The essential challenge succinctly stated — and a path forward for those not offered employer health benefit plans

The two major issues that face us in healthcare reform are the cost of care and the payment mechanism for that care. Any proposed solution that does not meaningfully impact the cost of care (like Obama’s Affordable Care Act) cannot succeed in the end. Similarly, a proposed solution that does not include a practical method of assuring payment for that care (like Ryan’s American Health Care Act) does not provide a real opportunity to resolve the existing problem.

The question becomes, then, whether there is a way to impact both cost of care and method of payment, and I believe there is an option which meets these criteria: Medicaid should be offered to anyone wanting to be covered, with income-tiered premium contributions starting at a selected percentage of the Federal Poverty Level, and Medicare (and supplemental Medicare Advantage plans) should be able to be purchased by everyone 50 and over.

Source: AHCA? Obamacare? Isn’t there a better way forward? | Bruce Gilbert | Pulse | LinkedIn

The first paragraph sums up the enduring global challenge facing policymakers better than just about anything I’ve read in the blizzard of news and commentary of the past two weeks leading up to yesterday’s collapse of the House health care reform reconciliation bill.

In the second paragraph, Gilbert lays out a path to incorporate the working age population not covered by employer-sponsored benefit plans into the large government silos of Medicare and Medicaid. A seasoned insurance professional who has worked in both the public and private sectors including a stint as executive director of Nevada’s health benefit exchange, Gilbert rightly points out insurance (no matter the type) depends on the law of large numbers and spread of risk these programs offer.

The non-group individual market will continue to be challenged to comply with those basic principles regardless of whether the Patient Protection and Affordable Care Act or a successor reform plan is law since the long term viability of non-group medical coverage is ultimately governed by market dynamics and not public policy. Policymakers should be thinking about an alternative model like Gilbert suggests should the non-group market enter a terminal phase — which could very well happen over the course of the next two years.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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