- 30,577
OK Folks Here is Our Chance to Be Heard. Lets Help Trump
- Thread starter pahealthquotes
- Start date
Trump MUST get health care right. Midterms are in 2 years. He didn't ask for my 2 cents, but here it is anyway. My plan gets rid of taxes, fees, the exchange, navigators, the MLR, all provider networks, non-transparent prices, HMOs, ACOs, out-of-network, MAGI, subsidies, CSR, CMS/HHS oversight Medicaid expansion, individual and employer mandate/penalties, Minimum Value, MEC, EHBs, Affordable formulas, Family Glitch, SEPs, and OEP, but keeps Guaranteed Issue, pre-ex condition coverage, free preventive, maternity, kids to age 26, unlimited max, vouchers for the poor, and coverage for the sick, with pressure to bend the cost curve at the root level.
GUARANTEE ISSUE AND PRE-EX
1 - Guarantee Issue. But if you answer "yes" to a few SIMPLE questions on the app, the excess risk is reinsured by the govt or a high risk pool. To the consumer, it's the same policy at the same price as anyone else gets. To the insurer, the risk is cut.
2 - No pre-ex wait with creditable coverage. But make certificates of creditable coverage simpler. You can print one off of your member portal anytime you want, showing what months you were covered with the insurer.
3 - If your cert of creditable coverage shows a gap of 63 days or more, you have a pre-ex wait. This worked in group insurance for 20 years. It works.
4 - If your cert of creditable coverage shows a gap of 1 year or more, you have a load on future premiums, like Medicare Part D has. Transition rules for people who can't afford these 2016/2017/2018 premiums.
5 - If your cert of creditable coverage shows a gap of 63 days or more, you start maternity and mental health benefits at a lower level, grading up for the next 18 months until it reaches the standard level.
6 - If your cert of creditable coverage shows a gap of 5 days or more, you lose all future vouchers for the rest of the year (see "vouchers" below).
VOUCHERS
7 - Give the low income folks vouchers. It's like a coupon. Like Amazon.com, you can attach that coupon to your electronic premium payment. Or use paper. Or set up autopay where the insurance company gets it direct from the IRS monthly. No exchange needed.
8 - Vouchers are based on your income on the LAST tax return required to be filed. For instance, today, that would be the 2015 tax return, filed by 4/15/2016. If your income dropped significantly since then, or your household changed (like you had a baby), you can appeal. Simple appeal, direct to the IRS, with simple standard documentation required. You can also appeal to the insurance company who immediately issues a policy, and waits for your appeal for extra voucher money from the IRS.
9 - You can use your voucher to pay for any kind of insurance you want, with certain restrictions. Simple restrictions, not MEC/QHP/EHB/Metal Tier hell. If the insurance company sells you a non-qualified plan, the IRS doesn't accept the voucher. So, it's stupid of an insurance company to sell a non-qualified plan. The voucher can be for Individual/Family plans, Group Plans, or Medicaid. This takes the heat off of businesses, takes the heat off employees to stay stuck in a job, and takes the heat off States for Medicaid expansion.
10 - No need for CSR. As your income goes down, your voucher goes up, so it can pay for a richer insurance plan, with lower deductibles, copays, etc. That is the best for lower-educated people who may not be able to understand more complicated designs. But for some folks, the idea of a "decreasing deductible for good health" is attractive. You can start with a higher deductible, but if your claims are low, your deductible goes down every 6 months. And once your deductible has gone down three 6-month periods, you can use the extra cash to pay for dental, vision, wellness, smoking cessation, weight loss, fitness centers, family planning, etc. No cash refunds. No tattoos or medical marijuana. To the consumer the "decreasing deductible, then you get more benefits like dental too" is simple to understand, but to the insurance company it's nothing but an HSA type of funding mechanism.
11 - HSAs for the non-poor are expanded for the same kind of wellness expenses. This promotes greater health in our nation.
12 - The IRS can at any time request an asset test, so that the "poor on paper" wealthy folks can't grab up the vouchers. This is a major loophole in Obamacare. The IRS can also request a mid-year re-evaluation for people who had low income on the last filed tax return, but it's clear from payroll taxes that they are raking in the bucks now. This is between the IRS and the client. No exchange needed. No clawbacks unless it's fraud.
13 - Voucher is based on AGI, not MAGI, and the number of people in your household. That solves MAGI hell. Add in an area factor. That solves the problem that some areas have higher standards of living, so a single person's income of $45,000 is poor in NY, but not poor in Idaho. And since I'm going to propose getting rid of the 3xs age bands in a paragraph below, have a mechanism for helping poor people who pay higher premiums because they are older. I realize that my idea is more complicated than just "AGI", but how hard would it be to create a table for every state's rating areas anyway? Going with a Federal Poverty Level doesn't take into account the cost of living in San Francisco versus Albuquerque.
