I think it would be instructive to launch a discussion about how best to repair the ACA (aka Obamacare).\u00a0 I suggest the following would be useful changes that would be broadly accepted:<\/p>\n
1) Permanently remove the employer mandate:\u00a0 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<\/p>\n
2) Permanently remove the individual mandate:\u00a0 The notion that the individual mandate is ‘required’ is, I think overblown.\u00a0 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<\/p>\n
3) Keep the exchanges and community rating, BUT:\u00a0 relax the 3:1 rate variance (old to young ratio) and allow true rating by age and geography.\u00a0 Also, erase the requirements that minimum insurance is 60% actuarial value.\u00a0 Let insurers offer as high a deductible as they would like, as long as it is still community rated.<\/p>\n
4) Repeal the IPAB:\u00a0 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<\/p>\n
5) Remove the limitations on admin costs (i.e., the\u00a0 mandatory Medical Loss Ratios):\u00a0 I don’t think anyone believes this reduces premiums; it just decreases the admin functions that may improve utilization control.\u00a0 Let the payers compete on premiums.<\/p>\n
Let me know what y’all think.<\/p>\n
TSB<\/p>\n","protected":false},"excerpt":{"rendered":"
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