Archives for July2013

How ought we modify the ACA to improve it?

I think it would be instructive to launch a discussion about how best to repair the ACA (aka Obamacare).  I suggest the following would be useful changes that would be broadly accepted:

1) Permanently remove the employer mandate:  I think most economists think this is bad policy, and probably has a significant influence on restricting job growth and increasing the incentives to shift to part-time workers

2) Permanently remove the individual mandate:  The notion that the individual mandate is ‘required’ is, I think overblown.  If the law were changed to implement eligibility rules that require advance purchase (e.g., must buy insurance by 12/1 of the prior year to get coverage, or be continuously insured the change insurers), that would mitigate the tendency of folks not buying insurance until they are sick

3) Keep the exchanges and community rating, BUT:  relax the 3:1 rate variance (old to young ratio) and allow true rating by age and geography.  Also, erase the requirements that minimum insurance is 60% actuarial value.  Let insurers offer as high a deductible as they would like, as long as it is still community rated.

4) Repeal the IPAB:  I don’t think this will have any discernible impact on cost, and is likely to cause more administrative burden in an already overburdened system

5) Remove the limitations on admin costs (i.e., the  mandatory Medical Loss Ratios):  I don’t think anyone believes this reduces premiums; it just decreases the admin functions that may improve utilization control.  Let the payers compete on premiums.

Let me know what y’all think.


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