After the Election: Remembering the Fundamentals of Healthcare Reform

Now that we have had a week to digest the historic election headlines regarding the Republican gains both at the state and federal levels, it is time to move beyond the political whirlwinds and begin to evaluate how we can improve the healthcare system in a meaningful way.  BenefitMall has a unique perspective on this as we represent thousands of brokers and agents who help underwrite billions of premium dollars annually. 

Addressing the Downpour

Certainly, pitfalls and challenges abound as the U.S. Department of Health and Human Services (HHS) and other federal agencies implement the Patient Protection and Affordable Care Act (PPACA).  While outright repeal is unlikely, attempts will be made to roll back or eliminate certain provisions of the Act.  Here is a short list of some of the pressure points:

• Establishing a level playing field.  State-wide Healthcare Exchanges, whether private or public, could de-stabilize the marketplace through adverse selection.   Great care needs to be taken to ensure a level playing field is established for insurance coverage whether purchased inside or outside the exchanges. 
  

• Using navigators who can make a difference.  If brokers and agents are not properly paid to help individuals navigate the healthcare maze and help resolve coverage issues with health plans, who will replace them?  Don’t expect government officials to give the same level of personalized or timely attention. 
  

• Promoting informed decision-making.  Consumers will still have difficulty navigating the healthcare system due to fragmentation and segmentation.  PPACA could make things much worse if proper precautions are not taken. 
  

• Making a realistic financial commitment.  Can we really afford to pay for or help subsidize the healthcare for tens of millions of Americans without coming up with a well-designed cost containment system that does not compromise the scope or quality of coverage?  Do state and federal governments really have the resources to implement PPACA under the current timeframes with the current economic climate?
  

• Realizing there are limits to cost cutting.  How will physicians and other providers absorb cuts in Medicare and Medicaid, along with private sector expense reductions, without hurting their medical practices? 
  

• Establishing appropriate legal foundations.  Over 18 states are suing the federal government over healthcare reform.  We need to address and resolve the many lawsuits challenging the individual mandate to purchase personal coverage and other issues.  Another concern is the over-reliance on the “interim rulemaking” procedures that have been used by the federal agencies to expedite and promulgate final regulations without a proper comment period or vetting process. 
  

• Implementing the right proportions.  Implementing incorrect Medical Loss Ratios (MLR) could lead to marketplace departures by insurers and health plans due to unrealistic actuarial assumptions.  BenefitMall recommends that broker commissions be exempt from the MLR formula. 
  

• Ensure the availability of clinical resources.  How do we reconcile the shortage of primary care physicians and other clinicians with the expected increase of covered lives and the decrease of reimbursement levels?

Every Cloud Has a Silver Lining

With some recent lessons learned in 2010, public policymakers have the opportunity to reevaluate the current PPACA implementation requirements and decide which elements of the new law should be tweaked or reconsidered next year. 

Clearly, there are several attributes of the new law that have received little or no criticism, including:

• Funding for electronic health record systems and interoperable healthcare technology platforms;
• The promotion and greater reliance on evidence-based medicine;
• A move towards greater transparency and accountability through comparative effectiveness research;
• The expansion of quality improvement programs including patient safety initiatives;
• Reasonable and well-timed insurance reforms that don’t disrupt the marketplace or create unfunded mandates; and
• The expansion of case management, wellness and prevention programs, which can help to improve care.

Moving carefully and striving for a bi-partisan approach will greatly benefit us in the long run.  Our nation has an incredible opportunity to implement reforms that make both incremental and fundamental enhancements to the way health insurance is offered and paid for, while using methods that do not jeopardize or destabilize the U.S. health care system.