What if SCOTUS holds that the ACA is Unconstitutional? What can the GOP put in its place? You hold the solution, here!

Several years ago I jotted down a few ideas which, if implemented, would address at least the biggest issues in medical insurance and healthcare delivery: cost and access. With the recent Court decision deeming the ACA unconstitutional we need, that is the GOP, needs to offer betters solutions. The ideas below are a start toward that better solution.

You all know that I am an optimist trapped in a cynic’s body so my hopes of replacing the ACA with a workable solution are real but also guarded. But, what if you/we were asked for input to design a workable solution. Could you do it?

I have expanded the solutions, since jotting down my initial 12 points in prior posts, because I believe that there is an easier and less expensive means to address healthcare financing for the chronically poor, the uninsurable and the chronic uninsured. You may think that I have left a few issues untouched and if so let me know your thoughts.
However, I know that these ideas, if put in place, build the framework to address:

  • Those that want to buy insurance but are un-insurable.
  • Those who want to buy but who can’t afford the premiums charged for insurance.
  • Those who currently buy and pay for their coverage but are finding the increasing premium too much to pay. 
  • Those that don’t want to buy or will wait until they have a problem to buy insurance.
  • Guaranteed acceptance.
  • Pre-existing conditions.
  • How to push premiums lower
  • How to push unit cost of healthcare lower
  • Transparency (Total & Complete Transparency).

So, together we can develop the core outline of what Congress could build if it truly tried to bring about the best reforms for our system. Please give us your input to improve upon these points as well as address issues that we have not addressed or not addressed well.

It may be fun and interesting but who knows we might even make a difference.

Since Americans are used to the ACA mandates of kids to 26, unlimited lifetime, and wellness or preventive let’s leave those in. But,  let’s eliminate the Medical Loss Ratio (MLR) limits since no other industry in the world has its profit margin restricted like insurers are by the ACA. Other than that let’s assume we have a blank canvas upon which we can draw our ideas.

Here are the basic ideas to include in a bill to replace the ACA:

  1. Make health insurance premium 100% tax deductible for anyone who pays it.
  2. Make all fully-insured plans for individuals and families guaranteed issue but with a reasonable Pre-existing period for no prior coverage.
    Example – Pre-ex period: 12 months.
  3. Group plans of 2+ employees remain guaranteed issue with full take-over or “No Loss-No Gain” as it used to be called..
  4. Allow carriers a reasonable corridor for Risk Adjustment Factors (20%). Also, eliminate artificial pricing rules (such as 3:1 ratio) and let insurers determine pricing with their area rating factors based on their data and statistics.
  5. Tort reform: Loser Pays and/or Fixed Attorneys at 15%.
  6. Allow carriers and plans such as Association Health Plans to sell across state lines. (Possibly the most difficult of all.)
  7. Eliminate Essential Health Benefits and allow No new benefit mandates from states or Feds for five years. Allow insurers freedom to build plans as they determine.
  8. Mandate HRAs and MERPs permissible and available to implement on all plans.
  9. All insurers must publish and release statistics and experience data.
    It’s ok and can remain consistent with Hippa.
  10. Universal enrollment forms for all group plans and all individual/family plans.
  11. Health plan commission set at level 7% and does not increase as premium does.
  12. All Providers must post their rates per service. Hospitals must post their outcome statistics as well as infections, error rates, and other outcome data.
  13. State based or plan based re-insurance pools to assist Insurers in controlling premiums. If unlimited lifetime benefits are retained then Insurers and Plans need support to handle the increasing number of mega-claims. 
  14. Providing coverage for those who can’t afford to pay premium regardless of its cost:
  • Eliminate Exchanges. Allow people to be enrolled directly with the Insurer or Plan of Choice.
  • The IRS can maintain these enrollment records and disperse payments to Insurers and do so without adding fees to premiums.
  • That also eliminates the huge fees added to premiums by Exchanges to compensate the Exchanges.
  • Set the income levels for participation in subsidies (even use the current formula).
  • Eliminate the Medicare Expansion as it pushes people toward poverty.
  • Instead, keep these folks covered by the private market and allow them to obtain their coverage from private Insurers and Plans.

I also think we need to build incentives for employers to support wellness plans. If we want to bend the cost curve downward we must address behavior and expectations through affective wellness and benefit structure.

I do address coverage for the poor as I mentioned above. Setting a poverty level which assists folks in need but forces folks into Medi-Cal (Medicaid for outside Cal) is problematic as it may discourage folks from working their way out of their financial circumstances. Besides, those Medi-Cal plans “suck”. You would not want to be covered by one so why push these unfortunate folks into it.

So, this is our starting point. I encourage you to give this some thought and to give us your input. If we offer a worthwhile solution then who knows; we might make a difference. That’s what I mean when I say “We’re all in this together”.

Let me know what you think.
Until next week.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf
It means “Walk the Faith”.

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