NRLC’S STATE-BASED PLAN FOR
HEALTH CARE REFORM WITHOUT RATIONING

* INSURANCE FOR ALL.  Just as basic liability insurance is required of everyone who registers an automobile, basic health insurance would be required for everyone in the state.

* CHOICE OF PLANS THROUGH STATE EXCHANGE.  Private insurance companies would compete by offering health insurance plans through a state-based insurance exchange; each company offering health insurance would have to offer at least one basic plan.  Employers would have the option, in place of contracting with specific insurance companies to insure their employees as is now common, of instead allowing their employees to choose their insurance through the exchange, with the employer payment for or toward the premium paid through the exchange.  (Employees who chose plans costing more than the employer pays could have the extra charge deducted from their paychecks on a pre-tax basis.)

* INSURANCE FOR THOSE WHO CANNOT AFFORD IT.  Those with incomes too high to qualify for Medicaid but too low to be able to afford to pay the full premiums for basic health insurance would be certified by the state as entitled to discounted premiums, on a sliding scale based on degree of need.  Need would take into account income, family size, and similar relevant factors.  They could choose among any basic insurance plans offered through the state-based insurance exchange, and would be charged based on their particular certified sliding-scale discount.

* COVERING THE COST.  The prices health care providers charge those covered by private insurance now have to help cover the cost to those providers of treating those who are now uninsured – effectively resulting in private-sector cost-shifting reflected in the premiums insurers charge their customers.

Under the new proposal, those now uninsured would now be covered by insurance, and cost-shifting at the level of the provider would no longer be necessary.  Accordingly, third party payers such as insurers would be authorized to “withhold” a percentage from the payments they make to providers who submit claims for reimbursement, which would go to a fund to cover the costs of the sliding-scale subsidies for insurance premiums.  This percentage would be set in advance of each year by a commission, calculated to be adequate to cover the projected costs.  Essentially, this would shift existing private sector cost shifting from the level of the provider to the level of the insurer; the net cost (ultimately reflected in insurance premiums) would be about the same.

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