I’ve been looking at various Patient Protection and Affordable Care Act (PPACA) defenses and replacer proposals and noticing a lack of concrete ideas (even bad ideas) for improving the current framework, as opposed to throwing it out and starting over from scratch.

See also: Republicans eye quick partial PPACA repeal if party wins White House

On the one hand, maybe starting from scratch is the only feasible path forward.

On the other hand, America’s Health Insurance Plans (AHIP) and the National Association of Health Underwriters (NAHU) used to seem to like the concept of an exchange-based system. If throwing out the current system and starting over is too hard, but some change is possible, maybe there are ways to revamp the current system.

On the third hand, if people started throwing out even doomed ideas for revamping the system, maybe that would help create the policy “manure” necessary to fertilize the creation of good ideas.

Here are some ideas:

1. Get operation of health insurance exchanges out of the hands of the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS): 

HHS and CMS seem to be doing the job poorly and provide little transparency. If HHS and CMS were simply regulating the exchange system, not running the system, maybe they’d develop and enforce better transparency standards.

2. Acknowledge that the main users of the central exchange system will be live-human advisors and a few consumers who like tinkering with complicated websites, not typical consumers:

Just about every private health insurance sales website has gone down that path. Why not the PPACA public exchange system?

3. Recognize that the exchange system is a means to an end, not the end:

Stop making a distinction between on-public-exchange and off-exchange sales. A public exchange should be a distribution tool, not a Web-based Obamacare temple.

4. Let health insurers and reinsurers design and run their own risk-adjustment system, or risk-adjustment systems:

Get the government out of the operational middle. If the government plays a role, it should play the role by wrestling with law-abiding insurers’ risk-adjustment systems, not by wrestling with law-abiding insurers directly.

5. Tie each household’s open enrollment period to the birthday anniversary of the head of household, and let an issuer charge whatever rate the market will bear (or that the market will bear and regulators will allow) on the coverage purchase date:

That would make an exchange more like a stock exchange, with freely (or somewhat freely) moving coverage prices. The price of coverage would be stable throughout the year for the insured, but the insurer could change prices for new customers throughout the year and avoid getting locked into offering the same unsustainably low rates for all of its insureds for an entire year.

See also:

View: Sanders’ health care plan is missing price tag

View: Gaming of Obamacare threatens the whole program

 

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