Eight essays listed in this annotated bibliography involve –
(1) Reducing problems associated with high out-of-pocket costs,
(2) Maintaining continuous health insurance coverage during job transitions,
(3) Ramifications of the Medicare-for-All Proposal
(4) Expanding access to specialists and top hospitals,
(5) Consequences of an unregulated medical review process
(6) Financial risks associated with short-term health plans
(7) Ramifications of Medicaid double dipping
(8) The Case for a Third Party Health Care Agenda
Mitigating Problems with High Out-of-Pocket Health Costs
Out-of-pocket costs have doubled over the last two decades leaving many people to forego necessary health care or reduce savings for retirement. The recently enacted Trump tax bill does not assist the people most affected by higher out-of-pocket costs. Alternative more effective policy changes designed to assist people with out-of-pocket costs include – (1) elimination of use-or-lose rule for Flexible Spending Accounts, (2) a tax credit to replace or augment tax deductibility to Flexible Spending Accounts and Health Savings Accounts, and (3) exempting prescription drugs from deductibles on high-deductible health plans.
Improving Health Insurance Outcomes with Employer Subsidies of State Exchange Health Insurance
Several reasons why people would be better off with employer subsidies of state exchange health insurance instead of firm-specific employer based policies.
· Easy transition to premium tax credit if you get laid off.
· No new deductible if you switch job
· Wide variety of health plans offerings
· More competition on state exchange
· Lower reliance on Medicaid by people losing health insurance coverage
Should Democrats Adopt Medicare-for-all in 2028?
Progressives in the Democrat party will likely advocate a Medicare-for-all plan in 2028, similar to the one they favored in in 2020. This approach is not likely to succeed politically, is not the best possible reform, and is not feasible in the United States in 2028. Medicare-for-all abolishes all private health insurance, an outcome that is even more extreme than outcomes in progressive European countries.
Problems with the Medicare-for-All approach include:
· Worse outcomes, especially longer wait time, for some people with good private health insurance,
· Lack of a clear transition plan from the current system,
· Changes and disruptions to health insurance during annual budget and debt limit debates,
· Complete government control of all insurance funds for abortion and reproductive health services
· Higher taxes needed for Medicare-for-All are also needed for other priorities including restoration of Social Security and Medicare Trust Funds.
How best to expand access to health care providers
Most health insurance plans in the United States restrict usage outside of a narrow network or have financial incentives encouraging the use of preferred networks or providers. The No-Surprises Act attempted to mitigate problems associated with these health plan restrictions by limiting charges on out-of-network emergency services and out-of-network services at in-network facilities, and by establishing a dispute resolution services. This approach did not reduce and may have increased incentives for the adoption of narrow-network health plans with limited access to top hospitals and specialists. Additional legislation proposed in this memo incentivizes the adoption of more complete health networks.
Thoughts on the Medical Necessity Review Process
Abstract: The decision on whether medical procedures are medically necessary or unnecessary is having a large impact on the practice of medicine. Insurance companies now frequently use computer programs to flag certain procedures to facilitate higher profits. The medical necessity review process appears to often create financial uncertainty for households and impede access to better health outcomes. This review evaluates the impacts of the growing use of medical necessity decisions often through artificial intelligence programs with examples pertaining to breast reconstruction surgery, back and spine surgery, and new drugs.
The case for the elimination of short term health plans
Abstract: The Trump Administration is expected to issue an executive order expanding the use of short-term health plans, which offer fewer protections than state exchange or employer-based health plans. Insurance companies are not obligated to issue short term health plans to people with pre-existing conditions and can base premiums on health status. Short term health plans differ from state exchange and employer based insurance because of routine benefit denials, substantial limits on expense reimbursement, annual benefit caps, and the absence of automatic renewability, a cap on cost sharing, and a minimum loss ratio. This post discusses features of short-term health plans and their impact on insured households.
Ramifications of Medicaid Double Dipping
Abstract: The WSJ is extremely concerned about Medicaid double dipping because of potential fraud and potential impact on estimates of the uninsured. Analysis presented here suggests double dipping need not lead to fraud because most Medicaid expenditures are related to actual delivery of services and there are severe restrictions on Medicaid payments to out-of-state providers.
The Case for a Third Party Health Care Agenda
I am slowly building the case for ACA 2.0. More to follow.