Accessible, consistent, health care coverage regardless of employment status is the first recommendation of a reform proposal called “Health Care Choices 20/20” released in November.
The plan, offered as a blueprint for Congress and the president, was developed by medical professionals, state and national health care policy experts, and public policy organizations over two years to address rising health care costs and declining accessibility. The plan proposes to make patients better off in health care in ten ways by giving them more control over spending, more choices in health care delivery, and better price transparency.
As workers become more mobile and endure the loss of employment because of pandemic shutdowns, the employer-sponsored health care model that covers more than 157 million Americans is primed for revision, says Marie Fishpaw, director of domestic policy studies at The Heritage Foundation.
“It doesn’t make sense that we should have to change our doctors or coverage when we change jobs,” said Fishpaw. “Instead, we should be able to have health insurance that can travel with us even as we move from job to job, place to place, and in and out of the labor market. This could include traditional types of health insurance as well as innovative coverage options such as short-term plans, direct primary care arrangements, and health care sharing ministries.”
The key to solving these challenges is individually owned policies and self-directed subsidies, the proposal states.
The Health Care Choices 20/20 plan calls for codifying and improving President Donald Trump’s executive order, which went into effect on January 1, 2020. The order authorized more flexibility regarding “health reimbursement arrangements (HRAs)” which allow employers to offer employees funds to pay for health care outside of the employer plan. Employees can keep these arrangements if they lose or change jobs. “The COVID-19 pandemic has exposed the need for people to have secure, portable health coverage,” states the proposal.
The Trump HRA plan took the concept one step further. There is the “individual HRA” which gives employers the freedom to vary the terms and reimbursement allotments for different classes of employees, like part-time or temporary workers. This way, employers can give something to these workers, rather than nothing under the former HRA arrangement.
Giving even part-timers health plan money may reduce the temptation to quit work to qualify for health care through Medicaid, the government-funded health care system for low-income individuals which provides often-substandard care and poor access to it. Enrollment in Medicaid has been soaring since government lockdowns in response to COVID-19 eliminated tens of millions of jobs. People who lose their jobs and thus their employer-provided health insurance coverage have the option to continue care under the federal regulation known as COBRA, but it is expensive and many workers who have lost their income find they cannot afford the coverage.
Plan Receives Kudos
The Wall Street Journal gave the Health Care Choices 20/20 proposal a thumbs up in an editorial on November 29. The authors of the proposal “deserve credit for continuing to push this rock up the hill even without many champions in Congress,” the paper’s editors wrote. “Republicans have lost muscle memory on health care with the departure of members like Tom Coburn and Paul Ryan.”
Personal and portable health insurance is an idea for which the time has come, says John Goodman, co-publisher of Health Care News, one of the signatories of the proposal, who was mentioned in the editorial.
“The idea that health insurance should be tied to an employer may have made sense 70 years ago when people expected to have the same employer for their entire work life,” said Goodman. “The idea makes no sense in a highly mobile labor market where people change jobs many times over the course of a career.”
The proposal is the polar opposite of what congressional Democrats want to impose, says Grace-Marie Turner, president of the Galen Institute and proposal signatory.
“The Left is organizing to push further its goals of a bigger role for government in health care that takes more power from patients and doctors,” wrote Turner in an email to supporters. “We stand ready with a better path—Health Care Choices 20/20—that puts you and your doctor in charge, lowers costs, gives you better coverage, and provides secure safety nets for the vulnerable.”
Ashley Bateman (firstname.lastname@example.org) writes from Alexandria, Virginia.
Health Policy Consensus Group, “Health Care Choices 2020: A Vision for the Future,” October 2020: https://www.healthcarechoices2020.org/wp-content/uploads/2020/10/HEALTH-CARE-CHOICES-2020_A-Vision-for-the-Future_FINAL-002-1.pdf