A few suggestions on ACA Reform

Since the House and 13 Senate Republicans have decided not to listen to the American majority or review actual data, here are a few suggestions on reforming the ACA. The ACA is imperfect and seeing higher premiums than expected in some places, but critics overlook three key things. It has dramatically reduced the number of uninsured, it has introduced positive benefit requirements to all plans including employer sponsored ones and its premiums are even higher due to Republican Senators stiffing insurers.

What should we do about improving the ACA? First, do not pass any variation of the ill-conceived AHCA bill passed by the House. It is obvious the gang of thirteen GOP male Senators are not listening to the American majority. For what it is worth, here is what this retired benefit consultant, actuary and manager suggests for consideration.

– Pay insurers for the amounts promised them under the ACA to take on initial adverse risk (as was done when Medicare Part D was rolled out) and invite them to stay or return to the exchanges. Part and parcel with this change is to restore the risk corridor funding for adverse selection going forward. This will bring premiums down.

– Fully expand Medicaid in the remaining 19 states. The National Governors Association advocates the positives of Medicaid expansion with Ohio Governor and former Presidential candidate John Kasich calling it a “no brainer.” This will help rural hospitals, economies and residents as well as others in more urban settings.

– Reduce eligibility to Medicare to age 62. This will reduce the overall risk profile under the exchanges and Medicare since the added Medicare population is older than the average exchange population it would leave and younger than the Medicare population it would be joining.

– Where competition in the exchanges is nonexistent with only one provider, offer a public option through Medicare or a variation therefrom. The pricing needs to be fair when contrasted to the lone offering as you want provide viable choice, but not drive the lone insurer away

– Finally, I would suggest we evaluate the efficacy of all fee arrangements under the ACA. Which ones make sense to continue, which ones make sense to alter, and which ones should be shelved or replaced?

It would also be helpful for naysaying for the sake of a party position to cease. Some impressionable people have refused to consider the ACA because a politician told them not to saying it was horrible or in a death spiral. People need to be mindful that health care and insurance are complex and politicians are offering advice in areas for which they are not licensed or knowledgeable to do so.

To be frank, I would rather see us go down the path of a national health insurance model. Yet, that is s tough sell in this country. So, improving the ACA is the better course versus what is being discussed. Plus, the strategic expansion of Medicare noted above will permit us to study this option and expand or contract it based on its measured veracity.





30 thoughts on “A few suggestions on ACA Reform

    • Thanks Dru. It is an uphill battle, since so very few are aware of the Republican role in making the premiums even higher and McConnell and Ryan view the bill as a tax cut for the wealthy.

  1. Dear Mr. Keith Wilson,
    As a citizen of the United States, though not of your own state, I am urging … nay, begging … you to run for Congress in 2018. Now, while logic would dictate that you start out in your state legislature, then move on up, we have no time to waste. Now, I would prefer to see you run for Senator, but unfortunately neither of the senators in your home state are up for re-election this year, so a House seat it shall be. No matter … we need to level the playing field in the House, and it will be good experience for your run against Senator Thom Tilliis in 2020!
    Your ideas on how to improve ACA are the best I have heard. Hats off and two thumbs-up, Representative Wilson! Has a nice ring, doesn’t it?
    I support you 100%, but can only offer limited practical support. I am a reasonably decent writer, so I could write such things as speeches and campaign slogans. My granddaughter is a great artist, so perhaps she could help by designing posters? And I am a CPA (retired), so I would be happy to offer accounting and financial services to your campaign!
    Let’s start getting the word out now!!! Keith Wilson For Congress!!!!! (picture confetti, streamers, and loud applause!)
    Sincerely yours,
    Jill Dennison, concerned citizen (senior) and voter!

  2. One further recommendation … please look at the healthcare systems of New Zealand, Austria, France and Canada, all of whom are ranked quite high in terms of having very good public health care. Thanks!

    • Jill, most systems are better than ours. This is an old World Health Organization statistic, but the US was ranked with the highest per capita health cost which gained us a 38th ranking in health outcomes.

      We have too many who believe national health insurance is evil. Like any system, it is not perfect, but what we have now is much less perfect than others.

