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Talking points for fixing healthcare

I see more value to using the established systems than trying to recreate the wheel. Most of us insurance professionals are using exchanges so we just have to work on making it consumer friendly. I know that the brokers are a dwindling resource because most get torn up between customer needs and insurance company’s demands. Some companies have failed to pay brokers as they rely on the exchanges for their sales force, while others that have reduced their support to the point that some brokers have had to resort to charging additional fees to keep the lights on. If you ever need any help or want me in the room then let me know and we will be happy to be a resource for you. Here are a few talking points to improve the current system. –Matt McColm at www.

A. The high risk pools proven to be unsuccessful in providing affordable service to the small population that they served. We recommend reinstating the reinsurance corridors to the companies participating in the Health Exchanges. This allows the small population of heavy healthcare uses to be spread out among a greater population and does not drain government resources as it has in the past.
B. Preventative Care is currently included in healthcare and Medicare thanks to the ACA. Keep them included so that health problems can be identified early which lower costs.
C. Same rates for women and men. Before the ACA women were charged higher rates. The power of insurance is spreading out costs among a pool. Having one gender pay the way for society is obsolete.
D. Reproductive Healthcare as essential coverage. We have had fewer abortions because of better access to birth control. This is between a consumer and their doctor and not their employer.
E. Companies have been allowed to sell policies across state lines for some time. They have to register with the state that they wish to operate in. This allows the state insurance regulators to protect customers and reduce the chance of another Penn Treaty. (Penn Treaty was described by Wall Street journal as “one of the nation’s costliest insurance failures ever”) with $600 million in assets to cover projected claims of $4 billion. Regulation for the insurance industry protects everyone.
F. The annual out of pocket maximum should be kept and protected. It functions just as it sounds with a limit reached for a year then the consumer has zero out of pocket for additional expenses other than the premiums. Yes, this can be burdensome for insurance companies. However it is easier for consumers to manage a $6,000 bill in a year instead of a $60,000 medical bill. This provides a solid target number for consumers to use a Health Savings Account.
G. The individual mandate should be kept to balance the ability to insure everyone regardless of health conditions. The penalties provide incentive to participate and help fund programs. This reduces the government’s cost in the program because without it, additional funds would have to spend on High risk pools or reinsurance corridors.
H. Keeping the number of young adults on parents plans until 26 serves multiple purposes. It reduces the numbers of low income adults going on Medicaid. It also boosts group plans with young adults which help reduce costs to companies that purchase insurance in this manner for their employees.
I. Expanded Medicaid has benefited 32 states and Washington DC. The 19 states that have rejected it have created a coverage gap between Medicaid and subsidies. The 138% of poverty measure has helped millions and expanding it to the 19 states would reduce the strain that the millions of uninsured are creating in those last few states.
J. Health Savings Accounts can be improved by:
1. Align the definition of applicable plans for Health Savings accounts. Currently the Health Exchange has one definition and the IRS a second. This ends the confusion.
2. Expanding how they are used to include fitness activities and over the counter medication.
3. Increasing the amount to be placed into the plan.
4. Allow for improved family sharing of Health Savings account.
H. Immigrant access to Healthcare improved by:
1. Allow ITINs to be used as well as Social Security numbers to purchase healthcare. This allows a vulnerable population to purchase healthcare instead of relying on Emergency Rooms and Medicaid. This also keeps families together instead of splitting households. This can also be sought after at the state level if an exemption is filed to CMS.
I. Improved outreach can be improved by:
1. A commission for every plan sold on the exchange. This allows licensed and regulated assistance. This has been done in a couple of states. If it is done on a Federal level then CMS can set prices and training limits similar to Medicare. This will insure the best customer interaction and reduce costs of funding navigator programs.
J. Improved drug pricing can be improved by:
1. Negotiated rates. CA attempted to use VA negotiated rates for Medicaid drug pricing. This is the biggest driving in healthcare cost and needs to be addressed in any plan.
2. Keep reducing the prescription drug coverage gap (“donut hole”) for those receiving the Medicare Part D Prescription Drug Benefit.
3. Have an Amnesty year for people enrolling in Medicare to waive the penalty if they failed to enroll in their enrollment year.
4. End the FDA ‘orphan drug’ program so that drug manufactures such as Turing Pharmaceuticals and Mylan cannot inflate price to the point it harms the market place. We need to reestablish free market by having multiple manufacturers.
K. Improved Veterans Access to healthcare:
1. Add a tax bonus to exchange plans for Veterans to use exchanges. This could be set by using the pricing for the state’s benchmark plan. It increases their access outside of the VA and provides them professional resources.


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