14 - Insurance companies can screen applicants for alien status, green cards, etc. They already do it when they hire people. Ain't hard, and we don't need an exchange to do it. They can insure these people if they want to. But the IRS won't be releasing vouchers for illegal aliens. And since there is no cash value to a voucher, the scam-appeal is zapped.
15 - Vouchers are available to parents who buy insurance for their adult kids, up to age 30, based on either the adult kids' income or the parents' income. Tax deductions are available to non-poor parents who do the same thing. This promotes having young adults in the system.
16 - These kinds of vouchers replace Medicaid expansion. For regular Medicaid, block grants are available from the Feds, and if the State wants to fund it through their own voucher system, they can. States rights. Less Federal involvement. Lower Federal costs.
PROCESS
17 - No need for an exchange. Insurance companies can handle vouchers, like a grocery store handles coupons. Their reimbursement comes directly from the IRS like coupon reimbursement comes from the manufacturer. Their underwriters can understand a tax return that the client submits as documentation. After all, underwriters have been doing it for years in disability insurance, mortgages, loans, etc. It's not like it's rocket science. The number of people on your tax return, the AGI, and your zip code are all there on Page 1 of the Federal Form 1040. No need for that 3.5% exchange fee. No need for Navigators.
18 - Insurance agents can handle the paperwork. For a commission. They can help with the tax issues, but the voucher eligibility is based on the last filed tax return, so it's not like it's rocket science. The voucher comes from the IRS, so if you didn't file a tax return, you ain't gettin' one.
19 - MLR is gone. No need for it. If insurance companies price their plan right, they get customers. If they don't price it right, they will lose market share. It's a free market system. Certainly, state DOI oversight is still needed, as it always was, but no Federally mandated MLR. All that did was create a perverse incentive where an insurers costs to process a claim doesn't change with big premiums, however 20% of a huge premium is a lot of money and 20% of a low premium is barely enough to pay overhead.
20 - You can change insurers any time you want. Since you lose vouchers for a gap of more than 5 days, the pre-ex and graded maternity/mental health for a gap of more than 63 days, and the load on premiums for a gap of more than 1 year, then SEP and OEP is not needed. OEP hell is gone. Definitely, we will need rights for certain qualifying events (like having a baby), but the insurers can handle that without an exchange. They have been doing it for decades.
21 - No individual or employer mandate penalties. Not needed when there are pre-ex, graded benefits, premium loads, and vouchers that are usable for IFP, Group, and Medicaid.
22 - No Family glitch. You can use your voucher for IFP, Group, or Medicaid. You can split the voucher among family members with different insurers. No need to figure out if your Employer's plan is affordable or not. No need to figure out minimum value, because if the insurer tries to collect a voucher for selling you a non-qualified plan, then they IRS doesn't pay them, which would be suicide for an insurance company to do.
23 - No need for employer reporting.
24 - No need for Form 8965, exemptions, blah blah blah.
FUNDING
25 - Get rid of the bureaucratic monster. Taxes, fees, fund-transferring shell games ------ gone. Get rid of PICORI, HIIT, Cadillac tax, Medical Device taxes, Insurers' extra taxes, extra Medicare tax on investment income, extra Medicare tax of .9% for high earners, newest FSA & HSA limits, etc.
26 - Get rid of the exchange which costs 3.5% of premium, and is a headache ---- gone.
27 - Keep the kids to age 26 thing. It makes the risk pool healthier. You can expand it to age 30. Blue Cross of Arizona used to go to age 30, before the ACA. It helps keep these young adults in the risk pool, and keeps them out of the Emergency Room.
28 - Let insurers design plans. Get rid of the 3x age banding and go to 5xs or 7xs. This prices it right for the young. The problem of high premiums for the older folks is counterbalanced by factoring age into the voucher calculation. Get rid of the deductible mandates. Make maternity a graded benefit, but with cert of creditable coverage, you go to the top of the grade immediately (like stated above). Cap mental health and substance abuse with those graded benefits waived for cert of creditable coverage. Put an inside cap on mental health and substance abuse anyway, but add it to wellness benefits for which you can use an HSA-type of funding. Let them design plans where prescriptions go to deductible & co-insurance, or through an HSA so the consumer puts pressure on the pharmaceuticals. Let insurers develop plans, not bureaucrats. Let the market decide what it wants to buy, after consulting experts. Let people decide between going on their group plan or IFP plan, without losing vouchers. Free markets lower costs and increase value buying.
