Again: HI should revert back to it's original intent: Catastrophic Insurance only, along with being non-profit. Take out the profit, HMOs, shareholders, contracts with providers, etc, and what the consumer will find is health care costs that are much lower.
If we have to make a co-pay at the Doc's office, logic would dictate the co-pay would cover the actual visit to begin with.
Well, one way to shift away from profit-driven insurance would be to foster strong non-profit competitors. That's why
non-profit, member-driven CO-OPs are being seeded right now. Expectations for their impact are being kept low but it would be nice to be pleasantly surprised.
High deductible plans are allowed right now and they're likely to become even more prevalent. This year, high deductible plans have a minimum deductible of $1,200 (and a maximum out-of-pocket of $5,950). KFF
commissioned three consulting firms to get an idea of what deductibles for single coverage might look like in the health insurance exchanges launching in states in 2014:
In a new study we just released, we commissioned three different actuarial consulting firms to estimate what deductibles may look like for people buying coverage in the new health insurance exchanges beginning in 2014. The analysis is complex because the levels of coverage in the ACA are specified using an "actuarial value" (the percentage of health care expenses the plan is expected to cover for a typical population of enrollees). Needless to say, actuarial value is not exactly a concept that makes a whole lot of sense to most people. The combination of deductible and coinsurance amounts that satisfy an actuarial value -- which determine how much someone with a given level of health expenses will pay out-of-pocket -- will vary from plan to plan and can only be estimated at this point. That's the reason we used three firms -- to surround a difficult technical task.
The three firms produced a wide range of estimates (a notable result in itself, and one that has implications for consumers and for federal policymakers now writing the regulations that will guide how state exchanges operate). But significantly, in all cases, the deductibles were high -- ranging from $2,750 with 30% coinsurance to $6,350 with no coinsurance for an individual policy for the basic Bronze plan in 2014, which is the minimum people can buy and satisfy the so-called "individual mandate." Patient out-of-pocket costs would be capped at $6,350, an amount that's specified in the ACA. All of these amounts would be double for a family policy.
That is, we're moving in exactly the direction you'd like. I'm not sure how you'd get rid of insurer contracts with provider organizations.
Again: competition that crosses state lines is a win for consumers. Of course all states would have to agree to same state over-sites, such as Maine currently has.
The call for interstate sales is generally aimed at either 1) facilitating more health plan offerings, or 2) providing a vehicle for undermining state regulations. In the political sphere, the intent is usually the latter. Since you recognize the need for common baselines regulations, it sounds like your intent is the former. The recent reforms offer several pathways to increasing plan offerings in states (allowing interstate sales, subject to baseline regulations):
- The creation of multi-state health plans that will be sold in every state
- Regs for interstate health care choice compacts that allow insurers in participating states to sell products in other participating states
- Multi-state exchanges (i.e. insurance markets covering more than one state)
Again: ZERO states have deregulated the sale (and acceptence of sold HI) of HI across state lines.
States can't force other states to accept the sale of policies issues in their states; they can, however, allow policies issued in other states to be sold within their borders. That's what I'm referring to. And I'll repeat the examples I already mentioned:
- Wyoming's Enrolled Act 61 (signed in 2010) allows health insurance plans issued in certain other states to be sold in Wyoming
- Georgia's H.B. 47 (signed in May of this year) allows for the sale of individual health insurance policies issued in other states
- Maine's LD290 (passed in May of this year) allows out-of-state insurers access to the state's health insurance market