Someone who has actually sold, and designed, commercial individual health insurance plans has tried coming up with a TrumpCare proposal of his own.
Jeff Smedsrud is the co-founder of Miami-based HealthCare.com Inc., a web-based health insurance supermarket. He also runs other group health insurance marketing and purchasing efforts.
He helped build a fully insured health insurance business at the Stamford, Connecticut-based IHC Group Inc. Back in the days when people with health problems often needed to go to special subsidized risk pools to get health benefits, he set up risk pools.
Smedsrud's amazing new idea is: Keep a lot of what people like about the Affordable Care Act and the ACA commercial health insurance rules, but kill off or change the parts that clearly work poorly.
Related: View from ACA World: Jeff Smedsrud
Smedsrud has bizarrely moderate ideas such as: Keep the Affordable Care Act exchange plans and the ACA premium subsidy, but loosen up the product design rules so insurers can innovate and come up affordable, sustainable plans that are designed to please ordinary broke people. (As opposed to plans that, in my opinion, are designed to please think tank analysts who get much of their grant money from hospitals and pharmaceutical companies.)
Here are some of Smedsrud's other wacky ideas:
Let any web-based entity or insurer that can meet the same privacy and identity verification standards as the current ACA exchange system administer ACA premium tax credits.
Allow sub-bronze "copper plans" that cover only about half of the actuarial value of a basic benefits package.
Replace the current ban on limits on lifetime benefits with something more flexible.
Let consumers use the premium tax credits to buy short-term health insurance and other alternatives to standard major medical coverage, especially in markets where the supply of major medical plans is limited.
Expand access to tax deductions for health care expenses and out-of-pocket medical expenses.
Let insurers offer wellness discounts to consumers in the individual market to consumers who take measurable steps to improve their health.
- Create a new generation of flexible, affordable risk pool programs aimed at people with serious health problems.
Of course, insurance company actuaries will hate many of these ideas, and federal budget hawks will hate many of the others. I don't know if any of the ideas would work.
But what's interesting is that none of these ideas really depends on the existence of the Affordable Care Act or depends on repeal. These are the sorts of ideas both Democrats and Republicans cheerfully talked about, together, in 2005. They're also the sorts of ideas that drafters could propose bolting on to the existing ACA framework in such a way that open-minded Democrats and Republicans could both vote for, actuaries and budget hawks willing.
If only more brokers, who are having a hard time getting paid to sell individual health insurance these days, had the energy and paid-up bills needed to follow Smedsrud's lead and reinvest the time they used to spend on selling individual health insurance in selling the idea of... Democrats and Republicans talking. And, possibly, compromising with each other.
Maybe Hollywood could take that idea and put it in a science fiction movie.
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