Reinsurance, expanding coverage and the search for a deal

Slammed with project deadlines so light on the blogging….but wanted to point to Reihan Salam’s interesting and useful post about different approaches to reinsurance/federal guarantees to help move toward universal coverage. He points out that there are a fair number of liberal/progressive types who have embraced models of trying to get universal, catastrophic coverage with various mixes of public and private payers. Such a proposal is central to my book. Further, here is a series I did on the federal flood insurance program, that highlights some potential lessons and/or the usefulness of this model to inform the possible use of federal reinsurance/backstopping of some sort.

I see lots of issues in Obamacare that could be improved and addressed within the parameters of the law, and there are lots of alternatives and ideas. I especially want to highlight Reihan’s highlight of Gene Steuerle’s critique of the ACA and of Republican critiques of the law as well. Federalizing the dual eligibles and moving over time to buying low income persons into private insurance is a worthy goal on many fronts,and would remove one of the “tranches” as Gene calls them.

There is some convergence from right and left on key issues if you focus on the policy, and if we can at least start from a goal of providing everyone with some level of predictable coverage. The stumble is the politics….we have to figure that out. By that I mean I am open to and even prefer large changes to Obamacare as should be clear from my book. However, these steps need to be negotiated and enacted from the basis of the existing law. I just don’t see how it is politically feasible for the first step to be a repeal of Obamacare without clarity of what comes in its place.

The next step is the election. Somehow we have to get to the point after that where good policy also becomes good politics.

update: revised wording.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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