McCain Pushes Tax Credit, Choice as U.S. Health Care Fix
National News • April 30, 2008
Republican presidential candidate John McCain called Tuesday for greater competition for health care coverage for Americans, saying more choices for insurance will drive down costs and improve the ...
Insurance Journal is not responsible for the content of the message below.
Subject: Comprehensive & dramatic solution is the only fix
Posted On: May 1, 2008, 12:37 pm CDT
Posted By: Whimp Stomper
Comment:
The big cost issues; insuring the un-insured, Deal with the cost shift from Medicare and Medicaid fee schedules, Reduce the cost of defensive medicine with some form of Tort Reform, restrict the unlimited research and development open insurance checkbooks provides, and push managed care/ wellness practices.
Wrap up reform in the Essential Services Benefit by the following.
The un-insured:
Now to get most residents insured, I agree we must change the individual market to a Guaranteed Issue, but to avoid what occurred in Washington, we must implement a system where most are insured. Have all residents prove by certificate of credible coverage they have a benefit package no less than a defined Essential Services Benefit, or they're automatically enrolled in the States Essential Benefits Package. (This package isn't a rich package, but is low cost, and when I say low cost plan, I don't mean high deductibles, I mean a managed care plan that limits or excludes as many lower-value health care services or practices as possible.) This affects no one with current major medical, only those without. Those without, will miss out on a Tax Credit, AND be automatically enrolled in a no frills plan, which includes enrollment with a PCP and some participation in wellness and managed care. Those without coverage from an employer who have not purchase the minimum insurance on their own end up paying their portion by not receiving a tax credit. Now we have substantially increased those participating in an insured environment lowering the cost to the rest who currently are, AND those currently covered will have an option of buying a low-cost plan, not currently an option.
How do we capture those not enrolled? All children registering for school must not only prove immunizations, but also certificate of credible coverage, or they're enrolled in the Essential Benefits Package. Their parent/s or guardian/s must also prove they're covered, or they're enrolled. All receiving public health services must also prove credible coverage, or will be enrolled in the EBP. All those receiving any public service to residents must prove residency with evidence of picture ID or State Photo Driver's License. Those attending a clinic or ER (or any access point) must prove credible coverage or will be enrolled in EBP on the spot.
Medicare, Medicaid Cost Shift:
Have the EBP pay providers on a fee schedule we do this now with Worker's Compensation. We also do this on auto insurance, where Personal Injury Protection (PIP) is limited by statute how much it will pay for the insured's injury claim. Why not have a fee-schedule and adjust up or down in area's the fee schedule needs to go? (up for PCP's for example willing to see EBP patients, down for say specialists?)
Tort reform:
Have tort caps for all services provided under the OEBP too, again, same as with Worker's Comp, where Worker's Comp is the sole remedy, and for the most part, subject to no more than $250,000. Many States have Tort Caps of $200,000 or more; why not subject EBP to that cap too? We have the Federal Tort Claims Act immunity for community clinics, why not something like that for EBP? If we lack providers, there are community clinics up and running? Support them in some way to deliver EBP, or contract out to TPA's?
Unlimited funding of research and development:
There is little or no rationing or restricted certificate of need. With 7 MRI's in a local small town, and no 24/7 access, we have excess in expensive services, equipment and supplies. Have the EBP allow for say only the first three MRI's to be covered by the Essential Benefits Package, the others may be covered by private pay or any willing insurer covering beyond the OEBP. Have too many specialists? Only certain few are covered by the EBP. This should result over time in a dramatic price difference between EBP and coverage beyond EBP, building up a market force to keep costs down, yet allowing for choice, innovation, etc.
Managed care:
Require the EBP benefits payable be done in a Managed Care environment. Monitor insurers for enrollment in use of wellness programs, see that insurer pay providers more for better outcomes and manage subsidies for those limmited income.
Subject: Comprehensive & dramatic solution is the only fix
Wrap up reform in the Essential Services Benefit by the following.
The un-insured:
Now to get most residents insured, I agree we must change the individual market to a Guaranteed Issue, but to avoid what occurred in Washington, we must implement a system where most are insured. Have all residents prove by certificate of credible coverage they have a benefit package no less than a defined Essential Services Benefit, or they're automatically enrolled in the States Essential Benefits Package. (This package isn't a rich package, but is low cost, and when I say low cost plan, I don't mean high deductibles, I mean a managed care plan that limits or excludes as many lower-value health care services or practices as possible.) This affects no one with current major medical, only those without. Those without, will miss out on a Tax Credit, AND be automatically enrolled in a no frills plan, which includes enrollment with a PCP and some participation in wellness and managed care. Those without coverage from an employer who have not purchase the minimum insurance on their own end up paying their portion by not receiving a tax credit. Now we have substantially increased those participating in an insured environment lowering the cost to the rest who currently are, AND those currently covered will have an option of buying a low-cost plan, not currently an option.
How do we capture those not enrolled? All children registering for school must not only prove immunizations, but also certificate of credible coverage, or they're enrolled in the Essential Benefits Package. Their parent/s or guardian/s must also prove they're covered, or they're enrolled. All receiving public health services must also prove credible coverage, or will be enrolled in the EBP. All those receiving any public service to residents must prove residency with evidence of picture ID or State Photo Driver's License. Those attending a clinic or ER (or any access point) must prove credible coverage or will be enrolled in EBP on the spot.
Medicare, Medicaid Cost Shift:
Have the EBP pay providers on a fee schedule we do this now with Worker's Compensation. We also do this on auto insurance, where Personal Injury Protection (PIP) is limited by statute how much it will pay for the insured's injury claim. Why not have a fee-schedule and adjust up or down in area's the fee schedule needs to go? (up for PCP's for example willing to see EBP patients, down for say specialists?)
Tort reform:
Have tort caps for all services provided under the OEBP too, again, same as with Worker's Comp, where Worker's Comp is the sole remedy, and for the most part, subject to no more than $250,000. Many States have Tort Caps of $200,000 or more; why not subject EBP to that cap too? We have the Federal Tort Claims Act immunity for community clinics, why not something like that for EBP? If we lack providers, there are community clinics up and running? Support them in some way to deliver EBP, or contract out to TPA's?
Unlimited funding of research and development:
There is little or no rationing or restricted certificate of need. With 7 MRI's in a local small town, and no 24/7 access, we have excess in expensive services, equipment and supplies. Have the EBP allow for say only the first three MRI's to be covered by the Essential Benefits Package, the others may be covered by private pay or any willing insurer covering beyond the OEBP. Have too many specialists? Only certain few are covered by the EBP. This should result over time in a dramatic price difference between EBP and coverage beyond EBP, building up a market force to keep costs down, yet allowing for choice, innovation, etc.
Managed care:
Require the EBP benefits payable be done in a Managed Care environment. Monitor insurers for enrollment in use of wellness programs, see that insurer pay providers more for better outcomes and manage subsidies for those limmited income.