More on Reimbursement

Approaches, public policies that could help health insurance coverage expand through public plans

For a number of approaches, the paper examines where the plan would operate and who would be eligible.

Jeff Lagasse, Associate Editor

As proposals to expand public health insurance are being put forward, the American Academy of Actuaries' Health Practice Council is providing policymakers and the public with information to better understand and evaluate the proposals in a new public policy paper published today.

"Proposals to expand health insurance coverage through public plans have important implications for consumers, taxpayers, insurers, employers, and health care providers, but those implications can vary considerably based on the specifics of each proposal," said Academy Senior Health Fellow Cori Uccello, the paper's lead author.

"The new paper details the key design features that need to be considered when developing or evaluating an expansion proposal."


The Academy paper identifies expansion approaches through four general categories: a government-facilitated or -administered plan available in the Affordable Care Act marketplaces; a Medicaid buy-in option; a Medicare buy-in option; and "Medicare for more" or "Medicare for all."

For each approach, the paper examines the key design elements that need to be addressed, including defining where the plan would operate and who would be eligible.

It also examines whether the public plan would be a supplemental choice or the sole coverage source available; whether the program would rely solely on public coverage or would also incorporate private plans; what benefits would be covered and what cost-sharing might be required; how providers would be paid; how premiums and other financing would be set; and transition issues.

Decisions made on these design features would affect the viability of the plan, as well as coverage availability and affordability -- not only of the public plan, but also of other sources of coverage.


The paper is published as both insurers and healthcare organizations spoke out against the Medicare For All Act introduced last week by House Democrats.

Payers are against a plan that would eliminate private insurance. Providers say a government-run health plan would ultimately result in lower reimbursement, as has been the case in the past.

The American Hospital Association said Congress has a history of slashing provider payments for government health programs and that Medicare and Medicaid reimburse providers less than the cost of delivering care.

Twitter: @JELagasse

Email the writer:

Off White X Max 98