Late last week, the Blue Cross and Blue Shield Association released a three page proposal to for an ACA 2.0 bill. This proposal identifies the biggest issues as not enough young people in the pool, idiosyncratic risk and premiums being too high for folks who currently are not eligible for premium subsidies. The pay-for is appropriating Cost Sharing Reduction (CSR) subsidies.
- Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
- Older adults are held harmless
- All individuals, regardless of income, are eligible for subsidy assistance
- CSRs appropriated
- CSRs expanded
- Full advertising and outreach funded
- Health insurance premium tax suspended
This is an industry proposal. It is a first cousin of the Democrats’ proposed ACA 2.0. The Democrats in HR 5155 were indifferent to the health insurance premium tax but they sought to expand premium tax credit eligibility and upped CSR payments to higher income groups.
These are discussions that are going in the same general direction.
The ACA was the result of several years of stakeholder consensus building. Advocates were involved. Wonks were involved. Hospitals were involved. Physician groups were involved. Insurers were involved. Pharma was involved.
It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.
We should look to see what the other major interest groups that can elect to drop $100 million in support or in opposition to major health policy bills. There policy papers will shape the contours of possibility and the trade-offs of ambition.
TBH all I want them picking out for 2021 or 2022 is what color of wreath they want to lay on the company’s headstone.
We tried compromising on policy with insurers, and they turned around and wrote fat checks to the GOP. Fuck them all straight into the ground.
How difficult would it be to make the benchmark plan the second cheapest gold plan? Would it be worthwile? Seems it would give bigger subsidies and less cost sharing for those who don’t qualify for CSR.
BCBS is actually realizing that premiums are too high? When I lost corporate coverage I had to take on a part time job just to pay for health insurance; it was that or go without. I realize it isn’t a novel observation, but your choices are too make so little that you can’t live comfortably and get premium support or else make a decent salary but then go broke paying the health insurance premium.
@Aang: That’s tomorrow’s post (and real easy :)
@David Anderson: Hmm…am I crazy or is this the start of the push to divorce health insurance from employment in this country? I know ACA had some of that however it got watered down
@Matt: Amen. The ACA was the last chance for private insurers.
But at this point, I don’t trust the legislative process to come up with any workable public-centered implementation of any health care policy. Let’s just change the Medicare eligibility age and call it done for a few years. Find the place in current statute where it says “65” and write a single-sentence bill to change it to “50”. Maybe we should start at “45” and the lobbyists can talk us up to “52” or something, but let’s not give them a year and a thousand pages to hide their nonsense in.
I know that sounds like small ball compared to Medicare-for-all ambitions, and it is. But even assuming Dems gain sufficient political power, trusting the legislative process is likely to yield poor results until more basic reforms are made.
A five-run inning constructed out of singles and doubles is far more likely to occur than a five-run home run. This is what Our Progressive Betters can’t seem to understand (or refuse to acknowledge).