Ive been swamped the past few days. Lots of ACA things in the hopper and lots of contingency planning going on.
I only read the article so its was pretty high level stuff. A few cursory thoughts...
-I am a huge fan of state high risk pools. You can do a lot with these product & rate wise. I think it was a wasted opportunity to throw them away w/ the ACA. They can really help get people enrolled while keeping non high risk pools rates lower.
-I do think we need innovation, crazy innovation actually, in Medicaid as the traditional FFS model just doesn't work well, IMHO. That being said, I haven't a clue what their patient centered Medicaid plan is. Im one of these crazies that thinks we can get innovation in the managed medicaid space but its a tough nut to crack. Would love to incent states to pilot, test, innovate.
-I think we need to change the tax treatment of employer sponsored insurance. I think its crazy that this is tax free in the employer space. This leads to over insurance which I think drives higher costs. It sounds like they were arguing something different.
-Low income people need access to premium assistance and I don't think tax credits as they laid out will get us there. I think the ACAs tax credits are ok in theory (advanceable, sliding based on income) but way too complicated and way to skewed to cover older people. My biggest issue is they are indexed to premium and since insurance costs increase faster than wages, its a disaster waiting to happen.
-It is missing transparency. We need to create cost transparency in this space with providers.
-It was also missing Medicare reforms. I think we need to overhaul how we pay docs in this space using some of the innovation from private payors in outcomes, cost/ quality data, etc.