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Publisher's Summary
  1. Healthcare Beyond Reform: Doing it Right for Half the Cost
  2. Healthcare Beyond Reform
  3. Defining the Goal
  4. Book Healthcare Beyond Reform: Doing It Right For Half The Cost 2012
  5. Healthcare Beyond Reform: Doing It Right for Half the Cost - CRC Press Book

Sell yours here. Currently unavailable. We don't know when or if this item will be back in stock. Book Description Publication Date: April 24, The only way to do that is to do it a lot better. In pockets and branches across healthcare, people are receiving better healthcare for a lot less. Some employers, states, tribes, and health systems are d.

Healthcare Beyond Reform: Doing it Right for Half the Cost

Show more. The real problem is how to make coverage affordable for all within the risk pool, recognizing that any individual might end up needing coverage for high-cost care.

Healthcare Beyond Reform: The Book

Segregating the risk pool causes more problems than it solves. Coverage should also continue to be reasonably comprehensive, as it is now under health plans in the individual and small group market. The services added by the ACA that were not commonly covered before—pediatric oral and vision, habilitation services, and to a lesser extent maternity and mental health and substance abuse disorder coverage—are generally not the highest-cost services. Some are also services where noncoverage presents concerns about discrimination on the basis of gender or disability.

Mental health and substance use disorder federal mandates, for example, were enacted independent of the ACA. Individuals with incomes below to percent of the federal poverty level will continue to need substantial help to afford health insurance and health care. Current Republican proposals do not offer them assistance adequate to meet their needs.

Moderate-income Americans, however, have some capacity to pay for their coverage and care, so it makes sense to require them to continue paying something for premiums and at point-of-service. The means-tested tax credits currently in place do allow a calibration of assistance to ability to pay.

Healthcare Beyond Reform

There are, however, two problems with the current approach. First, premium payments and in particular the cost-sharing requirements remain too high. This is a result of the budget constraints under which the ACA was adopted and can be fixed by raising both the levels of assistance and the metal level of the standard plan to which assistance is keyed. The Urban Institute has put forward reasonable recommendations to accomplish this by lowering the percentage of income that households would be required to spend on premiums to receive tax credits with a maximum of 8.

A more difficult problem administratively if not politically is finding a way to ensure the accuracy of advance premium tax credits without imposing unrealistic paperwork and repayment burdens on persons eligible for assistance.

One approach that would improve accuracy would be to send quarterly notices to tax credit enrollees reminding them of their initial income projections and asking them to update this information based on their current income. Tax credit recipients could still be required to file tax returns to remain eligible. But the IRS could, using the income reported on the and the information currently reported by the marketplace on the A, itself reconcile credits that individuals received with those they were entitled to.

In the unusual situations where additional information was needed—where there was a marriage during the year or where a tax dependent is shared—the enrollee could be required to file an additional form. As long as the reconciled amount was reasonably close to the amount actually paid, for example, within 10 percent, no further action would be taken absent evidence of fraud or misrepresentation.

In any event, recoveries should be capped, as they are now.

Defining the Goal

Means-tested tax credits help low-income Americans, but moderate and middle-income Americans also struggle with affordability issues. Means-tested tax credits could phase out at to percent of the federal poverty level, but at that point be replaced by fixed dollar tax credits, as proposed by ACA opponents. These could be age adjusted but could also be adjusted to take account of geographical variations in health care costs.

Fixed dollar tax credits could either be assigned to an employer to pay for employer coverage or be used in a public or private exchange to purchase insurance in the nongroup market, at the direction of the individual recipient. Fixed-dollar tax credits could only be used for health coverage that covered a set of essential health benefits, established on a state-by-state basis, and that had an actuarial value of at least 60 percent.

Tax credits would be payable in advance if used in the nongroup market, but employers could claim the tax credits by adjusting withholding, with end of the year reporting. As the tax credits would be fixed and not depend on income, there would be no need for reconciliation or for clawing back overpayments. Fixed dollar tax credits could be set at a high enough level so that there would be a smooth transition from means-tested to fixed dollar tax credits at some point around percent of federal poverty level.

