For years the GOP has been running on the repeal of the Affordable Healthcare Act. We gave then the House, the Senate, and now the Presidency – and they return this honor by merely tinkering around the edges and using the progressive socialist democrat trick of slight of hand re-definition.
I read Rand Paul's letter to Senate Leader McConnell, and it is typical Rand Paul -- broad strokes with startling and unintended implications that may raise the costs of healthcare.
1. Association Health Plans - While I appreciate the inclusion of Small Business Health Plans in the BCRA, I believe improvements could be made to expand upon this provision to allow for greater freedom for individuals and small businesses to pool together for the purpose of obtaining health insurance coverage.
a. The bill currently allows for self-employed individuals to participate in small business health plans. However, I would suggest that the language be changed to allow any individual, including self-employed individuals, to form associations for the purpose of purchasing group health insurance.”
b. Furthermore, I would suggest that small business plans or association health plans be allowed to self-insure like other large employer groups are able to do under ERISA. Self-insurance provides significant flexibilities to create innovative plan designs free from many mandates.
c. Finally, I believe we have an opportunity to completely free the group market from unnecessary ACA regulations, and restore HIP AA and ERISA regulation over the entire group market, including for association health plans.
My take ...
(1) His proposals do nothing to alter state restrictions on insurance companies that provide healthcare insurance in limited monopoly areas. So unless you could purchase insurance from an out-of-state insurer, you are merely adding one layer of bureaucracy to the system.
(2) Few associations have any expertise in phealth careso they would necessarily rely on brokers and brokerages to perform the analysis and purchasing.
(3) Lack of fiduciary relationship between an individual, their association, and the association and their middlemen. This is necessary to prevent organizations and brokers from being incentivized into getting the best deal for themselves and not their clients. Sort of like Black church ministers taking "walking around money" from the progressive socialist democrats to steer the vote to the progressives.
(4) Perhaps the greatest unintended (but I am not sure it is unintended because Rand Paul, like his father, is a dodgy weasel who speaks conservative but appears to be a grifter) consequences is that major associations like AARP would not longer be restricted to licensing their name for a fee plus a small cut of the action, but could actually become full-blown brokerages. Other associations such as the AAA and NRA could also take advantage of the legislation to move to a direct brokerage model. Not to mention the actions of the various unions whose offerings are highly regulated.
(5) As for the idea of self-insuring, many of these associations have tremendous cash flow and asset bases that support the idea of self-insurance, but many turn to re-insurance with other insurance companies to cover catastrophic losses in the case of a natural region-wide disaster. Adding additional costs to protect themselves from the adverse consequences of their association members during a mass casualty event.
There is no demand that any self-insurer that wants to offer customized plans be required to prove these “modified” plans are actuarially sound.
(7) The regulatory bureaucracy would expand as the need for inspection, analysis, and regulatory duties expand with each association
(8) Who or what assumes the liabilities should one of these associations fail? Are they simply pass-through broker-representatives whose agreements and arrangements would become null and void under insolvency or other adverse circumstances?
(9) While this could improve the accessibility to healthcare for certain individuals it is unlikely that the wealthier association members would belong to associations with a broader population of individuals with lesser income.
The bottom line ...
The devil is certainly in the details. Without adjustments to the insurer risk pools by enlarging to across-state-lines competition, and demanding actuarially sound plans, all you are doing is redefining the modes of waste, fraud, and abuse.
Notice Paul is saying nothing about the expansion of Medicaid by the States.
Ask yourself, where are the actual architects of the GOP reconciliation proposal and were they influenced by outside lobbyists for the special interests. Not inconceivable because the 2018 and 2020 election cycles are right around the corner and hands are out in both the House and the Senate.
The government has proven that they can’t manage healthcare at the VA, why should we trust them with managing the country’s healthcare.
We are so screwed.
For those wishing to read Rand Paul’s letter to Mitch McConnell, it can be found here.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius