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Six steps to address worst insurance problems


Timothy Jost, writing for the Commonwealth Fund, proposes six steps that he says that Congress should take immediately to address the most pressing health-insurance problems, before trying to make  broader, systemic changes in America’s fragmented healthcare “system”.

They are:

“First, it must focus on the individual market, where we face an immediate crisis.”

“Second, we need solutions that can be implemented immediately through existing programs.”

“{T}hird, we may need to accept short-term increases in federal spending to get us through the immediate difficulties, as we have when our country has faced other crises. … But in the short term, simply shifting the burdens to individuals who will lose insurance coverage or face much higher deductibles and premiums is not acceptable.”

“Fourth, Congress should reinstitute the ACA’s risk corridor program for 2018 and 2019 for any county with fewer than two insurers.”

“Fifth, Congress should leave the individual mandate in place until it can devise a credible replacement. ”

“Sixth, Congress should rework the premium tax credit formula for 2018 through 2020 to allow younger enrollees to claim more generous tax credits.”

To read Mr. Jost’s essay,  please hit this link.

GOP ideologues will have to face healthcare math


Princeton healthcare economist Uwe Reinhardt writes in Vox that the Republicans can repeal the Affordable Care Act but they can’t repeal the mathematics of healthcare and especially the huge expense of caring for the chronically ill. He notes that:

In 2013, 10 percent of patients accounted for nearly two-thirds of healthcare spending and 1 percent accounted for more than a fifth of spending.

He says that a central question is: “Which treatments should high-cost patients receive and how should they be financed?’’

The ACA subsidizes care for high-cost patients through  such provisions as the individual mandate and community rating premiums, which  force younger, healthier individuals to pay more than their “fair” share in premiums. Republican ideology against the ACA targets rising premiums, but, he notes,  “the health insurance debate will be driven mostly by actuarial logic, not ideology.”

The GOP will face the problem of how to finance healthcare for the very sick  — and generally older — part of the population. Giving everybody a refundable tax credit, as proposed by House Speaker Paul Ryan’s “A Better Way,” wouldn’t do much for a very sick person charged very high actuarially “fair” premiums.

The complaints by younger, healthier people about what they see as their too-high premiums and co-pays ignore the reality of all health insurance, if it is to work  — that the healthier must help subsidize the unhealthy, and that younger, healthier people should bear in mind that they, too, will eventually get sick as they age.

As Vox’s Sarah Kliff points out, Mr. Ryan’s proposal “makes insurance better for people who are young and healthy. It makes insurance worse for people who are old and sick.”

Mr. Reinhardt asks if GOP-run government will be “content to leave millions of Americans without the benefits of health insurance, and the access to essential healthcare it provides.”

There would be quite a political reaction t0 throwing the 22 million people who have gained health insurance through the ACA off the insurance rolls.

To read Professor Reinhardt’s piece, please hit this link.

Trump’s seven-point healthcare program


The Trump for president campaign offers a seven-part healthcare-reform program:

  1. “Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
  2. “Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
  3. “Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  4. “Allow individuals to use Health Savings Accounts (HSAs).  {Editor’s note: These are already allowed — and used by millions.} Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
  5. “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. (Editor’s note: Such transparency is already called for under the Affordable Care Act.} Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  6. “Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
  7. “Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers. (Editor’s note: Many  U.S. patients now get their  prescription drugs from Canada, which are generally much cheaper than American drugs.}






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