Act II - Did it have to be this way (Solutions For Moving Forward)
In short, the answer is no, it didn’t have to be this way. From the time that the ACA was introduced in the U.S House of Representatives, health insurance professionals who had operated under this type of proposed healthcare system were offering solutions that did not include more of the same that had decimated the healthcare systems in the 4 Reform States. When then President Obama had said “if anyone has any other ideas, he was all ears”, we were shouting with a volume found at a Motorhead concert but as expected, he ignored us.
So, what exactly were we proposing? It is clear that healthcare is expensive and only a complete dismantling and overhaul of the entire system will completely fix this problem. Politicians do not have the stomach for such an endeavor and so we are left to create a comprehensive band aid.
Now, under the right circumstances, this “comprehensive band aid” could indeed be the cure. It touches on all the subjects that make healthcare unaffordable for many.
These are the same ideas we introduced during the initial Affordable Care Act debates that got ignored. We will now go into depth on each proposal and show how they were conceived and how they can help.
1. Allow Association Health Plans in All 50 States - In 46 out of 50 states, people can join pools of coverage based on interest and occupation known as Association Health Plans. The National Federation of Independent Business (NFIB) allows for their members to pool together to create a wider pool of insureds which helps spread risk and lower premium rates. The American Bar Association (ABA) and American Medical Association (AMA) also have such risk pools for their membership. Currently the 4 Reform States do not allow their residents to join these pools. Making these plans available in all 50 states would both create competition and provide another outlet for people being crushed under nearly unaffordable premium amounts.
2. Allow For Reciprocity In Plans Across State Lines - Right now because of network rules and state regulations, a plan that is offered in one state can not be offered in another. It is true that some plans offer out of state coverage through their out of network coverage but aside from some very select issues, no captitated, managed care plan will provide in network services in another state on a non emergency basis. There has been talk about this for years in regards to large carriers who provide coverage in multiple states to be able to eliminate state lines in offering coverage options. There has also been talk of creating regional alliances. I do not believe these regional alliances will work especially in the Northeast where most of the Reform states reside. One of the biggest concerns of this proposal is the states lack of desire to allow the smaller “regional” carriers into their market if they believe they do not have the reserves to meet utilization costs borne by its membership. A state’s health of its citizens will help alleviate that concern in that no smaller carrier will willingly put itself in harms way by offering products in states where they know they will take crippling losses. How we address the concerns and open up these tougher state’s markets will be discussed in the next two proposals.
Reciprocity is absolutely necessary!
ReplyDeleteI agree. Aetna has done something similar in the past by building a regional network. What that did was if someone bought a plan in NJ, they could see doctors in Philadelphia and New York. Crossing borders is possible but we have to open our minds and think outside the current box of how we deliver health coverage. Thanks for writing and commenting, it is appreciated.
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