More on catastrophic plans

In May 2012 I blogged that the ACA was going to allow quite high deductibles, even as Republicans criticized it for ending the practice, and I have generally felt that default catastrophic options hold the best chance for a future reform deal between the two political sides. Now we’ve come full circle and Republicans are criticizing high deductibles in the ACA, and lining up against narrow networks as cost control measures (aka markets actually having a chance to work). I will assume that at some point Republicans will realize they are running out of their own ideas that Democrats actually tried, albeit inelegantly. Republicans certainly have shown an ability to change their mind, so at some point is has to get back to the policy (right?).

If you assume that a broad based default “catastrophic” option holds the best chance for an inevitable deal someday, or for cold feet states to move ahead as I do, there are many tricky issues that must be sorted to put a default catastrophic plan in place (where does the insurance vehicle come from?). For North Carolina, I suggested the use of the State Employees Health Plan to provide a vehicle for stop-loss catastrophic hospital insurance for those left uncovered after a Medicaid expansion and a well functioning exchange. I think one of the most difficult aspects of such a stop loss plan (based totally on financial loss) is determining what is an acceptable health care expense (presumably one couldn’t charge their carbon road bike?), and how the unit price for care will be determined.The State Employees Health Plan has already defined benefits and negotiated prices.

In much the same way that the Federal Employees Health Plan is often invoked in reform discussions (let people buy in, etc), State Employee Health Plans could become more important in States that have heretofore sat out the ACA, but may be wanting to devise a state-specific health reform approach.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. 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

3 Responses to More on catastrophic plans

  1. RojabNac says:

    I think this is a real great article.Really looking forward to read more. Really Cool.
    The Hillford Site Plan

  2. richard says:

    The one issue I have with both sides characterization of catastrophic health plans is that they are catastrophic in name only. There is still a lot of first dollar coverage. A true catastrophic health plan would require the patient to cover everything under the deductible. I think that is part of what is driving premiums so high. The catastrophic plans are more like PPOs with a higher deductibles. These products are also unnecessarily complex.

  3. Pingback: Burwell Nomination: Faint echoes of a deal post ’14? | freeforall

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