There are a lot of misconceptions out there.
A group of centrist lawmakers is set to begin work on a bipartisan health care bill. Meanwhile, public opinion is tilting in favor of government involvement in health care, with a third of Americans supporting a single-payer system.
If you locked experts of various political affiliations in a room and told them to draft a health care bill, what would they come up with? We’ll find out.
- Chris Jennings Former senior health policy adviser in the Clinton and Obama administrations; president of Jennings Policy Strategies, a consulting firm
- Joseph Antos Wilson H. Taylor scholar in health care and retirement policy at the American Enterprise Institute; former health adviser to the Congressional Budget Office
- Mary Agnes Carey Partnerships editor and senior correspondent, Kaiser Health News.
What Did They Agree On?
During their conversation, Joe and Chris laid out four key areas to improve the current healthcare system. In the short term, the administration would have to find a way to continue to pay the current cost-sharing subsidies while helping insurance companies cover the most high-cost patients. Eventually, the government will have to work on controlling the cost of care and insurance, and keep encouraging healthy people to enroll into the system before they get sick (something the individual mandate is meant to do).
Our conversation didn’t produce legislation that’s ready to pass, but our panel did start a conversation about compromise.
One major issue to address is the Affordable Care Act’s cost-sharing subsidies — payments that go to individuals to help pay for care. If these aren’t maintained to some degree, “premiums will go up,” Chris Jennings said. “Some plans will arguably have a rationale for pulling out.”
Helping insurers cover highest-cost cases
If insurers can’t deny coverage for pre-existing conditions, then people who would previously have to pay more for coverage will cost more to insurers.
“The ACA changed the social norm,” Joseph Antos said. “Speaking personally, I think that was a good idea. But when you change the social norm, you have to then think about the business aspects of the insurance market. If you’re going to have insurance companies cover very expensive people immediately, then you’re going to have to find some way to come up with the money to compensate them for that for those additional costs.”
Jennings responded with a potential solution. “To deal with these outliers, these people who are very very sick, that the plans have not been able to deal with, you need to have some sort of reinsurance mechanism, which is basically a payment to help reduce the cost of caring for outlier patients,” he said.
Is the requirement to cover patients with pre-existing conditions likely to stand? “Even President Trump has made statements that would lead anyone to believe that they don’t want to take a direct attack on kids that are born with birth defects,” Antos said. “However, there’s always the possibility, which I think is also very remote, that there could be changes in what has to be covered by insurance, these so called essential health benefits package. So, that wouldn’t excuse insurers from covering everybody, but they could cut back on what they do cover, and that could lead to higher costs. Would that happen? I think we’re basically past that.”
Our panel agreed that keeping the costs for treatment lower would be essential to any successful health care plan.
“I think Joe [Antos] and I would both agree that a lot of these conversations [in Washington about health care] are absent the need for having a real engagement on the issue of cost containment,” Jennings said. “You can’t just talk about putting more money into the system without finding ways to get more affordable care out of our system.”
“Well let’s be clear about this,” Antos said. “It’s not just pricing. And you’re suggesting that the government go in there and start regulating prices. The government has not been good at that. It has tried it. It generally has been soaked by people smarter than they are.”
“What price really matters to consumers is not the theoretical price that the insurance company might pay, it’s mostly, ‘what am I going to pay out of my own pocket?'” Antos continued, adding that, “knowing the price doesn’t help you very much, because you also want to know whether the service is going to be provided at high quality with high professionalism, and it’s also, ‘is this the right service for me?’ These are really difficult questions, so knowing something about what the real price is would be a step in the right direction, but it’s only a small step.”
One of the most controversial parts of the Affordable Care Act is the individual mandate — the requirement that everyone have insurance coverage.
“That’s absolutely something that conservatives oppose,” Mary Agnes Carey said.
“If you really want to have people buy insurance, then you need both positive incentives and negative incentives,” Antos added. “The positive incentives are subsidies to cover the premium. Also, it has to be a product that you actually want to buy, which is much harder to come up with. But also, oftentimes people have to be reminded that this is something that is virtually a precondition of being a good citizen.”
But having no pre-existing conditions without the individual mandate “blows up the insurance marketplace,” Jennings said. “That’s a basic fundamental of insurance principles. The reason we have to have an individual mandate, or something like it that assures people sign up for coverage is that we can’t have a stable marketplace that’s affordable for everyone if we don’t, and have those protections that we want to have.”
“It’s also utilization,” Antos said. “It’s expectation on the part of patients, about what they think they deserve, of course at no cost to themselves, and it’s also the efficiency or the inefficiency of the way healthcare is delivered … There are lots of problems in the way healthcare is delivered. We need systems of care that are disciplined by market forces that recognize that there’s a bottom line, and the patients also have to recognize there’s a bottom line, and it’s their bottom line. It’s not just a gift.”
It’s not quite legislation, but maybe these topics will guide you as you watch the health care debate play out in Congress.
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