Uh... Obamacare has price control provisions that attempt to force young people and men to subsidize women and the elderly (which have failed), among many other disastrous regulations like the supposedly popular but stupid 26-year old rule and pre-existing conditions rule. I would prefer to see no subsidy, but I'm trying to be politically realistic. We also need to stop endlessly blaming everything on the insurance and pharmaceutical industries and start getting tough with healthcare providers. Lack of transparency is what allows healthcare providers to hide behind insurance companies, and the more layers of government and bureaucracy we add, the further from a truly free and transparent market we get.
Consumers (i.e. the market) are a far more powerful and effective force in changing the behavior of businesses than government could ever hope to be. The government's role should be to reduce the information asymmetry that currently exists with the opaque nature of healthcare spending in the US and allow the market to do its work.
1. Are you seriously proposing that we go back to the day where men and women are charged different rates? Talk about a political non-starter. I doubt a single Republican female Congressman or Senator would vote for that, nor would some of the moderate Republican men. Just imagine the tweets: "Republican health plan: raise rates on women to give men a break!! #WaronWomen"
2. As far as age rating goes, some have suggested that expanding the age curve from 3:1 to 4:1 or even 5:1 would pull a lot more healthy youngs into the market, maybe even to the point where the average rate goes down so much that old people don't really pay more. Maybe that's true - it's worth looking into. Note that it would make no difference for the people receiving subsidies, so it would need to attract
moocher criminals uninsured young people who aren't receiving subsidies into the market to make a difference.
3. Getting rid of the pre-existing conditions rule is a terrible, unworkable idea. The vast majority of people with PECs are losers in the genetic lottery - it's not their fault. Why should they have to pay extra for something beyond their control? I could understand adding on a surcharge for people who got diabetes because they didn't eat right for decades, but how do you do that logistically?
If you boiled down the ACA into a single phrase, it would be "no discrimination on the basis of pre-existing conditions," both in allowing coverage at all, or charging extra for them. Everything else on Obamacare is what needs to be there to make that possible. Gotta have the individual mandate to keep the pool healthier and keep costs down. Gotta have the subsidies to help people obey the individual mandate. Etc. If you keep the pre-existing conditions rule, you keep Obamacare, and it looks like that's what we're going to do if Trump was serious about that.
4. The subsidy formula could definitely use some reworking. First, it doesn't need to cut off at 400% FPL. The 401%ers are totally screwed and get nothing. Even worse, it can incentivize people into making less money so they can get their subsidies. Better to let the subsidies taper off but theoretically apply to anyone whose insurance costs more than 9.5% (or 10% or whatever) of their income.
Even worse, The subsidy is based on the second cheapest silver plan, but that usually just means some bare-bones high deductible silver plan with a really cheap network, which means lower subsidies for everyone. It would be a lot more workable to base it on the "standardized" silver plan from a more robust network. One of the major reasons people are seeing their bills go up is because bare-bones barely-silver plans are entering the market and tanking everyone's subsidies.
5. Your point about getting tough on the providers is a good one. Generally speaking, health insurance companies don't have nearly the profit margins of hospitals. We could really save on health care costs if the Feds required hospitals to accept the Medicare rate for everything.
Poll
