As legislative repeal of the ACA is likely down for the year, we need to think about what is next. We need to lay out a couple of critical questions.
1) Money
I’ll support a fully funded high cost risk pool. I’ll support fully funded single payer. If the mechanism means that at least as many people have coverage that is at least as good, I’m on board with the mechanism. The money must match the promises being made.
2) Corner cases
The $12 million dollar man in Iowa is a market distorting corner case that drove every insurer but one out of the market. How does any policy handle a case like this? California has a $21 million dollar claim year from a single individual on Medicaid. What happens when state revenue collapses and eligibility goes up? Is this person sacrificed?
3) Recessions
How does a bill work during a recession? Are we adding a counter-cyclical piece of macro-economic insurance or a pro-cyclical tool for mini-Hoovers to do their worse?
4) Experimentation
How can states experiment? How are good successes disseminated more widely? How are seemingly attractive but ineffective ideas shot down? Who determines success?
These are the first set of questions at the top of my mind right now.