Concerned American

Simplified Health Care Reform Proposal

October 7th, 2009

This proposal is attempting to address the issue of the cost of health care in the United States as it continues to grow, out of control, due to a number of factors, some of which are: the cost of medical malpractice insurance, the cost of individual health insurance, the cost of treating the uninsured or underinsured.

The goals of this proposal are the following:

Allow Americans to purchase affordable health insurance, as individuals or part of a small business, with coverage that includes preventative care and wellness programs.
Allow Americans with little or no income to have access to “basic” medical coverage, with the intention of providing access to doctors and hospitals, including basic preventative care, at little or no cost.
Allow Americans who lose their income or employer based coverage to continue their coverage, with no added cost or surcharges.

There are four groups of Americans that will be addressed in this proposal:

Americans with employer based health coverage, which lose their coverage as a result of a change in their employment, whether voluntary or not.
Americans with individual insurance plans with preexisting medical conditions who cannot afford the increased cost of the medical insurance, or who are unable to find an insurance provider who is willing to provide the insurance, but with riders that eliminate coverage for the preexisting medical condition.
Americans who are self employed or proprietors of a small business that is unable to offer a group plan to themselves or their employees based on cost. As a result, they and their employees are forced to purchase individual plans from insurers.
Americans with no insurance and no income, or such limited income that they are unable to afford any form of insurance.

Basic assumptions of the proposal:

The Congress of the United States of America will create a fund that will provide financial assistance to the states for the exclusive purpose of meeting the goals of this proposal.
Each state will administer and control the funding for these programs. They will create, within their state, programs dedicated to meeting the goals of this proposal.

Proposal for Group 1

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Americans who lose their employer based coverage may continue their coverage under the currently existing COBRA programs in each state. This provides for up to 18 months of continuous coverage, at no additional charge. Once COBRA is finished, if the individual is unable to obtain coverage through another employer, that individual has the option to purchase a plan from their state. This plan will be provided and administered by the state’s current State Employee Health benefit. This benefit will be a separate plan, which will provide comparable coverage, priced using the cost structure negotiated by the State for their employees.

Proposal for Group 2

Americans, who are unable to purchase individual insurance coverage due to preexisting conditions, may purchase additional insurance coverage from their State Employee Health benefit. This benefit is a supplemental plan, with coverage for the conditions that the existing insurer will not cover under the individual plan. This benefit will be a separate plan, which will provide the additional coverage, priced using the cost structure negotiated by the State for their employees. This additional cost will be itemized as a health care cost as part of the federal income tax return.

Proposal for Group 3

Americans who are self employed or proprietors of a small business that are unable to offer a group plan to themselves or their employees will be allowed to participate in the group plan offered to State Employees. This benefit will be a separate plan, which will be priced using the cost structure negotiated by the State for their employees.

Proposal for Group 4

Americans with no insurance and no income, or such limited income that they are unable to afford any form of insurance will be allowed to participate in a “basic” insurance plan, subsidized by the state, using the funds provided by the federal government. This benefit will require regular reapplication, much like the assistance provided under other state programs (WIC, Welfare, etc.) This benefit will be a separate plan, which will be priced using the cost structure negotiated by the State for their employees.

Limitations and exclusions

It is the exclusive domain of the state to establish regulations for eligibility and administer the benefits under their plan. The Federal Government may not withhold or delay funding to the state programs defined in this proposal.
The Federal Government may not intervene or otherwise influence the process of establishing or administering the state programs defined in this proposal.
Each state must offer this program to their residents. The state or federal government may not obligate individuals to participate in any insurance plan, for any reason.
Americans who are residents of a federal district (ie. Washington, DC) are eligible for the Federal Employee Health Benefit, as these state based proposals to not address their particular situation.

How this proposal addresses the increasing cost of health care

This proposal addresses the issue of health care by first providing all Americans with some form of coverage. Coverage for the vast majority of Americans will continue to be provided by Employers. This proposal will cover the remaining population that cannot afford insurance. As a result, health care providers will now be able to provide health services and reasonably expect to be able to get paid for them. This will reduce the losses and write-offs.

Private Insurance providers will be able to offer lower cost policies since pre-existing conditions, riders and limitations of coverage will be addressed by the State program. Since each state regulates insurance providers operating within that state, regulations may be created that bring premium prices and benefits in line with that of the State employee benefit programs. An example would be to negotiate volume pricing with private insurers wishing to access participants in the state programs.

Individuals, who are part of a state provided benefit, will receive lower priced health care, much in the same way that large employers offer group benefits to their employees. In many cases, preexisting conditions are not exempted from group plans. As a result, many individuals could see a reduction in the cost of insurance, without sacrificing benefits.

Finally, states will compete against each other to draw new businesses into their economies. As each state will be allowed to craft their own benefits, insurance companies and employers will be encouraged to offer low cost, high quality benefits. This follows along the same principles as employers seeking talented employees by offering enticing benefits.

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May 28th, 2007

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Concerned American

Simplified Health Care Reform Proposal

A humble America, honors its true heroes

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