Replace Obamacare with The Texas Whole Healthcare Plan

Before our Federal representatives get started repealing the components of PP&ACA (Obamacare) Texas needs to come up with a plan that we can point to and legitimately say replaces it.
Things people like in ACA are:
No drop/No cancel – a person or family can’t suddenly find themselves without healthcare insurance
No pre-existing condition exclusions – if you’re honest you cannot be denied coverage
Family coverage – including family members is reasonable
Portability – unintended except for individual policies

Something that makes people feel comfortable with ACA plans but insurers hate is the No Limit on coverage, either annually or lifetime. Caps allow actuaries to set a reasonable rate, but requiring everyone to have unlimited coverage makes it costly for everyone.

Things people don’t like in ACA are:
Premiums. They’re outrageous.
Deductibles. They’re ridiculous.
Flex plan incompatibility. Employees still lose their account balances at year-end.
Eyewear. Still no coverage.
Dental. Still no coverage.
No rollover of any unused premium, if entitled to any.

People like “shopping” as long as the choices make sense and no huge penalties accrue to making a mistake. So, if you’re locked into deducting a certain amount because you selected (for example) excluding pre-natal care, you would want to be able to change your mind later, if needed, by paying the difference down the road when you find out you do need it. This also applies to the maximum coverage amount, even if an infinite limit is not available.
Insurance companies don’t want to get stuck with huge bills for people who claim to be in risk pool P but actually are in risk pool S, whatever those are.
In Fire Insurance the state created the FAIR plan to cover structures otherwise uninsurable. Healthcare insurance needs multiple risk pool designations PLUS a high-risk pool funded by all state-licensed insurers to cover the uninsurable.
Typically, insurance is Standard, or Premium risk. Sub-standard is also occasionally offered, but High Risk is just a dream. Perhaps the High Risk pool needs to be funded like the FAIR plan, and all insurers should offer sub-standard risk policies, too.

Savings. Medical Savings Account. This idea keeps coming up but without any detail. If we enable insurers to offer insurance policies similar to Whole Life Insurance, but based on Healthcare Insurance, then we can actually put some detail into the “savings” idea. What can an insured use the savings account for? Perhaps unexpected changes in his coverage he or she needs, like pregnancy for an “infertile” couple. Perhaps a procedure outside the coverage paid for but where the insured doesn’t want to change risk pools or policy coverage. Perhaps at the end of life, they need hospice care or they need geriatric care of some type, including assisted living.
The amount extra over the normal premium is determined by the insured. Usually Whole Life or Universal Life offers different return rates, like linked to Dow-Jones or straight percent return, or linked to some index with a guaranteed return. But an insurance specialist needs to describe these plans to help the insured choose wisely. Young people almost always choose the cheapest coverage, but perhaps they’ll plan ahead when they see the balances they can accumulate if they start early enough.
A long-term healthcare insurance policy coupled with a savings plan would mimic whole life, but would have periodic claims against the value. Actuaries will rise to the challenge of “Whole Healthcare” insurance, if we empower them.

Employer-based Plans. Right now employers are forced into offering insurance because under FDR they started offering doctoring and later healthcare insurance when FDR slapped wage controls on employers. They competed at that time via healthcare benefits. A downside of employer-based plans is that employees lose the coverage when they quit or are laid off. Make ALL healthcare plans portable. They belong to the employee, not the employer. The employer can negotiate for the employees, but the employee can get insurance from any insurer.
The Flex plans should be merged into the Whole Healthcare plan allowing the employee to spend or save his Flex dollars instead of use-it-or-lose-it mentality.
The contributions the employer makes on behalf of the employee can be made directly to his Whole Healthcare insurance policy. If some is left over, it can go into the savings plan. If the employee wants to add more, he should able to, but many people think in terms of Federal Income Tax regulations. While this is not under Texas’ control, we can suggest tax-free treatment of employer-paid premiums and deductibility of employee contributions.

Eyewear (optical) and dental need to be optional coverages from Texas healthcare insurers. These should be structured similarly, perhaps as part of the same policy, where if you find out later you need orthodontic coverage, you can go back and add it by making back payments at that coverage rate. Or if you find you need $20,000 coverage instead of the $2,500, you can go back and increase your coverage. Okay, yes, it might cost $10,000 or more to do that, but this can be structured as a loan from your insurance plan.

So, these steps all help maintain competition among insurers, keep insureds in control of their care, and promises to solve the major issues that PP&ACA intended to address, except one item: those unable to pay enough to get their own insurance.

In many cases charities have successfully managed healthcare services for impoverished people, and hospitals and public health departments have offered programs to reach out to the poor. In some cases families have made appeals to philanthropic individuals and organization to pay for healthcare procedures they could not afford. It is important that the legitimacy of such claims be verified to prevent abuse and fraud, preferably by attestation of the diagnosing doctors. Doctors themselves are a huge source healthcare treatments, often on a pro bono basis.
The state has an interest in keeping this work protected from financial liability as well as encouraging medical personnel to participate as caregivers. While some “Samaritan” laws do exist, these need expansion to provide coverage of the facility and personnel and other providers who so selflessly give of themselves. This includes teaching schools as well as free clinics.
The state should also consider contributing a portion of lottery revenues to a fund to support these charitable activities. A sizable portion of lottery revenue is actually derived from the indigent, who believe they can “win” their way out of poverty. In effect, they would be helping to fund their own care.