Here’s a plan to make health insurance more affordable for all Americans
This week, a bipartisan compromise unveiled designed to extend ObamaCare subsidies to health insurance companies holds the promise of being a short-term fix to protect millions of Americans from losing health insurance they can afford. But a long-term solution is still needed to make health care more affordable and fix the flaws of ObamaCare.
President Trump may have provided the impetus for the compromise announced by Senate Health Committee Chairman Lamar Alexander, (R-Tenn.), and ranking member Patty Murray, (D-Wash).
They proposed extending ObamaCare subsidies to insurance companies for two years and giving states more flexibility to implement the health-care law. However, the compromise has drawn criticism from some Republicans and it is unknown if it can win approval in Congress.
{mosads}The Alexander-Murray proposal solves a crisis created by Trump when he recently said he would cut off payments to insurance companies used to reduce health insurance costs for about 7 million low-income Americans. In addition, Trump began the process of making it easier for small businesses to offer employees bare-bones insurance coverage purchased through association plans.
Both actions by the president would sharply increase the price of the comprehensive health insurance policies mandated by ObamaCare. This would prompt many young healthy people to drop those policies, leaving insurance companies with a larger percentage of sicker older people to insure. Many insurers would then stop offering ObamaCare policies.
The long-term problems of ObamaCare can only be solved by a more permanent solution that can draw support from lawmakers in both parties. Many people have advanced and will advance proposed solutions. I have one that is based on my experience as a health insurance company executive for 25 years (now retired) and as a former Democratic state legislator in West Virginia.
The proposal I’m describing here addresses ways to make health insurance premiums more affordable — but not that’s only half of what’s needed. Actions are also needed to slow the rapid growth of health-care costs. That’s a topic Congress and the president need to address in the future.
As a first step to make health insurance more affordable, Congress and the president must accept that health care is a right for all Americans — not a privilege. That means Medicaid needs to be preserved for the poor and disabled, but with stricter requirements that able-bodied people work. Medicare must be preserved for senior citizens.
Next, Congress should impose an enforceable requirement that everyone not receiving health insurance from the government or employers buy it on the private market, or through programs currently available to state and federal government employees. This would ensure that healthy people buy coverage, paying more in premiums than they collect in benefits. This is necessary to enable insurers to earn enough from healthy people to pay costly benefits to sick people.
ObamaCare already requires individuals not covered by employer or government health insurance to buy their own insurance. But this individual mandate, which draws objections from Republicans, sets the penalty for not buying insurance far lower than the cost of insurance. In 2015, the average individual mandate penalty was only $442.
As a result, in 2015 there were 5.6 million people who paid the penalty and another 11 million who received a hardship exemption to avoid buying insurance because it would cost more than about 8 percent of their income, the IRS reports. It’s safe to assume that almost all of these nearly 17 million people were healthy and concluded they did not need insurance coverage.
A good way to enforce the mandate so almost all adults get health insurance would be to require everyone getting or renewing a driver’s license to show proof of health insurance — just as they must now show proof of car insurance. There are about 218 million licensed drivers in the U.S.
To make mandated health insurance more affordable, Congress could raise the federal minimum wage by at least $3 an hour and require states to raise their minimum wage by that amount. And health insurance premiums could be made tax-deductible, even for people who don’t itemize.
With an enforceable individual mandate, the ObamaCare requirement that every employer with 50 or more employees provide health insurance could be dropped. Many employers would continue providing health insurance to attract and keep employees. But some struggling small businesses would drop coverage, enabling them to grow and hire more workers.
Even the weak individual mandate in ObamaCare has drawn GOP criticism for requiring people to buy an insurance product. Yet critics accept mandates requiring drivers to buy car insurance, many homeowners to buy mortgage insurance, and workers to pay Medicare and Social Security taxes.
And we pay taxes for services we may never use, including public schools, and fire and police protection. If these mandated payments are OK, why is a health insurance mandate wrong?
Before ObamaCare, insurers could hold down expenses for the sickest people by denying coverage for preexisting health conditions when signing up policyholders. They could also place restrictions on what treatments they paid for and cap the amount of benefits paid to someone over a lifetime.
ObamaCare requires insurers to cover preexisting conditions and eliminates lifetime payment caps. It also requires that all health insurance policies cover a list of diseases and medical procedures. These provisions benefit millions of people.
But the requirement for coverage of preexisting conditions is a disincentive for healthy people to buy health insurance. This has created a so-called “death spiral,” where insurance companies cover too many sick policyholders and too few healthy ones. This forces insurers to raise premiums, driving more healthy people off the insurance rolls and requiring insurers to raise rates repeatedly. Eventually rates become unaffordable and insurers stop issuing policies.
The requirement that all health insurance cover many conditions has drawn extensive criticism. A particular target has been the requirement that policies cover maternity care — something half the population will obviously never need.
But if only women were required to get maternity coverage the cost would likely double. And if only women who were planning to become pregnant or already pregnant bought maternity coverage the cost would go through the roof.
Right now the Affordable Care Act is not working. The system of exchanges and health insurance subsidies the law set up is incredibly complex and extraordinarily difficult for the average American to navigate. And premiums and deductibles are skyrocketing. Even Democrats who support the law acknowledge it needs be fixed.
Whether by enacting the plan I have outlined above or by approving something else, members of Congress and President Trump have a responsibility to take action to make affordable health care a reality over the long term and not just a slogan. That’s why we elected them.
Gregory K. Smith is the retired president and CEO of Mountain State Blue Cross Blue Shield in West Virginia and a former assistant majority leader of the West Virginia House of Delegates.
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