As Republicans in Congress look to repeal and replace the ACA, they’re considering a return to high-risk pools like one in Wisconsin, which some considered a national model. The “Health Insurance Risk-Sharing Plan” — which ran from 1979 to 2014, when the federal health law’s exchanges started — was funded through premiums, insurance company assessments and reduced payments to providers. “Pooling the high-risk individuals together and managing their needs separately was a huge factor in the state’s success in offering a competitive insurance market,” J.P. Wieske, the state’s deputy insurance commissioner, told the House Energy and Commerce Committee this month.
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Let the states derive their own health care solutions, particularly when it comes to cost containment. That’s why we may need to look to six states that are aggressively working to contain costs. The Florida, Georgia, Alabama and Tennessee legislatures are considering a proposal to eliminate defensive medicine by abolishing each state’s medical malpractice system and replace it with a no-blame model similar to workers’ compensation. Two other states are also examining the concept. When doctors are no longer the target of litigation, they would be less likely to order unnecessary tests, medications and procedures.
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The Trump administration and the House of Representatives are asking for a hold on a case over Affordable Care Act payments that has the potential to test the boundaries between the branches of government.
At issue is not just whether the executive branch had unconstitutionally funded certain ACA payments to insurers, but the limits on government power when it comes to appropriations.
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Arizona Gov. Doug Ducey heads to Washington this week to attend the Conservative Political Action Conference. The Washington Examiner asked him to preview his main priorities regarding Obamacare replacement and what they should know about Arizona’s healthcare challenges.
He said, “The damage from Obamacare is clear: Insurance markets have been wrecked; premiums have soared; and promises, such as “you can keep your doctor,” have been broken. That’s what happens when one party imposes a one-size-fits-all solution on one-sixth of the country’s economy without even bothering to read the bill. Congress should do the opposite of what occurred in 2010: It should seek to expand choices for consumers, not limit them; it should encourage innovation in the states, not stifle it; and it should read the bill and understand the implications of what it’s passing instead of simply hoping for the best despite ample evidence to the contrary.”
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Every day brings a new story about Republicans in disarray, the “mirage” of the GOP’s reform and the impossibility of change. The reality is that Congress is on schedule, progress is underway, and the many potential problems are avoidable.
Behind the scenes, members and staff are being briefed on options and the House will release a consensus proposal after the Presidents Day recess. The details matter and are under discussion, but the outlines are emerging. Congress will use the reconciliation budget maneuver to bypass the Senate filibuster and pass a version of the 2015 repeal bill that President Obama vetoed. This time they’ll incorporate as many replacement components as the rules allow to bring more predictability to insurance markets.
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The combination of high-deductible insurance with Health Savings Accounts (HSAs) is central to a market-driven reform of U.S. health care. There is, however, a problem with existing HSA policy that must be fixed if HSAs are to reach their full potential in improving the efficiency of health care arrangements: As currently structured, HSAs are not built to provide easy access to care from well-organized systems of health care. Rather, HSA enrollees buy services on a fee-for-service basis, which is, in most cases, a much less efficient way of getting needed care. The rules governing HSAs should be modified to allow account holders to buy access to care from integrated care systems on a fixed-fee basis.
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The Trump administration proposed new rules on Wednesday to stabilize health insurance markets roiled by efforts to repeal the ACA, by big increases in premiums and by the exodus of major insurers. The move came a day after Humana announced that, starting next year, it would completely withdraw from the public marketplaces created under the ACA. The proposed rules, backed by insurance companies, would tighten certain enrollment procedures and cut the health law’s open enrollment period in half, in hopes that a smaller but healthier consumer base will put the marketplaces on sounder financial footing and attract more insurance companies in states with limited choices.
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Molina Healthcare’s stock tumbled after hours Wednesday after the health insurer posted a fourth-quarter loss that was attributed to parts of Obamacare — a big problem for one of the health insurers that has had success in the program.
However, the company didn’t lose money because it had sicker-than-expected enrollees. In fact, medical costs for its Obamacare enrollees were $120 million lower than Molina thought. Instead, Molina got slammed because it had healthier members and had to pay $325 million into an Obamacare program called risk adjustment, which pools money from insurers in a given state and redistributes it to those who had higher-cost enrollees.
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The new administration should issue two new rules for the 2018 enrollment season:
- It should let online brokers complete enrollments for people who qualify for subsidies. No need to redirect these applicants to HealthCare.gov.
- It should stop imposing user fees to prop up its unnecessary website and finance ad campaigns.
These two changes would set loose an army of insurance carriers, traditional brokers and private online exchanges, all competing to enroll people in subsidized coverage.
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House Republican leaders began laying out components of an Obamacare replacement bill at a closed-door meeting with members on Thursday, Feb. 16. Party leaders, including chairs of key committees, proposed age-based tax credits to replace Obamacare’s subsidies, new options for Medicaid, and scrapping taxes. They also floated ideas on how to pay for the replacement plan, such as capping the tax exclusion currently offered only to employer-sponsored health plans. House members received a policy brief that outlines where legislation is headed to help them prepare for next week’s town hall meetings in their districts.
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