With President Trump now in the White House, the big question is, what will happen to the ACA? Of course big changes come with the switching of a presidential administration. With the last three presidents serving out two full terms, the United States has only seen three presidents in the last 24 years. That gives the incumbent president eight full years to put new laws and policies into place, and seemingly the next president just days to dismantle it all. So far, President Trump has vowed to leave the pre-existing condition clause in place as he attempts to dismantle the Affordable Care Act. Some believe him, some don’t, and many are upset over the prospect of not being able to qualify for insurance without this clause. I think it begs the question: is insurance a human right?
I don't think anyone would argue against the statement that everyone should have the right to high quality health care. But, does that mean everyone should have the right to have it paid for? Insurance at the core is simply a transfer of risk. A gamble for both the insurer and the insured. Why would an insurance company take on a guaranteed claim, when they know they are sure to lose money? It doesn’t happen in life insurance, car, house, boat, etc. When you add in millions of members paying subsided premiums, and then some leaving the plan after expensive procedures, it’s no wonder carriers are jumping ship, at least until the risk can be better maintained.
Arguably, the kinks are worked out in Medicare and the blueprint is there, but it didn’t happen overnight, and funding problems loom down the line for Medicare as well. How can we take what we’ve learned in the last ten years in Medicare Advantage and apply it to an ACA system? How about starting by cleaning up the 40 billion dollars unaccounted for in Medicaid fraud before looking elsewhere? Once those funds are exhausted, if we still need additional funds to support the new system, taxes or another means of funding would need to be raised.
Let’s look at how this possible ACA replacement can work:
The amount we pay into Medicare withholding will increase, also triggering an increase in the amount your employer contributes. Everyone under 65 then becomes eligible for a standard plan that has minimum essential coverage built in (compare this to original Medicare). Doctors would be reimbursed by the government for services rendered, at a negotiated rate like Medicare reimbursement. Now add in carriers such as Blue Cross/Blue Shield or UnitedHealthOne also offering richer plans, with a better network than original Medicare (compare this to a Medicare Advantage plan). People who wish to have these high tier plans will pay more, and people who cannot afford the premium will pay less, simply put. These plans could have star ratings (read more about Medicare star ratings here) that can result in more money from the government for the plan, thus creating competition between carriers, and accountability for the care provided by their network physicians.
Sound familiar? It should, if you sell Medicare Advantage or Medicare Supplement plans. It makes sense for the Centers for Medicare and Medicaid services (CMS) to manage the under 65 population alongside the over 65 population and Medicaid beneficiaries. CMS already has the blueprint for the under age 65 ACA marketplace. The question is, how long will it take for the American people to accept this inevitable prognosis for ACA 2.0?
Whether or not you believe health insurance is a human right, I think we can all agree that quality health care should be available to everyone. Working out the kinks will take time, but the blueprint is there for us to use. What are your thoughts? Is health insurance a human right? Would the Medicare footprint work for the ACA?