      Thanks again for your endorsement. Keith

  3. Dear Keith,
    I would move to NC to volunteer in your campaign, especially in asking for monies.Every organization needs a competent sales person. People of good will and who have a history of competence at anything need to step up to the plate.
    Meanwhile, thanks for your spot on ideas on fixing the ACA.
    Hugs, Gronda

      • Now that some things are settling down for us, my hope is to plan some trips around the country to grab lunch, dinner or cup of coffee with some blogging friends. Gronda, I have a niece near you. Jill, send me an email where you call home. I think I should know this, but let me know by email to jog my memory if you would like to get together and meet my wife and me. Thanks, Keith

  4. I love how you don’t just grumble – you actually look for ways to make things better. All good suggestions, and ones that should be seriously looked at. I was listening to NPR yesterday (imagine that), and they had a segment on healthcare in poor, rural areas. So many people love the healthcare now available to them through ACA, but hate Obamacare with a passion. Sad.

    • Janis, many thanks. What has not been discussed is the impact of knocking 22 million off healthcare will have on the economy in various states. People will be impacted not havin access to care, but for those who can’t afford it, services will be foregone, go unpaid or paid for by other budgeted dollars.

      In rural areas before the ACA, hospitals had high exposure to indigent care, sometimes more than 1/2 the budget. This is why a NC mayor walked to Washington as his state would not expand Medicaid and their hospital could not afford to stay open.

      I have used this example before, but hospitals also charge uninsureds the unnegotiated rate. An operation would cost $32,000 for an insured patient, but only $18,000 for an insured patient, eg. This is a real example.

      Thanks for your thoughts. Keep listening to NPR. Keith

  5. Dear Keith
    Being resident in the UK with our National Insurance System it was your comment that you would rather go down the path of National Insurance rather than accept the system which is being imposed upon the USA which caught my eye.
    A great deal of the American financing of health care is alien to us Brits, but your suggestion indicates, thought, practicality and above all concern for the ordinary person.
    Considering that the current occupant of the Whitehouse made much of draining a swamp he seems quite content to let the said swamp rise.
    All best wishes to the real USA from the UK

    • Roger, many thanks. The bill that passed the House and being debated by Senate Republicans are tax breaks for the rich. They have little to do with patient centered care. Americans have been fed a bill of a goods about national health insurance, focusing on its shortcomings, but not what is right with it. Medicare is a national health program here and it works pretty well, but people don’t consider it as such. Keith

      • Roger, my wager is a significant majority of Americans think we have a pure capitalistic economic system. In fact, we have fettered capitalism with some socialistic underpinnings with Social Security, Medicare and Medicaid. This observation would stun many. Keith

      • Very wise words Keith.
        And unlike some Italian City states of the 16th century you don’t have a mercenary armed forces for self-defence.
        As much as my heart is in state socialism my head tells me that a mix works best; different balances for different cultures and nations.

      • Roger, I do think a mix of approaches works well. It is not ironic that the most productive period in America was in the 1950s when we had the highest tax rate, but due to unions had the strongest middle class. Keith

  6. Note to Readers: The gang of 13 is in a back room throwing stuff against the wall to see what sticks. This is not conducive to a health care strategy. I was thinking this morning how Republicans have been against the ACA as a galvanizing force. Yet, what is lost on them is they own the ACA right now. With the purposeful stiffing of carriers that Marco Rubio bragged on in the campaign trail (look ma, I just screwed over insurers and Americans) which has been continued by this administration, Trump and the GOP own this. As more carriers leave the market due to uncertainty, it should be duly noted who is the orchestrator of the uncertainty.

    Right now, if the GOP passes a law that they are considering, they will have hurt Americans, the economy and shot themselves in the foot.

  7. Note to Readers: I watched the weekly episode of the Carolina Business Forum which included as a guest Dr. Bill Roper, the CEO of the UNC Health System and Dean of the UNC School of Medicine. He was extremely well spoken of the complexity of healthcare and need for dialogue on his to resolve our problems. When asked he said part of the solution has to include the expansion of Medicaid. We have to extend coverage, but look for ways to improve the system. He said political polarization has painted Medicaid expansion as a Democrat idea and Reoublicans have been taught they should dislike it. He defined himself as a bleeding heart conservative. We must cover people but spend our dollars wisely. Amen, brother.

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