynolds, RHU

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