29 - Unlimited max. But at $1 million, reinsurance kicks in for the carrier (transparent to the consumer). Reinsurance can be privately negotiated, or offered by the Feds or States. A carrier can reinsure at $500,000 or $250,000, at their will -- it's just that at $1 million it's automatically high-risk pool funded. But the consumer gets unlimited max. After all, with those underwriting screens at app time, high-risk pool kicks in at app time for the high risks. And you can make it so that at every yearly renewal, the insurer notifies the high-risk pool when a client that started out as standard issue winds up moving into guaranteed-issue-high-risk-pool territory.
30 - Total transparency of medical prices. Abolish networks like they are "price fixing" offenses. With networks abolished, the providers have no choice but to make their prices transparent, because the market demands it. Full transparency for pharmaceuticals required. When your doctor writes a prescription, the pharmacy should tell you the cost, the generics' cost, and alternatives. Full disclosure will put pressure on the pharmaceuticals. Consumers will rejoice at the abolishment of networks. Doctors will be glad for the release of paperwork. Gone are HMOs, PCP referrals to Specialists, small lists, out-of-network coverage at higher costs, no-out-of-network for HMOs or EPos, and all other such nonsense. You don't need out-of-network when there is no network. You don't need PCP referral to Specialists to control costs, when the consumer and the doctors know what % of Medicare is allowable under your policy, and the consumer is deciding if they want that expensive doctor or not. Insurance companies don't have to decide that for them anymore.
31 - Getting rid of networks solves another problem, which is where insurers are afraid to price their broad-network PPO well, because they will be slammed with people who want the finest doctors, but at the most competitive premiums. If every policy abolishes networks, then every policy can be priced according to benefit to premium ratio, or quality of the carrier.
32 - Allow insurers (at free will) to define a "percent of Medicare allowable" reimbursement schedule. For instance, a 110% of Medicare policy, as well as 125%, 145% and 165% of Medicare policies. When providers are up front with their prices (and maybe they can list their prices as a % of Medicare allowable), then you know right away if you bought a policy that will be acceptable to the finest doctors and hospitals. Why can't everyone go with % of Medicare? After all, there is a huge database already created, with every cotton' pickin' code in it. Every provider and every insurer already knows that list of allowable anyway. It's an easy barometer for consumers to use, when deciding what they want their policy to pay. The consumer doesn't have to know what a complicated diagnostic code actually means. They just know that their policy pays 140% of Medicare allowable, so they can expect acceptance by very good providers, for every kind of procedure code known to medical science. Then let the providers, through free market, hash out their own price setting, according to the pressures of free market.
33 - Speaking of barometers, keep the Platinum, Gold, Silver, and Bronze categories, but loosen up on the tight rules. For instance, I would buy a Bronze at 165% of Medicare, because I can afford the deductible of a Bronze, but I want the finest doctors to accept my policy. With just 2 barometers, the consumer can make informed choices.
34 - This releases pressure on the "pre-approval for ingrown toenails" problems. Providers will jump for joy at the release of that headache.
35 - INCREASE GREATLY the use of nurses who man the insurance company's phone lines and who can help consumers understand this new "% of Medicare allowable" structure so they can understand that they definitely need a certain procedure, but where is the best place to buy it from, and how much will it cost based solely on the "% of Medicare" factor in their policy. That's an easy thing for a nurse to do if s/he is sitting at a computer with the person's policy showing and with the database of diagnostic codes.
36 - That means HMO narrow networks are GONE, unless the consumer is very aware of what they just did. Clearly, limits have to be set on what is qualified for a voucher, otherwise big WBEs will be selling bare-bones policies. But make the qualifications simple, like the HSA qualifications are, not like QHP hell.
37 - Help the doctors out. Abolish the 90 day grace period. If the client gets a voucher and doesn't pay their premium, the IRS pays it and takes it out of the clients hide, through payroll taxes, refunds, welfare checks, etc. Then the policy lapses when the doctors can clearly see on their provider portal that it is TERMINATED before the doctor provides the service.
38 - Keep the free preventive, birth control, and kids to age 26 or 30, and no premium for the 4th kid. This promotes a better risk pool, and it's not expensive anyway.
