I’d love reader feedback on this, in the comments, on Twitter, by email, whatever. Below is a list of potential changes to the ACA that might be appealing to conservatives, and maybe even some near-center liberals. I’ve listed them in approximate order of technical — not necessarily political — feasibility (lower number = more feasible; ties are possible). But I could be wrong in ordering. (These are rough guesses.) So, correct me! I am almost certainly wrong in completeness. What did I leave out? And, which ideas aren’t as appealing to conservatives as I might be implying?
Even though I’m not considering politics here, you can. How would you reorder the list in terms of political feasibility?
The possible “conservative-appealing (?)” adjustments are:
- Some type of malpractice reform
- Support for more competition among providers (including reform of scope-of-practice laws)
- Paring back essential health benefits
- Permitting more catastrophic plans on exchanges
- Eliminating the employer mandate
- Replacing the individual mandate with some other inducement (late enrollment penalty?)
- More support (in some fashion) for coverage for medical tourism
- Allowing inter-state competition among health plans
- Permitting all Medicaid eligibles to shop on exchanges (akin to Arkansas’s private option)
- Capping and/or more quickly phasing out of the employer-sponsored health insurance tax subsidy
- Equalizing tax treatment of all plans and medical savings vehicles, regardless of source or type
- Creating high risk pools for sicker individuals without continuous coverage, if only as a transitional measure
- Universal, zero- or low-premium catastrophic (akin to Singapore)
- Risk rating (or a lot more of it). Note, if only tweaking the age-based constraints on premiums, this is a lot more feasible — move it up to near the top of the list.
To be clear, my notion of technical feasibility here is the extent of interference/disruption of the existing ACA structure and/or other insurance arrangements (like Medicaid or employer-sponsored coverage). I’ve deliberately ignored Medicare, but one could draw up a list for that program. My read of recent right-of-center thinkers is that structural reform of Medicare has fallen away or taken a back seat. The focus seems to be on how the ACA impacts group and non-group markets for the non-elderly, as well as Medicaid.
Have at it!
LATE ADDITIONS: I don’t want to further mess up the numbering, so here are some other ideas from comments: Price transparency (not sure what the specific policy is, but I’d give this a low number on the list because it’s not disruptive to the structure of the ACA at all.)