Simple Rules for Health Care Reform

1. Prohibit Health Insurance Providers from engaging in anti-competitive practices.

2.. Prohibit Health Insurance Providers from denying health care insurance to individuals with pre-existing conditions.

3. Prohibit Health Insurance Providers from placing caps on annual and lifetime benefits.

4. Establish a mandatory Medical Loss Ratio of no less than 85%.

5. Establish a National Health Insurance Regulatory Commission with the responsibility of ensuring providers adhere by above tenants. This commission shall also field consumer complaints/tips about violations of these provisions. This commission shall also investigate waste, fraud, and abuse in public health plans (Medicare, Medicaid, CHIP, VA, etc).

6. Establish a National Health Insurance Clearinghouse with the following responsibilities:

-Identifying various levels of health insurance benefit packages, and establishing maximum premiums/deductibles/co-pays  for each level, while taking regional factors into consideration. This commission shall certify plans that meet these standards. While insurers do not have to adhere by these standards, individuals may not use governmental subsidies to purchase non-certified policies.

-Collecting and providing electronically to the public, information about all health insurance plans that have been certified.

7. Allow Medicare to freely negotiate with all domestic insurance providers, pharmaceutical businesses, and medical equipment/supply businesses. Increase Medicaid and Medicare reimbursement rates to no less than 60% of average private insurance payments for identical billable procedures.

8.  Incentivize individuals studying to be, and serving as Primary Care Physicians or other non-specialty medical providers through a loan forgiveness option tied to service in clinics/hospitals in undeserved areas.

9. Cap medical malpractice lawsuits to $X million in the most egregious life-threatening instances. This shall represent the uppermost class of suits, a schedule  of other classes of suits shall be established with corresponding maximum liability levels. (Levels/ Amounts TBD by the National Health Insurance Regulatory Commission).

10. Mandate that all children under the age of 18 have health insurance coverage. Increase eligibility for the Children’s Health Insurance Program (CHIP) to 350% of the Federal Poverty Level (FPL). The penalty for non-compliance shall be 100% of the cost of the least expensive eligible health care plan in the individual’s market area. Such taxes shall be directed to a National Health Trust Fund.

11. Incentivize the purchase of health insurance plans by establishing a refundable health care tax credit of $1,000 per individual, $2,000 for couples. Individuals must have maintained eligible coverage for at least 9 months out of the year to be eligible for the credit.

12. Prohibit employers from dropping, without reasonable cause, health insurance benefits for their employees. The penalty for such unjustified actions shall be 100% of the cost savings achieved by the business by dropping the insurance. Such taxes shall be directed to a National Health Trust Fund.

13. Incentivize employer health care insurance benefit plans, by establishing a business health care tax credit of up to $1,000 per employee.

14. Tax employers with at least 50 employers who do not provide health care insurance to their employees 10% of payroll. Such taxes shall be directed to a National Health Trust Fund.

15. Tax individuals making more than $250,000 5% of gross income, and households making over $500,000, 5% of gross income.  All other individuals above 350% of the FPL will pay a 1% tax on gross income. Such taxes shall be directed to a National Health Trust Fund.

16. All tax collections in the National Health trust Fund shall be used to provide a) Subsidies to households making between 350 & 500% of the FPL to purchase certified health care plans & b) payments to providers for uncompensated care provided to uninsured individuals.

-kd-

Other types of reform are necessary as well, including some sort of regulation on Pharmaceutical companies. This list is just a basic beginning for reform, accepting that single-payer health-care’s time has not yet arrived. In addition, % and #’s I provided above where just numbers I threw out there, of course it would require a more thoughtful and deliberative process to hash out such details.

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