39 - Promote healthier risk pools outside of insurance. Use Trumps idea to build infrastructure, jobs and businesses by giving tax incentives to restaurants to start very healthy food outlets, including outlets where kids play on playgrounds but eat healthy foods. And tax incentives for low-cost fitness, wellness, and other programs that promote health. Tax incentives for learning health in the classroom, rather than producing a generation of people who don't understand basic medical terminology. The more the consumer knows about health care the lower the price curve bends. And speaking of bending the price curve, make mental health an issue for OUTSIDE of an insurance policy more than inside of one. Promote wellness classes for mental health, anxiety, depression, which bends the cost curve for a huge number of chronic illnesses. Most doctors will tell you that the majority of chronic disease is caused by mental health issues or food/exercise issues. Give tax incentives for doctors, and other trained professionals to provide mental health classes, and wellness in the general community. It is better to incentivize business owners to offer these classes at a lower price than to hide the expense in the confounding details of an insurance policy. Bend the cost curve in society, because hiding it in an insurance contract will never get us there.
40 - Give doctors tax incentives to promote wellness to their own patients, like hiring a nutritionalist for patients, a physical therapist, a physical trainer, weight loss programs, etc. Incentivize doctors to be preventive about wellness, by paying them for those efforts. This bends the cost curve.
GUARANTEE ISSUE AND PRE-EX
1 - Guarantee Issue. But if you answer "yes" to a few SIMPLE questions on the app, the excess risk is reinsured by the govt or a high risk pool. To the consumer, it's the same policy at the same price as anyone else gets. To the insurer, the risk is cut.
2 - No pre-ex wait with creditable coverage. But make certificates of creditable coverage simpler. You can print one off of your member portal anytime you want, showing what months you were covered with the insurer.
3 - If your cert of creditable coverage shows a gap of 63 days or more, you have a pre-ex wait. This worked in group insurance for 20 years. It works.
4 - If your cert of creditable coverage shows a gap of 1 year or more, you have a load on future premiums, like Medicare Part D has. Transition rules for people who can't afford these 2016/2017/2018 premiums.
5 - If your cert of creditable coverage shows a gap of 63 days or more, you start maternity and mental health benefits at a lower level, grading up for the next 18 months until it reaches the standard level.
6 - If your cert of creditable coverage shows a gap of 5 days or more, you lose all future vouchers for the rest of the year (see "vouchers" below).
VOUCHERS
7 - Give the low income folks vouchers. It's like a coupon. Like Amazon.com, you can attach that coupon to your electronic premium payment. Or use paper. Or set up autopay where the insurance company gets it direct from the IRS monthly. No exchange needed.
8 - Vouchers are based on your income on the LAST tax return required to be filed. For instance, today, that would be the 2015 tax return, filed by 4/15/2016. If your income dropped significantly since then, or your household changed (like you had a baby), you can appeal. Simple appeal, direct to the IRS, with simple standard documentation required. You can also appeal to the insurance company who immediately issues a policy, and waits for your appeal for extra voucher money from the IRS.
9 - You can use your voucher to pay for any kind of insurance you want, with certain restrictions. Simple restrictions, not MEC/QHP/EHB/Metal Tier hell. If the insurance company sells you a non-qualified plan, the IRS doesn't accept the voucher. So, it's stupid of an insurance company to sell a non-qualified plan. The voucher can be for Individual/Family plans, Group Plans, or Medicaid. This takes the heat off of businesses, takes the heat off employees to stay stuck in a job, and takes the heat off States for Medicaid expansion.
10 - No need for CSR. As your income goes down, your voucher goes up, so it can pay for a richer insurance plan, with lower deductibles, copays, etc. That is the best for lower-educated people who may not be able to understand more complicated designs. But for some folks, the idea of a "decreasing deductible for good health" is attractive. You can start with a higher deductible, but if your claims are low, your deductible goes down every 6 months. And once your deductible has gone down three 6-month periods, you can use the extra cash to pay for dental, vision, wellness, smoking cessation, weight loss, fitness centers, family planning, etc. No cash refunds. No tattoos or medical marijuana. To the consumer the "decreasing deductible, then you get more benefits like dental too" is simple to understand, but to the insurance company it's nothing but an HSA type of funding mechanism.
11 - HSAs for the non-poor are expanded for the same kind of wellness expenses. This promotes greater health in our nation.
12 - The IRS can at any time request an asset test, so that the "poor on paper" wealthy folks can't grab up the vouchers. This is a major loophole in Obamacare. The IRS can also request a mid-year re-evaluation for people who had low income on the last filed tax return, but it's clear from payroll taxes that they are raking in the bucks now. This is between the IRS and the client. No exchange needed. No clawbacks unless it's fraud.
