Watching the permutations of health insurance legislation and regulatory maneuvers by federal and state governments reminds me of my high school chemistry class. Mix a little of this with a bit of that may yield the expected result – but it may not. It could fizzle out or it may even create a dangerous outcome.
The Trump administration has been willing to try radical solutions and the news is filled with announcements which make knowledgeable participants in the system cringe with anticipation of what might be. Over the past two weeks, the administration has flipped twice on the availability of exchange risk sharing adjustments. This mechanism is so central to the existence of the exchanges, which are required to take all applicants, that their survival hangs on the balance.
The Federal government also stated that they may bar pharmacy rebates for Medicare patients. Another change which would dramatically impact and cause realignment of that segment of the market.
In another announcement, the government stated that Medicare would change the way doctors’ services are reimbursed, proposing to pay a flat amount for all doctor services rather than varying payments based upon the complexity of the service provided. Centers for Medicare and Medicaid Services (CMS), points to the potential administrative cost savings. Primary care doctors should be celebrating this announcement while specialists would have to be thinking about how they might realign their practice models.
Responding to the increase in individual responsibility for healthcare costs and in a furtherance to President Trump’s healthcare vision, the House passed a new Health Savings Account (HSA) rule. If passed by the Senate and signed into law, this bill would allow limited first dollar coverage, onsite clinics, telemedicine, gym memberships and some over the counter costs to be paid from HSAs. Additionally, limits would soar to $6,550 (from today’s $3,450) for individual coverage, and to $13,300 (from $6,900) for families, which is equal to the plans maximum allowable out-of-pocket costs. HSA eligibility would also be expanded to individuals enrolled in Medicare Part A and individuals enrolled in a bronze or silver plan. The plan would also allow – subject to limits – transfers between Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA) and HSA plans.
These changes are potentially seismic. Yet, the market response has been fairly tame – perhaps even numb from the sheer magnitude of proposals. To me, the scary part of all this is that the experimentation is with real people with real life and death medical concerns and mistakes will take their toll on those that are adversely impacted.