A Bipartisan Healthcare Solution

 

Can Democrats and Republicans agree on a bi-partisan healthcare solution? That seems unlikely, especially as they fight over interpretation of the just-released Mueller Report.

Democratic presidential hopefuls all seem to be declaring their loyal support of Bernie Sanders’ Medicare for All bill even though polls say there is more support for fixing ObamaCare. Republicans tried to repeal ObamaCare but were stopped by GOP prima donnas. Now they are doing their best to improve ObamaCare.

But the 2018 mid-term elections suggest Americans are unsatisfied with their healthcare. Neither party’s solutions have captured the enthusiasm of voters. John C. Goodman, writing in Forbes, says each party has a dilemma to overcome.

The Democrats’ Dilemma

Democrats focused on scaring people they would lose coverage of pre-existing conditions if Republicans had their way. They spent $90 million on healthcare ads to convince the American public they were right even though they were wrong. Sadly, many voters believed them.

But most voters are not satisfied with their healthcare coverage. The 5% of the population that purchase their health insurance on the ObamaCare exchanges are happy because most of them get highly-subsidized coverage at a fraction of the real cost. Most of these people were previously uninsured. But most of these happy customers don’t vote.

Middle-income people are less satisfied. They’re paying higher premiums, about twice as much as before ObamaCare, and their access to care has declined. They don’t have access to the best doctors and hospitals, which they had before ObamaCare. Most of these unhappy customers vote.

The Republicans’ Dilemma

Unhappy customers under ObamaCare are potential Republican voters. But Republicans have failed to deliver on their campaign promises due to a few rogue politicians who prefer the attention they get when they oppose the party line.

Before ObamaCare, most states had high-risk pools to provide insurance for people who were denied coverage due to pre-existing conditions. These same people have now entered the ObamaCare exchanges, driving up the prices for everyone. People worry they will end up in the exchanges if they lose their job and their employer-provided insurance. While the Trump administration has made several moves recently to lower the cost of insurance, many people are still anxious about the future.

A Bipartisan Solution

Goodman says two major reforms are needed to solve the problems both parties face.

  • Stop the group market (employers) from dumping costs on the individual market – The individual market is only 5% of the total but is bearing the full cost of social problems created in the other 95%.
    • Spread the social cost of “pre-existing conditions” over society as a whole – Fund risk pools with a small premium tax on all group insurance.
  • Radical reform of risk adjustment – Instead of creating incentives for insurance providers to attract only the healthy (with low premiums) and avoid the sick (with narrow networks), encourage insurers to attract both healthy and sick patients with financial protections.
    • Specialty plans for treatment of costly conditions – diabetes, heart disease, cancer
    • Allow medical records to automatically travel from plan to plan
    • Allow health plans to ask health questions and conduct medical exams at the time of enrollment
    • Allow market for risk adjustment in which plans compensate other plans when high-cost patients transfer enrollment

 

Goodman says Congress will have to give states more flexibility in devising their own insurance solutions to make this work. He says three conditions must be met:

  • States must have a credible plan to make insurance better for people with chronic health conditions– lower premiums, deductibles and wider networks.
  • States must show progress toward the ultimate goal of letting people leave the group market and buy their own coverage as good as before they left.
  • State changes must be revenue neutral for the federal government.

 

There are solutions to the healthcare problems we face today. But achieving them will require bipartisan support of the changes needed. Unfortunately, that may just be a bridge too far. Too many politicians would rather score political points than solve political problems.

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