13 - Voucher is based on AGI, not MAGI, and the number of people in your household. That solves MAGI hell. Add in an area factor. That solves the problem that some areas have higher standards of living, so a single person's income of $45,000 is poor in NY, but not poor in Idaho. And since I'm going to propose getting rid of the 3xs age bands in a paragraph below, have a mechanism for helping poor people who pay higher premiums because they are older. I realize that my idea is more complicated than just "AGI", but how hard would it be to create a table for every state's rating areas anyway? Going with a Federal Poverty Level doesn't take into account the cost of living in San Francisco versus Albuquerque.
14 - Insurance companies can screen applicants for alien status, green cards, etc. They already do it when they hire people. Ain't hard, and we don't need an exchange to do it. They can insure these people if they want to. But the IRS won't be releasing vouchers for illegal aliens. And since there is no cash value to a voucher, the scam-appeal is zapped.
15 - Vouchers are available to parents who buy insurance for their adult kids, up to age 30, based on either the adult kids' income or the parents' income. Tax deductions are available to non-poor parents who do the same thing. This promotes having young adults in the system.
16 - These kinds of vouchers replace Medicaid expansion. For regular Medicaid, block grants are available from the Feds, and if the State wants to fund it through their own voucher system, they can. States rights. Less Federal involvement. Lower Federal costs.
PROCESS
17 - No need for an exchange. Insurance companies can handle vouchers, like a grocery store handles coupons. Their reimbursement comes directly from the IRS like coupon reimbursement comes from the manufacturer. Their underwriters can understand a tax return that the client submits as documentation. After all, underwriters have been doing it for years in disability insurance, mortgages, loans, etc. It's not like it's rocket science. The number of people on your tax return, the AGI, and your zip code are all there on Page 1 of the Federal Form 1040. No need for that 3.5% exchange fee. No need for Navigators.
18 - Insurance agents can handle the paperwork. For a commission. They can help with the tax issues, but the voucher eligibility is based on the last filed tax return, so it's not like it's rocket science. The voucher comes from the IRS, so if you didn't file a tax return, you ain't gettin' one.
19 - MLR is gone. No need for it. If insurance companies price their plan right, they get customers. If they don't price it right, they will lose market share. It's a free market system. Certainly, state DOI oversight is still needed, as it always was, but no Federally mandated MLR. All that did was create a perverse incentive where an insurers costs to process a claim doesn't change with big premiums, however 20% of a huge premium is a lot of money and 20% of a low premium is barely enough to pay overhead.
20 - You can change insurers any time you want. Since you lose vouchers for a gap of more than 5 days, the pre-ex and graded maternity/mental health for a gap of more than 63 days, and the load on premiums for a gap of more than 1 year, then SEP and OEP is not needed. OEP hell is gone. Definitely, we will need rights for certain qualifying events (like having a baby), but the insurers can handle that without an exchange. They have been doing it for decades.
21 - No individual or employer mandate penalties. Not needed when there are pre-ex, graded benefits, premium loads, and vouchers that are usable for IFP, Group, and Medicaid.
22 - No Family glitch. You can use your voucher for IFP, Group, or Medicaid. You can split the voucher among family members with different insurers. No need to figure out if your Employer's plan is affordable or not. No need to figure out minimum value, because if the insurer tries to collect a voucher for selling you a non-qualified plan, then they IRS doesn't pay them, which would be suicide for an insurance company to do.
23 - No need for employer reporting.
24 - No need for Form 8965, exemptions, blah blah blah.
FUNDING
25 - Get rid of the bureaucratic monster. Taxes, fees, fund-transferring shell games ------ gone. Get rid of PICORI, HIIT, Cadillac tax, Medical Device taxes, Insurers' extra taxes, extra Medicare tax on investment income, extra Medicare tax of .9% for high earners, newest FSA & HSA limits, etc.
26 - Get rid of the exchange which costs 3.5% of premium, and is a headache ---- gone.
27 - Keep the kids to age 26 thing. It makes the risk pool healthier. You can expand it to age 30. Blue Cross of Arizona used to go to age 30, before the ACA. It helps keep these young adults in the risk pool, and keeps them out of the Emergency Room.
28 - Let insurers design plans. Get rid of the 3x age banding and go to 5xs or 7xs. This prices it right for the young. The problem of high premiums for the older folks is counterbalanced by factoring age into the voucher calculation. Get rid of the deductible mandates. Make maternity a graded benefit, but with cert of creditable coverage, you go to the top of the grade immediately (like stated above). Cap mental health and substance abuse with those graded benefits waived for cert of creditable coverage. Put an inside cap on mental health and substance abuse anyway, but add it to wellness benefits for which you can use an HSA-type of funding. Let them design plans where prescriptions go to deductible & co-insurance, or through an HSA so the consumer puts pressure on the pharmaceuticals. Let insurers develop plans, not bureaucrats. Let the market decide what it wants to buy, after consulting experts. Let people decide between going on their group plan or IFP plan, without losing vouchers. Free markets lower costs and increase value buying.
