The health account plan corrects the ACA exchanges' fatal flaw of multiple plan options. That is what caused soaring premiums, as it was impossible for insurers to predict risk migration and set appropriate premiums to cover medical costs.
The purple solution resolves that problem by replacing multiple plans with a single health account design, spreading the risk over more people. ACA health exchanges could be revamped to do the same thing, mandating one coverage blueprint and encouraging insurers to compete on price.
"We don't need to repeal and replace Obamacare," Gardner said. "We need to modify it and let it evolve."
Key features of the health account plan design should include:
- Government-subsidized health accounts to help offset copays and deductibles.
- Emphasis on primary and preventive care.
- Decision support for high-risk patients facing complex health conditions.
This design lowers premiums while protecting access to care and reducing healthcare waste, HCMS research shows. Contributions to health accounts are tax-free, giving consumers greater buying power. Health accounts make patients better consumers and change the behavior of providers, making them less profligate with drugs and tests.
Health-account subsidies of $2,000 a person would help patients with out-of-pocket expenses. That amount would be in line with the current subsidies of $3,600 a person for exchange policy premiums.
The real savings would come in providing decision support for the 5% of people who account for half of healthcare costs and 50% of waste. Patients in complex health situations need risk-benefit information that the healthcare system doesn't provide. HCMS has proven that providing this kind of support costs as little as $1,200 a year and can save millions of dollars.
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SOURCE HCMS Group