Advantage for All -- Affordable, Universal, Equitable, Understandable

 

Congressional critics continue to try to identify a replacement for what is still a controversial law.  However, as the results so far have demonstrated, merely reshuffling components and regulations without reforming the underlying system is bound to disappoint. What is needed is new thinking, starting with the criteria any alternative to the ACA should meet:

·         A base level of coverage must be universal and guaranteed.

·         Incentives to control costs and ensure quality care must, so far as possible, be inherent in the system design rather than imposed by regulation.

·         The system should be equitable and responsive to the needs of individuals.

·         Stakeholders’ roles and strengths must be recognized.

·         The system must be minimally complex and readily understandable to its various user populations.

Advantage for All – Real Reform

Advantage for All—based on the successful Medicare Advantage program, allowing seniors to choose between a government plan and an array of actuarily-comparable private plans—would meet each of the five criteria above.

Instead of today’s muddle of employer-paid plans, Obamacare exchanges, fifty different state Medicaid programs, Medicare, and individual insurance, plus no insurance at all for more than twenty million Americans, Advantage for All would create a single system in which everyone would be guaranteed a premium subsidy to make coverage affordable, and in which individuals—not employers or government—would determine the insurance they need.   

Over-65s would choose between the traditional government fee-for-service plan and a menu of private plans, just like Medicare Advantage today. Those under 65 would choose from similar menus of private plans.

To control costs and achieve the benefits of price competition, premium subsidies for both seniors and under-65s would be capped, dependent on regional medical costs and private plan bids. Those wanting costlier coverage would pay the difference, but over-65s would always be guaranteed a choice of at least two plans with no additional premium cost.

For seniors, benefits would be actuarially identical to today’s fee-for-service coverage. For under-65s, premium subsidies would be tied to income, age, and regional costs. The lowest-earning beneficiaries, close to the Federal Poverty Level, would receive subsidies sufficient to purchase coverage comparable to that now provided by Medicaid. Higher-earning beneficiaries would receive more limited subsidies, but would be able to “upgrade” using their own funds. Most current Medicaid recipients would be automatically enrolled in the program and the acute care component of Medicaid eliminated for all but the aged and disabled.

, the aged and disabled often suffer from chronic illness, and may be dependent on various forms of long-term care. It is appropriate that the two groups' different needs have different solutions.

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"Compared with other industrialized nations, the United States is unique in having a separate healthcare program--one with the reputation of providing inferior care--for its lower-income citizens..." -- from the Campaign study report.

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Children and families (and low-income adults) in the current Medicaid program, along with CHIP enrollees, will be merged into the overall private insurance population, but with special protections. 

Like the rest of the private insurance population, the former Medicaid and CHIP enrollees will receive premium support based on their reported incomes. Those at or below 100 percent of FPL will receive premium support sufficient to acquire zero-deductible, minimal co-pay coverage at no cost. Additionally, all those below 150 percent of FPL will receive priority assignment to the lowest cost available health plan, but with the option of purchasing other coverage.

The aged and disabled (including dual eligibles) will remain in state-administered programs, but with partial federal funding provided through block grants.

Block grant funding will increase annually at the rate of GDP growth, with states matching federal funding at the FMAP rate. This approach reflects the relatively stable and less economy-variable nature of this group and is expected to encourage better coordination of care and more use of social service alternatives to minimize medical needs.

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