Question: What's new or interesting?Answer: There are two ideas in this plan that jump out as new and creative ways to lower health care costs.
- There is a section of the plan titled, "Lawsuit Abuse Reforms" that aims to reduce the burden of medical malpractice claims by creating "best practice" guidelines for treatment of medical conditions to provide more legal protection for doctors who follow best practices, even if they unfortunately result in a poor health outcome for a particular patient.
- There is a section of the draft legislation (not included in the summary provided by Dr. Price's office) titled "Incentives to Reduce Physician Shortages" that aims to increase the number of medical doctors practicing in the United States through a series of incentives including increased student loans for prospective doctors and debt forgiveness programs for practicing primary care physicians.
- Tax credits - The Empowering Patients First Act makes tax credits available to all citizens and lawful residents, regardless of their income. We like this because it levels the playing field for almost everyone who buys their own health insurance. Today, people who get health insurance from an employer pay for it with pre-tax dollars. People who buy their own health insurance only get a similar benefit if their income falls below 400% of the Federal Poverty Level (FPL). We think this is unfair to people who earn above 400% of FPL or whose employment is sporadic, which makes it hard for them to confidently forecast their income. Under the current system, persons who underestimate their income when applying for tax credits are at risk of owing the IRS money at the end of the year.
- Benefit flexibility - Dr. Price's draft legislation defines qualified health coverage as major medical insurance but allows the state where the plan was purchased to define the benefits that should be included under major medical coverage. It also excludes from the definition of major medical coverage any "wrap-around plans," vision-only plans or disease-specific plans.
- Enrollment expertise - It makes it clear that "state transparency portals," which we assume could be based on existing exchanges, cannot assist with direct enrollment in health plans. Presumably this means enrollment must occur directly through an insurance company or with a licensed insurance agent or broker. We believe this is critical because unlicensed navigators - under existing law - cannot make plan recommendations or explain plan benefits. It's critical to have knowledgeable, licensed experts involved in the enrollment process.
- Maternity coverage isn't called out as a mandatory benefit - Dr. Price's overview of the draft legislation does not indicate whether maternity coverage will be guaranteed accessible in every market. Prior to the passage of the Affordable Care Act, individually-purchased health insurance plans with maternity coverage were not available in every market. It's critical that plans that cover maternity benefits be available as an option to consumers everywhere.
- We'd like more specifics about prescription drug coverage - The overview does not mention whether or not plans sold to individuals would be required to cover prescription drugs. eHealth research from 2015 found that 35% of people who bought their own health insurance from eHealth had unexpected drug costs 1. eHealth would like to see more detail about the availability of prescription drug coverage under any proposal.
- We'd like more specifics about open enrollment - The overview does not mention how or when people who buy their own health insurance would be allowed to change their coverage, which eHealth believes is a critical detail. People must have the option to review their coverage each year and, if necessary, change plans. Under the ACA, the open enrollment period occurs at the same time for everyone. eHealth supports a revised open enrollment period that would be tied to an individual's birth month each year.
- For people ages 18 to 35 the annual credit would be $1,200
- For people ages 36 to 50 the annual credit would be $2,100
- For people ages 51 to 64 the annual credit would be $3,000
- For people under age 18 the annual credit would be $900
- Young people will pay less - This plan allows insurers to charge older people up to six times more than younger people. By comparison, the current law allows insurers to charge older people up to three times more than younger people.
- Lower prices for the young could drive more young people to enroll - Theoretically, with cheaper prices, more young people would sign up for health insurance. With more young people insured, the overall risk pools could improve and drive down prices for everyone else, or at least mitigate skyrocketing premium inflation.
- Easier access to tax credits could increase the use of them - Under the current model, an estimated 2.5 million people who buy their own insurance today are choosing to forgo their ACA tax credits - presumably because they're too difficult to apply for. With the subsidy value tied to one's age instead of income, the tax credit becomes more accessible.
Notes:1 Source: eHealth's October 2015 Customer Satisfaction Index Report . 2 Source: The Department of Health and Human Services ASPE Research Brief dated January 21, 2016. eHealth eHealth, Inc. (NASDAQ:EHTH) owns eHealth.com, the nation's first and largest private online health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealth offers thousands of individual, family and small business health plans underwritten by many of the nation's leading health insurance companies. eHealth (through its subsidiaries) is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth also offers educational resources and powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online through Medicare.com ( www.Medicare.com), eHealthMedicare.com ( www.eHealthMedicare.com) and PlanPrescriber.com ( www.PlanPrescriber.com). For more health insurance news and information, visit eHealth's Consumer Resource Center.