Even the name Obamacare suggests its a plan or a scheme of sorts. The call to repeal and replace it stigmatizes it as a uniquely odd health plan. Obamacare is not a plan, you can’t qualify. You can’t signup for or buy it. Its insurance regulations. After it expanded Medicaid and Shrank the Medicare Doughnut hole, its mostly just a set of rules and regulations.
• Insurance in the free market wants to collect premiums and not pay claims.
Healthcare insurance found ways to deny claims and disallow coverage for sick people — (pre-existing conditions.)
• They also limited, benefits and put limits on individuals, families, limits per year and lifetime limits.
The ACA did away with all of that, and forbade Junk Plans that exclude sick people, limiting their healthcare, and dropping their coverage. It also defined comprehensive plans to compete with other comparable exchange plans.
The ACA also limited Insurance Profits by forcing companies to rebate premiums that exceeded the ‘medical loss ratio. ACA required Large companies to pay 85% of premiums back to the plan’s members- 80% for small companies.
This assured that exchange plans had good coverage and good value.
This was sustainable as long as there are healthy people to pay insurance premiums.
While the mandates got millions to buy insurance, some companies ran into trouble when disproportionately more sick people signed up for a plan.
The risk pools, aka reinsurance, needed fixing, and most of the co-ops went out of business early on.
These problems could have been fixed, but the GOP watched parts of the ACA struggle.
NOW, the GOP is cooking up schemes to replace it ( Replace Them , the many regulations ) with something ‘better AND more affordable.
How can you make plans Better?
• Lower Deductibles? Great! but that makes it more expensive.
• Lower payments to doctors? Doctors will not take your insurance if it’s too cheap.
• Expand coverage? Exchange plans have pretty broad coverage now. Expand it to include Vision and dental? Great ! Love it!
But that’s more expensive too.
How to Lower Cost?
• Expand the mandate so all people including healthy people sign up?
Great but not everyone can afford it, so they’ll need assistance to pay for it. That means there will be price relief for customers, but the total cost to government will include all the uninsured.
• Negotiate lower Drug Prices? Great. Wish they’d have supported it these last several years...
• Let companies compete across state lines? Yeah that’s fine but the medical loss ratio limits profits and overhead to 1 dollar out of 8 now, that’s not a lot of room for big savings.
Insurance companies are not too happy it.
Today the only way for an healthcare insurance company to increase its profits in the Exchange, is to be efficient, and get a bigger piece of that 1 out of 8 dollars, OR get more customers, and that usually requires lowering premiums to be competitive. This creates an environment where some companies will fail to gain market share.
Outside the Exchange, some employers sell “ Skinny “ Plans that are not quite total junk.
They get away with selling less for More, as long as its a workplace Plan.
In my opinion, the GOP will try to sell limited plans that resemble the junk plans that worked for most healthy people, but failed them as soon as their illness became expensive.
They may wave their arms and tell you of the wonders of a medical savings plan, but this is a just retirement plan that you can raid when your heal fails and your insurance fails too.
With Junk plans you get to insure yourself for the insurance you can’t buy, and self- insurance is no insurance at all. You need solid plans that cover your entire cancer, not just half of it.
Junk plans have low deductibles, low co-pays, and cover all but the most expensive healthcare issues. When you’re really sick, dip into your retirement savings, sell your house, and die leaving your family with none of your inheritance.
I’ve been in healthcare billing, business analysis and IT for over 20 years. Here’s my prescription:
Plan A: Single payer that covers everything paid out of a progressive income tax.
Plan B: Have ACA-like exchanges and standardized coverage so you can compare plans — apples to apples. A public option that operates like medicare , competes with private insurance and offers an alternative to for profit plans. and
Expand Medicare to age 55 so plans on average contain healthier people, and insurance plans, per person are cheaper and more affordable. Assistance is provided for private or the public option.
Coverage is universal. Medicare or Public option, unless you opt out to a private plan.
I suspect that the GOP will try to do something unconventional, something free market friendly-
and its likely going to be an inexpensive junk plan that works for 85% of the people, until someone gets really sick.
Watch out for them framing the debate about Obamacare, when they mean to de-regulate health insurance, and watch out for Junk Plans.