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Improving Wyden’s Healthy Americans Act

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 advocatesHerzlinger, 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.

2 thoughts on “Improving Wyden’s Healthy Americans Act”

  1. Joe — Good comments. Thanks.
    The notion of a means-tested copay is interesting, but I do want to clarify one thing:
    The $4000 thing is not a deductible. Rather, it’s exactly what you suggest – spread out in copays.
    Rather, it’s a maximum out-of-pocket in the event of a catastrophic event.
    So, let’s say you break your arm in a bike accident and have to be taken to the hospital.
    Before you pay a dime out-of-pocket, the ambulance ride is free, as long as its within 72 hours of the accident. The ER care is free, also within 72 hours. Depending on what happens next, it’s almost certainly a $250 deductible.
    The $4000 cap says that no matter what all the other rules are, if you have so much medical care, so many visits, so many x-rays, etc. that you have run up $4000 in personal out-of-pocket expenses… then all those expenses shut down, and everything is free going forward.
    Now, it’s definitely true that $4000 would be a huge hit for a lot of people. I’m looking forward to seeing how the system would handle low-income folks that can’t even afford the copays and minor deductibles.
    Again, my full disclosure: I’m managing the Stand tall For America website for Senator Wyden. I’m not a policy wonk, and I don’t speak for the Senator or his staff. Any errors and opinions are my own.

  2. All this talk of who can pay and who can’t pay bothers me.If your in the low to moderate income level your screwed period.We should have a VERY small tax on all consumer goods which goes into the National Health Care Fund and is distributed based on a world fair medical cost guide.Why do you think more Americans are going over-seas for costly procedures?

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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