| The CMS is asking the public for ideas and advice on how to make it easier for health insurers to sell policies across state lines. The agency issued a request for information on Wednesday for recommendations on eliminating barriers and enhancing insurers’ ability to sell individual insurance coverage from state-to-state. The request, which the CMS said is meant to promote competition and choice for consumers, follows President Trump’s October 2017 executive order on cost and competition in the health sector. CMS said it is interested in feedback about how states could use Section 1333 of the ACA, which allows insurers to enter into a “healthcare choice compact,” to sell out-of-state coverage if state regulators agree. |
The Trump administration is sounding out an idea to require that hospitals, doctors and other medical providers publicly disclose the “secretly-negotiated” prices they charge insurance companies for services, a move that proponents say would expose for the first time the actual cost of care. [Some are skeptical that anyone in the health sector knows the actual cost of care.] Hospitals and insurers negotiate pricing contracts which are generally bound by confidentiality. HHS is seeking public comment on whether patients have a right to see the discounted prices in advance of obtaining care.
In response to a request from Sen. Lamar Alexander (R-TN), chairman of the Senate Committee on Health, Education, Labor, and Pensions, health policy experts at the American Enterprise Institute and the Brookings Institution worked together to compile a list of policy options to slow the rate of increase of health care costs and attract bipartisan support. Among the key policy proposals:
- Limit the tax exclusion of employer-sponsored insurance
- Ensure effective anti-trust enforcement
- Discourage state governments from inhibiting free market competition
- Prevent surprise out-of-network billing
- Encourage the use of more generic drugs in Medicare Part D
Access to quality, affordable medical care should be something all elected officials can agree to work on because it’s something we all believe in, Rep. Westerman (R-AR) writes. The Fair Care Act has two primary goals: to increase the number of people with health insurance coverage and to decrease per person health spending. It’s a fair solution covering pre-existing conditions, tackling the cost of insurance premiums and increasing consumer flexibility. Highlights:
- Title 1: Private Sector Health Insurance Reforms
- Title 2: Medicare and Medicaid Reforms that Promote Solvency and Increase Access to Health Insurance Plans
- Title 3: Promote Transparency and Competition to Lower Prescription Drug Costs
- Title 4: Increase Competition and Lower Costs by Discouraging Provider Monopolies
- Title 5: Digital Health Care Reforms
The sales pitch for Medicare for all is appealing—universal coverage, free access to doctors and hospitals, and no insurance premiums, copayments or deductibles. But then come the tradeoffs: Everyone would be required to give up private health insurance, and taxes could double to finance $32 trillion in added government spending over the next decade. Washington bureaucrats would decide what services are covered and how much doctors and hospitals would be paid. Rationing and waiting lines are inevitable. The American people don’t want such a major upheaval. The right solution is to give people more choices of more affordable health coverage and have states, rather than the federal government, target resources to those who need help.
| Direct primary care (DPC) is fast becoming an accepted alternative to fee-for-service payment in the private market, but it has yet to find its way into Medicare. Over two-thirds of Medicare beneficiaries have two or more chronic conditions. This is a population that would benefit greatly from high quality primary care, but the program is still built on the fee-for-service model of payment, which creates barriers to low-cost, frequent communication between physicians and their patients.CMS could test ideas like DPC to see if they can deliver better care at a lower cost to the Medicare population. |
Medicare funds health-care services for 60 million elderly and disabled Americans. Of these, 39 million receive coverage through a plan known as “Traditional Medicare” or “Medicare Fee-for-Service” (MFFS) that the federal government administers directly. Increasing numbers of seniors—21 million in 2019—enroll in Medicare Advantage (MA), choosing from competing plans managed by private insurers. MA provides an incentive for plans to develop innovative care arrangements, but the rules under which MA plans operate can be restructured so that more of the efficiency gains can be passed on to beneficiaries.
| Two Republican congressmen introduced proposals Tuesday designed to fix America’s health care system through a variety of market-oriented reforms. Reps. Bruce Westerman (R-AK) and Jim Banks (R-IN) say their Fair Care Act of 2019 “addresses major drivers of health care costs as well as obstacles hindering individuals from obtaining health insurance coverage.” It proposes a bevy of changes to the health care market. Many of the bill’s provisions target availability of insurance to those who otherwise lack access. It also allows would put in statute short-term limited duration plans and association healthplans, which would increase competition. They worked closely with Avik Roy of the Foundation for Research on Equal Opportunity in developing the plan. |
As centrist Republicans contemplated an Obamacare repeal-and-replace plan, the CBO warned that doing so would boost the number of uninsured by 22 million. That scared enough Republicans away to kill the bill. The intrepid Philip Klein at the Washington Examiner noticed that, buried in a footnote, was a stunning rebuke of those CBO forecasts. Turns out, the CBO’s forecasts off by a factor of six. The report says that the mandate repeal will result in only 1.5 million dropping out of the individual insurance market, and 1 million from employer plans, with Medicaid enrollment unaffected. These forecasting errors don’t even rise to the “good enough for government work” level. But they were good enough to get Obamacare on the books, and then keep it there.
| Policymakers are debating whether Congress should enact a single-payer health care system or create a system based on personal choice and market competition. The fundamental question is whether government officials or individuals and families will make the key health care decisions. The adoption of a single-payer system requires major trade-offs: a loss of personal and economic freedom, the loss of existing health coverage, the imposition of unprecedented federal taxation, major payment reductions for doctors and medical professionals, long waiting lists, and care delays and denials. |