29 - Unlimited max. But at $1 million, reinsurance kicks in for the carrier (transparent to the consumer). Reinsurance can be privately negotiated, or offered by the Feds or States. A carrier can reinsure at $500,000 or $250,000, at their will -- it's just that at $1 million it's automatically high-risk pool funded. But the consumer gets unlimited max. After all, with those underwriting screens at app time, high-risk pool kicks in at app time for the high risks. And you can make it so that at every yearly renewal, the insurer notifies the high-risk pool when a client that started out as standard issue winds up moving into guaranteed-issue-high-risk-pool territory.
30 - Total transparency of medical prices. Abolish networks like they are "price fixing" offenses. With networks abolished, the providers have no choice but to make their prices transparent, because the market demands it. Full transparency for pharmaceuticals required. When your doctor writes a prescription, the pharmacy should tell you the cost, the generics' cost, and alternatives. Full disclosure will put pressure on the pharmaceuticals. Consumers will rejoice at the abolishment of networks. Doctors will be glad for the release of paperwork. Gone are HMOs, PCP referrals to Specialists, small lists, out-of-network coverage at higher costs, no-out-of-network for HMOs or EPos, and all other such nonsense. You don't need out-of-network when there is no network. You don't need PCP referral to Specialists to control costs, when the consumer and the doctors know what % of Medicare is allowable under your policy, and the consumer is deciding if they want that expensive doctor or not. Insurance companies don't have to decide that for them anymore.
31 - Getting rid of networks solves another problem, which is where insurers are afraid to price their broad-network PPO well, because they will be slammed with people who want the finest doctors, but at the most competitive premiums. If every policy abolishes networks, then every policy can be priced according to benefit to premium ratio, or quality of the carrier.
32 - Allow insurers (at free will) to define a "percent of Medicare allowable" reimbursement schedule. For instance, a 110% of Medicare policy, as well as 125%, 145% and 165% of Medicare policies. When providers are up front with their prices (and maybe they can list their prices as a % of Medicare allowable), then you know right away if you bought a policy that will be acceptable to the finest doctors and hospitals. Why can't everyone go with % of Medicare? After all, there is a huge database already created, with every cotton' pickin' code in it. Every provider and every insurer already knows that list of allowable anyway. It's an easy barometer for consumers to use, when deciding what they want their policy to pay. The consumer doesn't have to know what a complicated diagnostic code actually means. They just know that their policy pays 140% of Medicare allowable, so they can expect acceptance by very good providers, for every kind of procedure code known to medical science. Then let the providers, through free market, hash out their own price setting, according to the pressures of free market.
33 - Speaking of barometers, keep the Platinum, Gold, Silver, and Bronze categories, but loosen up on the tight rules. For instance, I would buy a Bronze at 165% of Medicare, because I can afford the deductible of a Bronze, but I want the finest doctors to accept my policy. With just 2 barometers, the consumer can make informed choices.
34 - This releases pressure on the "pre-approval for ingrown toenails" problems. Providers will jump for joy at the release of that headache.
35 - INCREASE GREATLY the use of nurses who man the insurance company's phone lines and who can help consumers understand this new "% of Medicare allowable" structure so they can understand that they definitely need a certain procedure, but where is the best place to buy it from, and how much will it cost based solely on the "% of Medicare" factor in their policy. That's an easy thing for a nurse to do if s/he is sitting at a computer with the person's policy showing and with the database of diagnostic codes.
36 - That means HMO narrow networks are GONE, unless the consumer is very aware of what they just did. Clearly, limits have to be set on what is qualified for a voucher, otherwise big WBEs will be selling bare-bones policies. But make the qualifications simple, like the HSA qualifications are, not like QHP hell.
37 - Help the doctors out. Abolish the 90 day grace period. If the client gets a voucher and doesn't pay their premium, the IRS pays it and takes it out of the clients hide, through payroll taxes, refunds, welfare checks, etc. Then the policy lapses when the doctors can clearly see on their provider portal that it is TERMINATED before the doctor provides the service.
38 - Keep the free preventive, birth control, and kids to age 26 or 30, and no premium for the 4th kid. This promotes a better risk pool, and it's not expensive anyway.
