Congressional Brief: 12 Fundamentals of Highly Effective Healthcare

Congressional Briefs | Health


Monday, February 06, 2017
by Larry Wedekind and Devon Herrick

Empowering Patients, Providers and the Private Sector by lowering costs, increasing quality and expanding access.

1. Reform Obamacare to better serve Americans

Congress should:

  • Repeal individual and employer mandates in a way that does not increase costs.
  • Repeal regulations that prevent insurers and employers from designing affordable health plans, including the “essential benefits” package.
  • Allow consumers to choose limited benefit plans and catastrophic coverage.
  • Repeal regulations that prevent insurers from fully adjusting individual premium rates to reflect known health risks.
  • Restore the right to renew coverage if an applicant has maintained insurance with no gaps of more than 62 days.

Insurers should sell multiyear coverage, allowing individuals to keep their health plans if they change jobs. Health plans should have built in cost-containment tools such as Health Savings Accounts, cost-sharing and pay for performance or value. Insurers and health plans should maintain exclusive provider networks, require competitive bidding and selectively contract for the best prices.

Under federal law states have the authority to regulate all insurance sold within their borders. Thus, the market for health insurance is a 50-state patchwork or differing regulations and mandates. Self-insured employer plans are exempt from state regulations. The only highly regulated insurance market is the health insurance market. Many insurance companies offer products in more than one state, but the process of complying with multiple regulations is inefficient. Insurers need the flexibility to meet federal guidelines and offer uniform products in multiple states without regard to running afoul of one state’s unique regulations.

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