Update: What's Going on With Healthcare? Let's Focus on Solutions!

​The effort to repeal the Affordable Care Act has currently stalled in the Senate. I have no doubt leaders in Congress will take up the effort again soon, but while we have some resting time we need to discuss what would make health insurance better for Americans. I wrote in previous posts and articles that the current bills being proposed are nearly guaranteed to raise consumer costs and leave millions of Americans unable to get insurance, because the real root causes are not being address and many of the consumer protections would be repealed.

It's time to start talking about solutions. I have some solutions of my own, but I want to hear your ideas, too. And most importantly, your representatives need to hear your ideas. As a very smart person once said, the price of complaining is coming up with solutions. Here are a few of mine:

Idea 1: Expand tax credits rather than cutting back. The paused repeal bill in both the House and Senate would make huge cuts to tax credits for almost everyone on the exchange. The Senate bill specifically would make deep cuts in the credits for middle-class Americans. Tax credits in the Affordable Care Act are based on age, location, income, and the actual cost of insurance. Both proposed new bills would simply give credits based only on age, and would have no relationship to the actual cost of insurance. In simple terms, this means that if the repeal were to go forward, Americans could expect less help and higher premiums every year. My solution is to expand the tax credits to middle class Americans. Right now, the credits only go up to 400% of the Federal Poverty Level (FPL). If we expanded the credits, many more middle-class families would find insurance more affordable, rather than more unaffordable.

Idea 2: Negotiate provider reimbursements. When the Affordable Care Act was being drafted, a certain faction of representatives wanted the federal government to set fees that doctors, hospitals, clinics, and drug companies could charge. This isn’t a radical idea: it’s exactly what Medicare does. This idea was quickly shot down, though, and didn’t make it into the law. Providers are making billions of dollars of profits on Americans seeking healthcare. In the Affordable Care Act, insurance companies have to follow the 80/20 rule—they must spend at least 80% of premium dollars on healthcare delivery. This leaves them with a 20% margin for wages, administrative costs, and profits (don’t fret, they are still making plenty of money). In my opinion, the 80/20 rule is awesome, but it has a fatal flaw: insurance companies and providers have figured out that if they just raise the 80%, their 20% gets bigger too! Providers should be paid well. But do we need two multimillion dollar hospital complexes with fancy fountains and atriums unmatched by even the Ritz-Carlton on every corner? (Or right across the street from another one?). No, in my opinion. I want great healthcare, I want everyone to have access to doctors/hospitals close to their home, and I want providers to be paid very well. I love money, and everyone should be paid what they are worth. But all your premium dollars largely aren’t going toward paying your doctor more, a good portion of your money is being used to build fancier buildings and to provide more hospital beds in communities where there are already plenty. I want our healthcare dollars spent wisely.  

Here’s a great example. Last summer, I needed an MRI on my ankle after a running injury. My doctor, who works at the biggest hospital system in Wisconsin, ordered the MRI at the hospital with whom she is affiliated. Being in health insurance advocacy, I called the hospital to ask for a price estimate. Ready? $12,000 before the radiologist reading. I cancelled that appointment immediately. I found a stand-alone MRI clinic covered by my insurance where the total bill would be $650 including the radiologist reading. The actual MRI would have been the same at either provider, but the place didn’t have a fancy lobby or 40-foot ceilings. Research shows us that hospitals charge more because they have more overhead but also because they are not always competing in the open market (i.e. most people getting an MRI at a hospital are admitted for an emergency and have no choice, or trust their doctor’s referral and blindly go in without asking for price beforehand). We need to have a serious discussion about what prices are fair and smart for consumers and providers. This is about financial waste, not cutting doctor’s wages. There’s no doubt in my mind that leaving the 80/20 rule intact and negotiating provider reimbursements will bring consumer premiums down—and we need both.

Idea 3: Negotiate drug prices. Much like Idea #2, the federal government refuses to negotiate drug prices. However, unlike #2, they won’t even do it for Medicare (and in Medicare we see unbelievable drug costs for seniors). The federal government could regulate prices, and in my opinion, we should. Just like providers, drug companies have no regulations on what they can charge for life saving drugs. Caps based on actual production cost and fair administrative costs is my recommendation.

I want to hear your ideas! Comment below or connect on Facebook or Twitter.
 
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