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On the Third Hand: Ted Cruz

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At least one part of the Patient Protection and Affordable Care Act (PPACA) commercial health insurance provisions could end up working pretty well.

That part is the provision that requires members of Congress and some staffers who want employer-sponsored health benefits to get their coverage through the PPACA public exchange system.

Sen. Ted Cruz, R-Texas, a leading contender for the 2016 Republican presidential nomination, made headlines earlier this week when he said he and his wife are leaving the health plan provided by his wife’s employer, Goldman Sachs, because his wife is taking a leave of absence to go on the campaign trail. Cruz and his wife are intending sign up for coverage through Cruz’s employer — the Senate.

The U.S. Office of Personnel Management (OPM) requires lawmakers to get their exchange coverage through a Small Business Health Options Program (SHOP) plan from DC Health Link, the locally based District of Columbia exchange. 

On the one hand, the idea of a candidate who says he wants to repeal every last letter of “Obamacare,” and then signs up for Obamacare, does seem hilarious. If Cruz hates PPACA so much but needs health coverage, why can’t he sign up for short-term health insurance, or join a health care sharing ministry? 

On the other hand: Lawmakers put the provision requiring members of Congress to have exchange plan coverage in PPACA to make sure members got a taste of what regular people were going through. 

Some people, even inside the health policy community, once mistakenly thought that PPACA exempted members of Congress from the PPACA coverage rules. Instead, PPACA makes members of Congress the only workers in the United States who are required to get their employer-sponsored health benefits through the PPACA exchange system.

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Members of Congress now get to see for themselves how well, or poorly, DC Health Link is doing at getting them enrolled in coverage, administering the coverage, and providing adequate provider networks. 

To me, that seems to be a wonderful idea.

The only way to improve it would be to somehow require a second randomly selected group of lawmakers to get health coverage through Medicare, and a third group to get their coverage through Medicaid, to ensure that members of Congress have personal experience with all of the country’s major health coverage systems.

On the third hand, one problem with requiring lawmakers to get coverage from the PPACA exchange system, but not to work in exchange administration or health insurance company administration, is that doing so may reinforce a huge, existing health policy problem: The fact that most policymakers understand the providers and the patients far better than they understand the payers.

All of us have experience with being a patient, and many have experience with listening to providers grumble about their pay and working conditions. But, outside the insurance industry itself, few people have ever administered an exchange or a health plan, reviewed medical claims for reasonableness, or read the health insurance company provider fraud case investigation files.

Even fewer people have had much direct experience with the pain caused by a health insurer liquidation.

As a consequence, we all have an easy time reading a story about a patient and saying, “Yes, of course we will pay that,” and a difficult time steeling ourselves to say, “No. We were exaggerating when we said every human life is infinitely precious. We can’t really afford to pay for that.”

Here’s a possible solution: Require a random sample of lawmakers to spend six weeks working as interns in the claims processing units or special investigations units at the health insurers that sell coverage through DC Health Link. Then, our lawmakers would know a little more about the consequences of being foolishly sentimental as well as faults and virtues of the PPACA exchange system.