The Cruz Amendment, what would it do for Healthcare Reform? Maybe, just maybe, it would provide options.

As I write this Post today, the Senate’s two attempts at HCR are on hold for voting purposes. Initially, the public reason given for the delay is that they are waiting for Senator McCain to be released and back at work. Please join us in wishing the Senator a speedy and full recovery!

Now, we hear that Leader McConnell is pulling the bills back all together.

In the interim let’s discuss the possibilities of the passing the BCRA (Better Care Reconciliation Act), or any Reform or Replace legislature, with the Cruz Amendment (CA) included. The opposition argument against the CA is some what logical and makes for good debate even though the opposition is too scripted and predictable to be conclusive. Their argument is that the CA will cause premiums to increase dramatically on full service standardized or ACA type of benefit plans. What’s wrong with that argument? Plenty!

For one, it makes us accept (or forget) that premiums haven’t already increased dramatically (over 100%) and done so to the point of being unaffordable.

Two, the opponent’s argument conveniently forgets to acknowledge that the ACA Bronze Plans and even Silver Plans leave members with such high out-of-pocket costs that the plans provide no real benefit for basic primary care or for higher cost care such as diagnostic care for most Americans covered by those plans. Who can afford to pay a $6,500 deductible before their plan pays anything?

Three, their argument neglects the fact that insurers are so regulated and handicapped by the ACA that the insurers have skinnied down PPOs to the point that finding a doctor to accept your Bronze/Silver plan is nearly impossible. In addition, by eliminating 50% of the providers in your area the opportunity for you to even receive care is reduced.
You might have a Health Plan Id card in your pocket but you have no providers at which to use it.

The opponents of the Cruz Amendment want you to forget that the ACA has allowed or even forced insurers to offer high-priced, high out-of-pocket, skinny network plans that people would not want to purchase unless they were forced to do so. And could not afford the richer Gold and Platinum plans available.

And don’t forget the subsidies paid to insurers which further drive up the costs of the ACA plans because we all pay those subsidies don’t we. Those subsidies also skew the pricing assumptions that insurers usually make.

Remember that the Cruz Amendment would require insurers to offer standardized HCR metallic-like health plans before they are permitted to make other plans, with less benefits, available. It is not a license for insurers to offer only stripped out benefit plans. It’s a chance for insurers to offer more options from which individuals and small employers can choose.
So, what could the Cruz Amendment create?

The obvious goal is that it could create a menu, with more options, from which Americans could choose the benefits important to them.
For example.

Individuals:

  • Young healthy men or woman(or older) might select benefits with limited  or no maternity coverage.
  • Older men or woman might select plans with richer Rx benefits than younger folks.
  • Young people might be more willing to buy catastrophic coverage with a deductible of $10,000, for example.
  • Certainly, many people would not want to pay for built-in pediatric dental that is forced on current ACA plans.
  • There are dozens of examples of how plans could be built and priced for more choice.

Small Employers:

  • Could purchase low-cost catastrophic plans then implement an HRA to enrich their employee’s benefits. (Thousands of employers would do this.)
  • Provide multiple options so employees can choose from more than a couple options
  • The employer’s HRA plans would provide employees with better choices so that they might include their families. It’s be nice to be able to afford to include their kids on the parents plan.
  • Employers could lower the cost and improve benefits for their employees.

The argument against the Cruz Amendment uses the well-tested tactic of fear to gain support for the opposition. Yet the opponents must rely on our faulty memories to forget that premium have increased by over 100% while out-of-pocket costs have increased and provider access is scarce, since the ACA went into play March 23rd, 2010.

What the Cruz Amendment needs is a solid national promotion campaign with an articulate spokesman to lay out the facts. The GOP must tell America that having more options from which to choose does not guarantee poorer benefits or higher premiums.

I recognize that I am being pretty basic here and that there are a few more details to address such as subsidies for those that need them, Medicare expansion, logical pre-ex provisions and more. But all of that can be resolved when we let competition take hold.

Fortunately these types of health plans and the solutions they bring are part of a solution for which your author has some experience. I challenge anyone to debate this issue with us. That is, if the opponents use facts and real experience.

What do you think?
Remember, we’re all in this together!

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

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