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.
3. Allow for Underwriting in Issuance - This one proposal gets to the heart of healthcare reform. Are we providing health insurance or health coverage? Many would argue that we are not providing health insurance as insurance requires elements of risk management to be in place to prevent the insurer from taking losses that could have been prevented. Under the Affordable Care Act, it would seem operates under a system of health coverage. The regulations enforcing the ACA do not provide the carriers any ability to assess or mitigate the risks they may be taking in providing coverage to members. The big bonus for the allowing of underwriting is how it will spur enrollments of younger Americans. Right now, the ACA “underwriting process” is literally age and zip code. Yes, there are a few other questions but the rates seem to base off of age and zip code. If we could allow younger Americans to use their age and health to their benefit then we wouldn’t have to worry so much about what the non enrollment penalty is because people will instead get a plan because they are now affordable. Underwriting will also support our national desire to get healthy. We tell people to exercise, eat right and try to get healthy. So they do all that and healthcare is still out of hand. How about letting people who do try to live that healthy lifestyle benefit from it? Allowing for medical underwriting will do that.
4. Allow for True Catastrophic Care Plans - This is one of the easiest ways to get young people insured at an affordable rate. Catastrophic Care plans work because they only insure for major claims like hospitalization. It allows the insured to “self insure for the sniffles” while having coverage for a claim that could potentially threaten them with bankruptcy. It works out well for all. The problem is not every state has allowed Catastrophic Care plans to be offered. We should make sure that the product offerings in each state includes Catastrophic Care plans. Now, if the states include underwriting in their Catastrophic Care plans, you can really save people some money. I really believe underwritten Catastrophic Care plans are a serious solution to the affordability issue.
5. Allow for Age 55 and older to Enroll In Medicare - There has been a lot of talk over the years about allowing Americans age 55 and older to enroll in Medicare. Right now, Medicare works because we are talking about limited pool and because of that the actuarial science works. To add a new dimension to this pool, it would require a recalculation of the risk management policies used to make Medicare work. To expand Medicare to this younger demographic pool would also mean deciding if the current Medicare plan descriptions can support this new load or will there have to be new plan descriptions created to meet the needs of this new pool. For instance, can we offer an Age 55 individual a zero premium plan currently offered to Medicare recipients in certain counties in our country? Can we offer the current menu of Medicare Supplement plans or will there have to be a new plan introduced much in the way Plan C was created to meet the needs of the disabled under 65 market? Here is a proposal. Make a 55 year old pay 2x the Part B premium to “buy in”. The member won’t care as it will still be cheaper than the private market. Create a specific Medicare Supplement for them. I would include underwriting on initial offering even though they might be in what would be considered their Initial Election Period. Yes, let the member use their good health to buy in the Group A Rate Table. Price it around the rate for Plan N and make it heavy on preventative services. Offer the same Part D prescription benefit services available to current Medicare recipients. For Medicare Advantage, allow the Under 55 member to access all of the MA or MAPD plans available in their service area. Since the Medicare Advantage plans are all managed care and the providers are captivated, the 2X Part B premium can help alleviate some of the pain that will be associated with the growth of this once limited pool.
No comments:
Post a Comment