This election cycle’s spectacle has thus far left Americans with few answers pertaining to the future of health care in the United States. Most can agree that the Affordable Care Act could benefit from an adjustment or two, but candidates in each of the two major parties have yet to put forth clear, reasonable points of reform. It seems as though Donald Trump and Hillary Clinton are too focused on spotlighting the general shortcomings of one another and not sufficiently so on specific points of reform on issues such as health care — one of the top four issues for voters, according to the Pew Research Center.
Mr. Trump, with his seemingly bottomless reservoir of bluster, has suggested the Affordable Care Act should be repealed entirely. Never mind that 20 million previously uninsured people now have coverage through the program and if we’re to believe those less politically motivated, including scholars and other respected authorities, unraveling Obamacare is impractical, and the uninsured and underinsured would benefit from improving the system, rather than pulling the plug.
Mrs. Clinton remains supportive of the ACA; she has voiced her plan to expand access to affordable health care. But it’s clear that there are cracks in the system that must be mended so it can thrive. For example, a considerable number of people — predominantly working families below the poverty line, those without a high school diploma, Hispanics and young adults —don’t have health coverage because of insufficient outreach to those populations, the rising cost of insurance and partial Medicaid expansion.
The truth is, neither candidate sees the whole picture. Talking points and one-liners are failing us. It’s time to stop bickering and focus on solutions; the American public deserves it. In my view, taking action in three key areas can make health care affordable and effective for millions.
Stabilize the risk pool to retain insurance company participation
In what seems like a bandwagon effect, health insurance companies and government- sponsored co-ops are backing out of the ACA exchanges. Many have lost millions — even billions — of dollars in just a few short years. Some like UnitedHealthcare and Aetna have had enough and are exiting the exchanges altogether. Others, including a number of co-ops, are now insolvent. All told, consumers’ choices are being drastically reduced and competition is thinning.
Why is that a problem? The risk pool has a disproportionate number of unhealthy people and, on balance, is not young or healthy enough. People have abused special enrollment period rules and even used alternative plans meant to be stop gaps as permanent solutions to traditional health insurance. The “Three R’s” — risk corridors, reinsurance and risk adjustment — that were designed to protect insurers under these circumstances have failed to provide the necessary financial support. It has gotten to the point where some insurers are suing the government for unpaid funds.
While the Centers for Medicare & Medicaid Services have announced actions to help in these areas, we need more. We need continued and enhanced protection against misuse during special enrollment periods. We need to curtail the misuse of insurance products that depresses ACA participation. Finally, we need greater focus on how to structure the “Three R’s” so that insurers are confident in their market investments.
Invest more in agents and brokers
The agent and broker community has been overlooked when it comes to the ACA. There are tens of thousands of trained professionals who continually assist millions of Americans in finding the best insurance protection at an affordable price.
For the average consumer, health insurance can be overwhelming. Many do not realize an agent can offer assistance that is unavailable through HealthCare.gov. Health insurance agents can provide consumers with the information they need to make educated coverage decisions, often at no cost.
Agents can engage those who are opting out of enrollment — such as millennials, low-income workers and the healthy — whose increased participation would help stabilize the market.
No doubt, a consumer who is better educated will surely find greater value from his or her purchase, which in turn provides a better customer experience and creates positive retention benefits for insurers.
The course is clear: There must be greater investment in and engagement with the agent and broker community to meet the goals of health care reform.
Demand price transparency
At the end of the day, if we can’t slow the growth of health care costs in America, we’re on a financially unsustainable path.
Prescription drug costs are rising at an alarming rate in spite of extreme criticism. Even with health insurance, the average consumer is not able to keep up with ballooning drug prices. Expenses that go with cancer treatments or long-term disabilities can cost more than $100,000 per year. And more recently, the price hike of the lifesaving allergy treatment EpiPen has fueled protests against lawmakers.
Consumers need to be made aware of the cost of their health care decisions. Too often the public is blind to the financial impact of medical treatment until they are bombarded with confusing bills weeks or months later. In some instances, the opacity that surrounds medical events has led to bankruptcy. Requiring upfront disclosure of medical costs, presented in a clear, concise way would be a great place to start. Only with true transparency can consumers make educated decisions about their health and financial well-being.
We need to be honest with ourselves. Obamacare is not going anywhere. While the pavement is potholed, the road still leads us in the right direction. Focusing on providing financial stability to insurers, engaging the insurance agent community and demanding price transparency are three key prescriptions to heal the ACA.
As we move forward through the final month of election season, I’ll be looking not for a barrage of talking points and rhetoric with little in the way of realistic solutions, but rather for the candidates to address in a clear, sober manner the health care needs of the American people. We all deserve it.
Michael Z. Stahl is two-time author, insurance expert and a Senior Vice President at HealthMarkets.