On the Third Hand: Son of PPACA

Whatever the nature of the crisis is, chances are that it will somehow burn brightly for a year or so, then calm down and burn with a nice, clear flame for a while.

Then we’ll get back to a new version of what 2002 looked like: Wondering what the next round of “health care reform” will be like. Because, really, either with PPACA or without it, we’ll get some benefit from higher consumer out-of-pocket costs, some from narrower networks, some from a combination of public and private exchanges, and some from sticking it to brokers. But then we’ll be coming face to face with the cold reality that health care costs have stabilized but are still really, really high. 

Early predictions on what the Son of PPACA might look like:

• A lot like PPACA. I think the parts that people in the insurance industry hate, for example, seem to be pretty small. Since PPACA was passed, for example, I don’t think I’ve received a single press release, legal commentary or survey having to do with the new standards for claim decision appeals. 

• Tough on aggressive underwriting. I don’t see any Republicans celebrating the idea of coverage rescissions or letting insurers exclude consumers because they happen to be a little overweight.

• More reliant on public reinsurance programs for people with hemophilia, severe diabetes and other catastrophically expensive conditions. One thing an early PPACA implementation disaster — the failure of the Pre-existing Condition Insurance Plan — taught everyone is that insuring catastrophically sick people is hard. You can’t just wipe away the costs of covering a boy with hemophilia by asking him to fill out a health risk assessment and getting him a nurse case manager.

• More realistic about benefits than the “I want a pony, then a unicorn, then another unicorn” approach evident in PPACA. Every life is infinitely precious, but, no, it’s actually not.

• Possibly more rigid in terms of provider network rules than PPACA. We could see some horror stories about the effects of lack of a meaningful level of provider choice.

On the one hand, getting to the point of thinking about the Son of PPACA effort may be pretty ugly and take some time.

On the other hand, this time has been coming since the Clinton health care proposal failed.

On the third hand, the irony is that Hillary Clinton could end up back in the health policy mix just in time to debate proposals that are Daughters of Clinton Care as much as Sons of PPACA.

See also:

• On the Third Hand: Numbers
• On the Third Hand: The 3 Rs
• On the Third Hand: Make a deal