39 - Promote healthier risk pools outside of insurance. Use Trumps idea to build infrastructure, jobs and businesses by giving tax incentives to restaurants to start very healthy food outlets, including outlets where kids play on playgrounds but eat healthy foods. And tax incentives for low-cost fitness, wellness, and other programs that promote health. Tax incentives for learning health in the classroom, rather than producing a generation of people who don't understand basic medical terminology. The more the consumer knows about health care the lower the price curve bends. And speaking of bending the price curve, make mental health an issue for OUTSIDE of an insurance policy more than inside of one. Promote wellness classes for mental health, anxiety, depression, which bends the cost curve for a huge number of chronic illnesses. Most doctors will tell you that the majority of chronic disease is caused by mental health issues or food/exercise issues. Give tax incentives for doctors, and other trained professionals to provide mental health classes, and wellness in the general community. It is better to incentivize business owners to offer these classes at a lower price than to hide the expense in the confounding details of an insurance policy. Bend the cost curve in society, because hiding it in an insurance contract will never get us there.
40 - Give doctors tax incentives to promote wellness to their own patients, like hiring a nutritionalist for patients, a physical therapist, a physical trainer, weight loss programs, etc. Incentivize doctors to be preventive about wellness, by paying them for those efforts. This bends the cost curve.
Last edited:
- 30,577
Nice job Ann, you really put a lot of thought into this...and in a lot less than 2,000 plus pages. You need to get this in front of Trump! Lots of good ideas.
Rx has been in major med ever since it was invented. Runaway drug prices didn't gin up until Rx copay's came into vogue followed by DTC advertising.
Rx claims now comprise around 20% of claims paid, almost double what they were in the early 90's. Some of that is driven by price increases but most of the price increase was fueled by consumer demand and almost unlimited coverage by insurance.
When the consumer has skin in the game, beyond small copay's, they become better consumers of health care.
Some of that is cost shifting caused by low reimbursement but a lot is also created by deadbeats that don't pay their bills.
This bears repeating.
If you want transparency, offer plans that don't have networks. Go have fun with that.
Medicaid expansion failed because the program is jointly funded by federal and state dollars. Supplement the current Medicaid with a federal low income program funded by federal dollars only. Problem solved.
Medicare has been mismanaged for years and is grossly underfunded now. Adding more bodies without additional funding won't help Medicare.
Price controls don't work. Ask Richard Nixon.
Truth.
Started earlier than that. PDP only added more fuel.
Sounds good, but has never been supported by actuarial studies.
Side note. Study many years ago found the price point for mammograms was $20. Women would have the exam if their cost was $20 or less. Once it exceeded that level the % of women having regular exams dropped off dramatically.
Lower participation in mamm's at any age among low income and minorities regardless of price.
Side bar on birth control. Low income and minorities don't care if it is free. They won't use it. Just ask social services.
Roughly 70% of the population, not covered by govt plans, get health insurance through their employer. How will eliminating group health insurance be better?
Current system, requiring people to speculate on next years income was one of the dumbest things to come out of Obamacare.
If you want to subsidize health insurance, handle the same way welfare, food stamps, housing subsidy, etc is set up.
Before managed care providers charged whatever they wanted and carriers paid 80% of "reasonable and customary". Consumers were responsible for the balance even if the original charge was not "reasonable".
Managed care is a form of market driven price control. It contains costs for the carriers (less money per claim) and protects consumer against balance billing.
I have often called managed care mangled care, but for all the faults it is better than what we had before.
That being said, I agree with most of what Ann posted. Very well done.
Most of you have not seen sausage, or health insurance, being made. You don't really know how it is assembled, priced, etc.
Having worked on both sides of the fence, manufacturing (carrier rep) and distribution (agent) I have a different perspective. I have seen revenue and loss ratio's by line of coverage and type of claim. Reviewed reinsurance treaties and pricing. It is a very complex system that operates like a balloon. Squeeze in one area and another get's bigger.
Large claims, those xs of $50k, comprise roughly 20% of claim dollars. Over half the costs of those claims happen outpatient, both health care and Rx.
Around 70% of chronic illness is attributed to lifestyle and 80% of those claims could be controlled or eliminated with changes in the way we take care of ourselves.
Now for the touchy part.
As a nation, we spend more on EOL (end of life) care than any other country yet most of what is done does very little to extend life or improve quality. Many of the crazy priced drugs, those costing over $5,000 per month, many times will only add 90 days or less to the life of the individual. For some of our most destructive illnesses we have turned people into human guinea pigs in hopes of finding a cure.
Most of the things that could be done to lower the cost of health care, and health insurance, may never come to pass.
