Let me start out by saying that I am 100% in favor of a single-payer system. It clearly is the best option. However, since that is not politically feasible and Republicans are dead set on repealing ACA, what about a system where the insurance carriers have to pay the first $X in claims and the federal government pays the rest? I'm not an expert but believe this is similar to how reinsurance works.
More specifically:
- We keep the ban on preexisting condition exclusions, the low-income subsidies, expanded Medicaid (ideally with some mechanism to force states to adopt)
- We would also keep in place the essential health benefit requirements, the medical-loss ratio minimums, kids being able to stay on the parents plan until age 26, and limits on gender and age rating
- Deductible maximums would be lowered to $1,000 a year for individuals, $2,500 for families.
- The individual and employer mandates go away (Republicans won't accept anything else)
- In exchange for preexisting conditions without a mandate, we would cap the annual amount insurance carriers have to pay out per policy. Not sure what this number should be but maybe something like $250,000, $500,000 or $1 million.
- Once the insurance carrier pays out that amount, the insurance carrier would submit any additional claims to the federal government for reimbursement for the remainder of the calendar year.
- For the uninsured who could have afforded coverage but chose to not buy it, they would be responsible for the first $X (maybe $50,000?) of any hospital bill and the federal government would reimburse the hospital for any amount above that.
There is a lot to hate about this plan. For starters, it essentially privates profits and socializes losses. Again, I want single-payer. However, I believe capping the insurance carrier's "loss" combined with maintaining the minimum medical-loss ratios that we have with the ACA would lower premium prices while still enabling people with preexisting conditions to get coverage. The subsidies would ensure that everybody still has access to affordable health insurance.
Thoughts?