7 Strange Things About the 2020 Individual Major Medical Market

1. It could all be a dream.

Having sophisticated, well-researched conversations about what is or isn't working, or could be improved, seems a little beside the point, because the 5th U.S. Circuit Court of Appeals is considering Texas v. USA — a case that's challenging the constitutionality of the heart of the Affordable Care Act.

If the Supreme Court upholds a 5th Circuit ruling killing the ACA, the current U.S. health insurance framework could simply vanish.

(Photo: Tim Roller/ALM)

2. The Republicans won't let the ACA individual public exchange system be like the Medicare Advantage program.

Like the Medicare Advantage program, the ACA public exchange program lets insurers use government subsidies to sell private plans on a guaranteed-issue basis, without consideration of the enrollee's health status. Republicans have backed risk-control subsidy programs for health insurers' Medicare Advantage plans, but not for the same issuers' ACA public exchange plans.

(Credit: Centers for Medicare and Medicaid Services)

3. Democratic supporters of Medicare 4 All won't let Medicare 4 All be like Medicare.

About half of Americans say they approve of a 'Medicare 4 All plan" — but Medicare uses deductibles and co-payments to hold costs down, and it offers ways for enrollees to use private insurers. The major Medicare 4 All proposals don't do that.

(Credit: Sen. Bernie Sanders' YouTube channel)

4. Few seem to respect the power of antiselection and providers' ability to go fishing.

Most of the life and health insurance programs ever created have collapsed, but most of today's would-be reformers assume that creating stable programs is easy.

Advocates of giving states, consumers or other players choices between multiple health finance systems tend to ignore the risk that the sickest patients will end up in one system and kill it. Advocates of programs based on limiting health care provider revenue tend to ignore the risk that providers will walk away — and kill the new programs.

(Credit: Shutterstock)

5. Few in Congress talk about their personal experiences with the ACA public exchange system.

The ACA requires members of Congress to get their congressional health benefits through the ACA public exchange system, to give them real-world ideas about how the system actually works. But few members of Congress other than Rep. Michael Burgess, R-Texas, say much about their own experiences with their public exchange plan coverage.

(Credit: House Energy)

6. Who buys what, at what price, is so complicated.

Actuarial analysts from Wakely show managers of Colorado's state-run ACA public exchange, Connect for Health Colorado, how complicated the picture is every year, with charts that reveal that purchasing patterns for bronze, silver and gold plans are completely different.

(Credit: Wakely, for Connect for Health Colorado)

7. Managers of President Donald Trump's HealthCare.gov program are working hard to get people into ACA public exchange plan coverage.

HealthCare.gov marketing spending may be down, but Randy Pate, the head of the office that oversees HealthCare.gov, has improved HealthCare.gov call center performance, expanded efforts to reach out to agents and brokers, and kept the number of users almost steady — as most Republicans in Congress work to kill the ACA system, and as most Democrats in Congress refuse to say anything nice about how the Trump administration is running ACA programs.

(Photo: Allison Bell/ALM)