There is one significant blind spot in Sen. Ron Wyden’s (D OR) Healthy Americans Act – because the benefit plan is based on the one enjoyed by Congresspeople and Federal employees, it fails to consider that many Americans can’t afford the maximum out-of-pocket limit, while to others it is a mere pittance .
The problem with the FEHBP and Congressional plan is all those folks have jobs so they can afford deductibles. A lot of folks working at Walmart can’t. As presently constructed the plan looks a little, well, elitist.
The fix is simple.
Add a means-tested copay.
Poor folks can’t afford the $1000 deductible in HSAs now, so they sure won’t be able to afford the $4000 max out of pocket in HAA. But, others can afford much more. The key is to not make it all in a deductible, but to spread it out in copays. That way people get treatment they need at a marginal but not inconsequential cost. And, they keep thinking about cost long after total expenditures have topped $10,000. Thus, they remain “consumers”.
Wyden’s proposal will be attacked by consumer-directed health plan advocates – Herzlinger, the Galen Group nuts, and the rest about how we need to get consumers engaged and all that. And the more rational among them will have a good point.
So, beat them with their own stick. The problem with CDHPs is that they have zero impact on the folks who spend the most – the chronically ill. By adding meaningful, means-tested copays, HAA would enable poor folks to get the coverage and care they need, while ensuring all are financially-sensitized to cost.