United Healthcare’s Incredible Approach to a Post-ACA World

It’s rare that I read something from one of the largest health insurance carriers, if not the largest carrier, and really agree with just about everything. That’s what happened when I read United Healthcare’s recent article, A Modern, High Performing, Simpler Health Care System-1. 

It suffices to say, I believe they have an entirely spot-on assessment of the changes we need to make right now to allow for future success in the health insurance and healthcare industry. They explain that the ACA should immediately be replaced with a more sustainable state-based public and private marketplace. Both private endeavors and state-based public systems can play a key role in getting us back on track after a lost 5 years under the current ACA. The Trump Administration can get the “ACA Repeal for Dummies” booklet from UHC.

The reality is that the employer-sponsored marketplace covers the majority of the 320 million people in the U.S (almost 180MM). Exchanges cover only 11MM, and 28MM are still uninsured today. UHC hones in on breaking down the areas of a portfolio – Medicaid, Flexible (key word) Individual Private Market Benefits, Defined, Funded & Well-Managed High Risk Pools and other sustainable, state-based coverage mechanisms.

They drive towards simplicity, choice, flexible and lower-cost solutions which, from our experience helping thousands of individuals and employers all over the U.S., is not where we are today. Granted, a chronically ill 50-year-old earning $30,000 in the U.S., who prior to the ACA was uninsurable, can get an almost free, rich healthcare plan – because of tax-funded subsidies (seemingly the biggest problem with the ACA’s funding, and where the money has already dried up). So we must continue care for this person, and at a very low premium cost point, but where it seems we get twisted is deciding what system or type of care is a person entitled to? Many working Americans, when polled on whether they’d prefer to be given the choice to be covered under Medicaid, or a similar program, when they are unemployed or suffering financial hardship, said absolutely! Even if these same folks had to switch physicians, specialists, and hospitals? Yes indeed, same answer. “Free or almost no cost” changes most folks’ minds when it comes to accessing healthcare.

So this is a keystone to a newly revamped ACA: we must avail the right systems and plans to the right segment of our population, for the price, during the right circumstances or events.  UHC has this right.

The second important discussion this article delves into is the removal of the essential benefits mandate and metallic levels, bringing back short-term and more limited coverage policies, but retaining the underwriting reforms and risk adjustments of the ACA. Simply put, pre-existing conditions will need to be a thing of the past, as it is now in an ACA world, though priced accordingly, where today they are not. As both an expert in this field, and someone who has medical needs – allergy induced asthma – I know as well as anyone the practical side of this. As such, my key areas of need are: very affordable generic meds, telemedicine, affordable urgent care, and for the catastrophic need, hospital-based benefits. Those are the key areas over the last 24 years working for me specifically. So if I do not require a plan this year that has robust coverage for durable medical equipment, skilled nursing, physical and occupational healthcare, any out-of-network coverage, or medical care delivered in an actual physician’s office, why pay for all of these benefits?

Availing free, or affordable physicals to all in the U.S. is a good thing, but how many folks are using the benefit, other than me? I’ve gotten a physical every year for 10 years, with or without the ACA freebee, but when I poll our clients, friends, colleagues, random folks, so many just don’t go. It’s amazing to me.

The last thing I want to highlight is the focus here on tax-advantaged accounts or HSAs (health savings accounts). I believe, as does UHC, that they should be expanded or become far more flexible in what they can cover, including individual health insurance premiums. Some of these items have been key tenets of the Trump Healthcare Plan, though we have yet to get firm details on what this plan entails.

I’ve often thought about Elon Musk disrupting the traditional gas-combustion engine model, ramping up Tesla as the first battery-operated growth player in the U.S. and succeeding. I understand that this all might seem a bit “far out”, but disruption on this scale has been accomplished before and can be done today.

If we can’t put politics aside, and come to a middle, common ground, we’ll continue to grow as an international laughing stock as it relates to healthcare. We do not have the best healthcare on earth, but we do have the most expensive healthcare on earth. Seemingly, folks are getting cost confused with quality.. “Ain’t” always the same.