published Thursday, July 25th, 2013

Cleaveland: What are possible insurance choices?

By Dr. Clif Cleaveland

Critics of the Accountable Care Act continue to call for the repeal of the legislation. The Republican majority in the U.S. House of Representatives has voted 37 times to overturn the ACA. Each measure has died in the Senate. While launching repeated attacks against ACA in Congress and in the media, critics have not united behind any alternative measure. Here are six choices:

• Maintain the status quo. Our current system of health care is unaffordable, consuming 18 percent of gross domestic product while leaving tens of millions of Americans without health insurance. Even for insured Americans, high deductibles and co-payments create financial burdens. Health care costs figure prominently in half of all personal bankruptcies. New therapies, especially for malignant diseases, are unaffordable for many people. Costs for childbirth leave many couples with substantial debt. In many instances, health care is inefficient with poor communication among multiple care-givers and no coordination of testing and therapy.

• Expand Medicare. Despite being linked from the outset to common and customary pricing for services, Medicare has set a predictable pattern for care for our nation’s older citizens for almost 50 years. Administrative costs are lower than most health insurance plans. Uniform benefits and access to care are assured nationwide. Medicare’s current challenge is to maintain solvency in the face of rapidly growing numbers of elderly persons. Expansion of Medicare to a younger population would secure its financial future.

• Single payer. Each state or the federal government would assume the responsibility for building new, public funding mechanisms to pay for medical care. Government agencies would replace private insurance plans. Vermont is currently considering a single-payer option in designing its health plan. Unified Green Mountain Care (http://hcr.vermont.gov/timeline/gmc) outlines the steps to assure universal coverage for that state’s citizens. The website is a model for clarity.

• Expand Medicaid. An initial goal of the ACA was expansion of Medicaid eligibility to 138 percent of the federal poverty level. This provision was struck down by the U.S. Supreme Court in 2012. Medicaid programs vary widely in terms of eligibility and coverage. If more uniform standards were adopted and the most successful state plans were copied, Medicaid could still provide a solution for health care for impoverished people. Expansion would only work if all states were required to participate at the same level of benefits. Congressional action for this option is unlikely given current gridlock. Some state legislatures would balk at any expansion of governmental powers.

• Vouchers. Based upon income, vouchers of varying value would be issued for individuals to shop among competing insurance plans and purchase care they deem most appropriate to their needs. While allowing greater choice, consumers would have to navigate complex and conflicting proposals from insurers. Vouchers would do little to control costs of medical services or to improve efficiency.

• State-based initiatives. In 2006, Massachusetts under Gov. Romney established a state-wide medical insurance plan whose goal was to provide affordable coverage for all state residents. Subsequently, the state has almost reached that goal. Controlling costs remains a major challenge. Massachusetts served as a template for much of the ACA with its health insurance exchange and individual mandate for obtaining health insurance.

If states were free to design their own health reform plans, problems would arise as families moved from one jurisdiction to another. We would likely end up having a crazy-quilt of incompatible plans. Adoption of the Massachusetts model on a state-by-state basis would likely take many years. Some states might never succeed in crafting a successful plan.

Questions that we must ask of critics of health care reform: What do you propose to replace the ACA? How would you finance and administer your plan? Would your plan control costs, improve care and broaden access?

Contact Clif Cleaveland at cleaveland1000@comcast.net.

story created on Tuesday 7/23/2013 at 1:22:59 pm by Shawn Ryan

story modified on Wednesday 7/24/2013 at 10:49:12 am by Sara Jackson

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