With fixed dollar tax credits available to subsidize employer coverage, current employer coverage tax exclusions could be phased out.

Employees could initially be given the choice either to use their fixed dollar tax credits to purchase coverage from their employer or to continue taking advantage of current tax exclusions, but the tax exclusions would be phased out over a period of time, say five years, to transition federal subsidies of employee benefit plans entirely to the fixed dollar tax credits.

The tax exclusion would remain in place for health benefits subject to a collective bargaining agreement until the termination of the agreement. Cost-sharing reductions should continue to be available as they are currently; indeed they should be expanded and simplified as recommended by the Urban Institute. Contributions to HSAs would otherwise be taxable — they should not simply become another retirement savings vehicle.

The tax credit would be claimed at filing time, but individuals could adjust their withholding or estimated tax payments in anticipation of it. To claim the tax credit, individuals would only have to provide direct deposit information for their HSA. But to establish an HSA, individuals would have to establish that they had health coverage meeting minimum requirements. Finally, the employer mandate, and possibly the individual mandate — could be repealed.

If the employer mandate was repealed, employers would likely continue to offer coverage for the same reasons that they have offered it historically: to recruit and retain employees and to maintain a healthy and productive workforce.

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Book Healthcare Beyond Reform: Doing It Right For Half The Cost 2012

They should be subject to nondiscrimination rules to ensure that they do not discriminate against less healthy workers or favor highly compensated employees, but they could otherwise be free to decide whether or not to offer coverage and what level of coverage to offer — except they would not be entitled to tax subsidies unless they offered coverage meeting minimum standards. Employees not offered coverage would be able to purchase nongroup coverage with their tax credits.

It is less clear what should happen with the individual mandate. The individual mandate plays a potentially important role in prodding individuals who do not have an immediate need for health care to get covered. Under the current law, it may be necessary to create an adequate risk pool, including healthy as well as unhealthy enrollees. But the mandate is unpopular politically. It also may not be administratively viable long term.

The individual mandate enforcement provisions in the ACA are weak and collecting individual mandate penalties that exceed the amount of refunds due to individuals is likely to be difficult administratively. Widespread noncompliance could do more harm than good. Repeal of the individual mandate would present three problems. First, individuals who chose not to purchase insurance might have a difficult time affording health care if they subsequently needed it.

Second, providers would face a higher uncompensated care burden in caring for the uninsured who cannot afford health care. Third, healthy people might remain outside the risk pool, driving up insurance costs for those in the market. Tax credits that are not claimed should be placed in a special fund. This fund could be used to expand community health center services and to reinsure extraordinarily high uncompensated care claims for hospitals. In this way, some services could be made available to the uninsured when they needed them and hospitals would receive some help with uncompensated care.

This book truly needs to be read by the entire healthcare industry. In fact, this book is a must read for anyone even remotely associated with healthcare. Because it really can be done better for half the cost, the impact of this book will not only benefit Americans everywhere, but bless the lives of generations to come. Worth reading. Joe Flower has produced a realistic blueprint for aligning America's medical marketplace with today's clinical, economic, and political realities.

Healthcare Beyond Reform: Doing It Right for Half the Cost - CRC Press Book

This book meets the need for a new and better approach to reform. Flower clearly outlines and untangles the many complex forces that act upon and create the U. This is an impressive contribution to creating better health and healthcare in the U. Joe Flower is an independent healthcare analyst and futurist, a veteran of 30 years of studying, reporting on, consulting with, and speaking to organizations across the industry.

His clients spread from the World Health Organization and the Department of Defense, to Fortune pharmaceutical companies, manufacturers, and health plans, to local community hospitals, free clinics, physician groups, nursing associations, start-up companies, and small employers. Routledge eBooks are available through VitalSource. Most VitalSource eBooks are available in a reflowable EPUB format which allows you to resize text to suit you and enables other accessibility features. Where the content of the eBook requires a specific layout, or contains maths or other special characters, the eBook will be available in PDF PBK format, which cannot be reflowed.

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