10 Steps to Reform Insurance While Covering Chronic Conditions - HC Pro

by Joe Cantlupe

Source: HC Pro

The government should initiate "small scale reforms" to its healthcare insurance system to overcome potentially devastating obstacles in serving an aging and chronically ill baby-boomer population, says one of the leaders in the healthcare consumerism movement.

 "We're going to have just a huge problem," says John C. Goodman, president and CEO of the National Center for Policy Analysis, referring to 78 million baby boomers retiring early or losing jobs and potentially facing burdensome health issues. Goodman, an economist specializing in healthcare issues, writes what he terms the only "right-of-center" health policy blog.

As Goodman sees it, revamped policies would include "portable insurance"-in which providers would allow customers to move from job to job and maintain health insurance-and special needs insurance "instead of requiring insurers to be all things to all people, they should allow plans to specialize in treating one or more of the chronic conditions." Goodman has been an opponent of existing healthcare reform proposals as falling short of meeting the nation's healthcare needs. The legislative proposals are currently stalled in Senate and House conference discussions.

The emerging baby boomer population represents a special need, he says, adding that more than 80% of them will retire before they become eligible for Medicare. "Employers should be encouraged to negotiate to cover retirees," Goodman says, adding "two of three don't have the promise of post-retirement care."

"Most proposals for dealing with the problems of pre-existing conditions would completely divorce health insurance premiums from expected healthcare costs," Goodman wrote Jan. 27 in "Ten Small-Scale Reforms for Pre-Existing (Chronic) Conditions" for Health Affairs.

"Yet a policy of trying to force health plans to take enrollees they do not want risks jeopardizing the quality of care they receive. Instead of suppressing the price system, I propose 10 ways of dealing with this problem that make greater use of it."

The 10 Goodman recommendations include:


Encourage portable insurance. Goodman contends the problem of pre-existing conditions occur because health insurance isn't portable, and employers aren't allowed to buy insurance they can own and take with them from job to job, or out of a job. Goodman says, "The NFL and mineworkers have such policies, where they can take it from job to job."

Allow special needs health savings accounts for the chronically ill. These plans would include "cash and counseling programs" in which homebound and disabled patients potentially take care of their own private plans. Pilot programs exist for such programs in which there has been nearly a unanimous satisfaction rate among participants. The programs could be models for future plans for chronically ill people, Goodman says.

Allow special needs health insurance. Insurers should be allowed to specialize in chronic conditions, instead of being "all things to all people," Goodman writes. Insurers should be allowed to charge market prices, while quality competition should be encouraged, he says.

Allow health status insurance. There should be two separate kind of insurance, with separate premiums, Goodman says. Standard insurance would cover the health needs of people during the insurance period, while status insurance would pay future premium increases people face if they have a change in health status and then try to switch to another health plan, Goodman adds.

Allow self-insurance for changes in health status. The tax law allows employers to pay for current-period medical expenses with untaxed dollars. But there lacks an opportunity for employers or employees to save for future changes in a health status, and people need to engage in contingency savings for future payments-such as a health savings account (HSA).

Give people on their own the same tax break employers get. Goodman says all insurance should get the same tax relief regardless of where it is obtained or how.

Allow providers to repackage and re-price their services under Medicare and Medicaid. Goodman calls for "innovative solutions" that would allow providers to offer different bundles of services in the care of diabetes, asthma, cancer, and other diseases to reduce government cost and improve care.

Allow access to mandate-free insurance. Costly mandated benefits have priced out health people, raises premiums for the chronically ill, and diverts money from their care, Goodman says. A diabetic, for example, shouldn't have to pay for other types of care simply to get his own needed care, according to Goodman.

Create a national market for health insurance. Competition among special needs insurers would benefit the chronically ill as well as having the ability to buy insurance across state lines, Goodman says.

Encourage post-retirement health insurance. Goodman says post-retirement insurance should be allowed because more than 80% of baby boomers will retire before they are eligible for Medicare, yet face the greatest obstacle for denial of health insurance because of pre-existing conditions.

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