Over a third of the adult population is considered obese. One in 20 is morbidly obese. Childhood obesity and related issues (type II diabetes, hypertension) is on the rise. Almost 3 out of 4 men are obese.
If you want to dramatically reduce health care costs figure out a way to mandate a healthy lifestyle. Personal responsibility isn't working.
Health insurance plans with copay's and low deductibles encourage over-utilization. Shift the low dollar cost of care away from the carrier and put it back on the consumer.
Reward healthy lifestyles and regular check ups. It works in the employer market.
When I was covered under my wife's plan and I finally convinced her to go the high deductible, HRA route our total cost of care dropped. We had premium savings and her employer put several hundred dollars in our HRA account in exchange for regular exams and an accountability program.
The same could be done for people covered by IFP as well as govt plans such as Medicare and Medicaid. It just takes a shift in thinking.
- 30,577
- Thread starter
- #16
- 1,007
Good Morning Mr. Peeler,
Amen to that!
Love you Ann,
How can we get you in Trumps ear for 15 mins?
Joe
Last edited:
Thank you again, Tom, for your feedback. I don't want to come across as I am right and everyone else is wrong, although some may read it that way. But I do have a different background and perspective on the entire health care system, not just IFP which seems to be the bulk of the complaints.
IFP is a very small percentage of the population and line of coverage. So infinitesimal to most carriers that they really don't care if they offer it or not.
Especially if they lose money on it.
When discussing reform you need to understand the factors that drive health care costs and health care financing. There is no one thing that will fix it. All aspects have to be weighed but encouraging personal responsibility will go a long way towards bringing down costs.
IFP is a very small percentage of the population and line of coverage. So infinitesimal to most carriers that they really don't care if they offer it or not.
Especially if they lose money on it.
When discussing reform you need to understand the factors that drive health care costs and health care financing. There is no one thing that will fix it. All aspects have to be weighed but encouraging personal responsibility will go a long way towards bringing down costs.
Love you too, PA.
It's funny the things you learn when you talk to the end consumer every day for 30 years.
Abolishing networks nationwide, via an act of law, will have an astonishing effect. Providers will take care of pricing by themselves. It was morphing into that already, as providers had cash prices readily available. If Washington DC didn't take care of this, the providers were going to, from the ground level.
And that's really a good thing. Prices should never have been hidden. Payments should never have come from 3rd party, 4th party, 5th party sources (the govt gives a tax deduction to your employer who pays a premium to an insurance company who pays a claim to a provider who takes an in-network discount, on overcharged rates, because someone else didn't pay their bill.) That kind of price hiding never results in the end consumer controlling costs.
Price transparency, consumer skin in the game, and healthier lifestyles will whack at these out of control prices in a serious way.
In fact, "skin in the game" is so important, that I would suggest abolishment of copays, and make the consumer pay 20% of every single medical expense, up to an out-of-pocket max. No deductibles, no copays, just co-insurance. That makes them focus on the real price. Exceptions would be well-care, and for children cut the co-insurance percentage in half.
----------
And, yes, Somarco is always right on. He's our sage.
It's funny the things you learn when you talk to the end consumer every day for 30 years.
Abolishing networks nationwide, via an act of law, will have an astonishing effect. Providers will take care of pricing by themselves. It was morphing into that already, as providers had cash prices readily available. If Washington DC didn't take care of this, the providers were going to, from the ground level.
And that's really a good thing. Prices should never have been hidden. Payments should never have come from 3rd party, 4th party, 5th party sources (the govt gives a tax deduction to your employer who pays a premium to an insurance company who pays a claim to a provider who takes an in-network discount, on overcharged rates, because someone else didn't pay their bill.) That kind of price hiding never results in the end consumer controlling costs.
Price transparency, consumer skin in the game, and healthier lifestyles will whack at these out of control prices in a serious way.
In fact, "skin in the game" is so important, that I would suggest abolishment of copays, and make the consumer pay 20% of every single medical expense, up to an out-of-pocket max. No deductibles, no copays, just co-insurance. That makes them focus on the real price. Exceptions would be well-care, and for children cut the co-insurance percentage in half.
----------
And, yes, Somarco is always right on. He's our sage.
- 7,012
This is good stuff, but how do we get this type of information to the people that make decisions??
- 389
Re. hospitals and doctors.....you must be drinking....it wouldn't change a thing.....BUT....if you get yourself a proctologist.....he/she would be much cheaper than a heart surgeon....but you get what you pay for.
Re. pharmacies....you have the option to shop just like selecting a mechanic (but a mechanic will NEVER state the total price up front....for obvious reasons....like insurance)
Similar threads
