The Wilson Health Plan

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The Wilson Health Plan

Posted: 28 Sep 2017 10:43 AM PDT

We have heard of Affordable Care Act, otherwise known as Obamacare, this system is failing for a number of reasons.  The Republicans have failed to pass a repeal or a replacement and seem to have no idea as to how to accomplish such a thing after seven years.  Since I have been following this since the beginning and have sold health insurance in many different states with different state laws both pre and post Obamacare, it is time I take a whack at it.  Introducing  WILSON CARE!!
I think I can do this in only a few pages, not the 10,000 ACA plan or even 20 pages put forth by the republicans.  Here we go.. I think my friends on both sides of the aisle will approve.
First for the purposes of this document we must define a pre-existing condition.  The is a  condition that happens BEFORE you have health insurance, therefore if you get a condition AFTER you have health insurance it is not pre-existing.
To understand versions of the Wilson Plan, you must first read sections of HIPAA.  Our politicians have not!  It was obvious by them continuing to say insurance carriers will no longer be able to cancel you because you get sick  HIPAA took care of that in 1996 (!  The Wilson plan will make one extension, by extending this law completely to the individual market, therefore, the only pre-existing conditions will be for those who have chosen not to purchase insurance.
Here is the Law:

Article 1
Repeals the Affordable care act, while some provisions will be re-added to the Wilson Plan, The Patient Protections and Affordable Care Act is hereby repealed.
Article 2

Open Enrollment every year from October 1 to December 15th.  This is for anyone who has chosen NOT to purchase insurance in the past.  These people may apply for insurance at this time only once per year.  This will be done from an insurance exchange in which every insurance carrier in the market MUST participate. Exchange plans would be required to offer a wider range of benefits such as maternity and mental health coverage, but the consumer would not be required to purchase. Rates will be as much as 50% higher in this exchange( if you are healthy you qualify standard issue), than rates off exchange.  This is to entice people to purchase insurance as soon as they come off their parents policy ( or as soon as they start their own business etc.).  If everyone were to purchase insurance when they came “eligible” there would be no pre-existing conditions.  Once you have had insurance for 18 straight months (per HIPAA), you would then be eligible to move out of the exchange to an off exchange plan at a lower premium.  After continuous coverage of 18 months whether from a group or individual insurance, all plans will be standard issue from a rating and issued with no exclusions.

Article 3 – Health Insurance Marketplace ( Insurance exchange)
To keep the insurance carriers profitable, all carriers in State must participate in the exchange.  However, once an insurance carriers volume for the year hits 5% of their total policy holders, they are done accepting applications on the exchange for the year.  This is similar to what the state of Ohio had done prior to the Affordable Care Act.  But do not ask Governor John Kasich about this as he has no idea, or he would have mentioned this during his failed presidential campaign.  I believe in limiting how many “substandard or higher risk” people will keep the insurance companies profitable.

Article 4 – Policies off Market Place ( Off exchange)
Then we have off exchange policies,  off exchange allow insurance carriers to have as many offerings as they would like as robust or as lean as you have on the exchange.  The only rule is that each insurer must have at least one plan that mirrors their on-exchange offering.

The Wilson plan will eliminate subsidies from the exchanges, but will allow all Americans who purchase insurance on the individual market to claim a tax deduction like a self employed individual would claim on his or her schedule C.  Yes, sadly you have to wait for tax time to claim it, but if insurance rates come back down to where there were pre-Obamacare, this is feasible. The tax credit would be aged based and be the same for everyone.  This is not a tax cut for the rich as this has been called by others.  It is a level playing field.  A thirty year old in California, would get the same as a 30 year old in Kentucky.  An additional $1000 tax credit per child would be added to the credit.  This credit is only given to those who purchase insurance.

All Health Insurance plans would become similar to other types of insurance plans in so much as, they will be designed to take care of things you cannot pay for.  Your auto insurance does not cover an oil change or a tune up.  Health insurance will not cover tune ups for your body.  This will accomplish a few things. One (1) it will force consumers to take an interest in their health care.  If they have more “skin in the game” they will think about how bad they need to see a doctor.  Two (2) it will force doctors to compete for business as the insurance payment goes away, they will have to adjust prices accordingly.  I think that doctors would go toward more of a  subscription service.  Maybe you pay your doctor a fee of say $500 per year for his expertise. Maybe you pay $75 whenever you see him.  The model would change, but the cost of care would go down. All of the Wilson Health plans will be Health Savings Account (HSA) qualified plans.  An HSA plan is a saving account used in conjunction with a High Deductible Health Plan.  You can use the funds that you put in the HSA for any medical expense.  Under the Wilson plan, this would include over the counter medicines as well as alternative medicines and treatments. Current law allows for 2018 to contribute $3450 for an individual and $6900 for a family.  It also allows $1000 per person aged 55 or older.  Currently not all High Deductible Plans are HSA eligible.  Under the Wilson plan they would be.  We would also classify the use of a Christian Health Share Ministry to become HSA qualified.  The Wilson Plan would increase the maximum annual contribution to $10,000 per individual and $20,000 per family.  The money in the HSA can be rolled from year to year.
Article 5 -Power to the States

Another feature of the Wilson plan is giving states autonomy of their plans as long as they meet a minimum criteria.  By minimum, I mean at least a plan that covers catastrophic care.  That can be a $10,000 deductible and 100% coverage or say a $10,000 out of pocket maximum on major medical plans.  This can be determined by the states as well.  Every state has its own needs.  They also have their own revenue streams.  So if Vermont or California want a single player type system and they can afford to do it, great let them.  Vermont looked at it a few years back and found it was not cost effective for them, but for purposes of discussion we will use that state. They would not receive any additional Federal Funding for such a program only their own tax payer dollars.

Article 6- Medicaid
Medicaid is another hot topic when it comes to healthcare.  Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources. People with certain disabilities qualify. The Affordable Care Act gave the states the option to expand Medicaid.  That expansion was for US citizens up to 133% of the poverty line.  The Wilson plan would have the Federal Government Grant money to each state for their Medicaid program.  The amount would be population of the state based so the larger state would get more money, but the amount of money per capital would be the same.  So California has about four times the population of New Jersey.  They would get four times the grant.  Now what the states do with that is up to them.  They can choose to expand Medicaid and pay doctors and hospitals less. The state can also decide to cover less people and pay doctors and hospitals more.

Article 7 – Medicare Prescription drug costs
Coverage gap.  The Wilson Plan will retain the features from the ACA towards closing the ” donut hole” in the Medicare Part D prescription drug plans.

Article 7-A- Prescription Drugs under age 65
Prescription drug costs in this country remain high.  The plan will allow people to obtain medications from any pharmacy anywhere in the world.  All fees will be HSA eligible and be applied to the deductible and out of pocket maximum.  The competition should reduce the cost of drugs manufactured here in the United States.

Article 8- Who can purchase
These plans will be offered to anyone who does not have group health insurance or who chooses not to participate in their company plan for any reason.  This will be the only type of plan offered to members of Congress.  They too may opt out if they are on a spouses health policy. The only way for members of Congress to understand what we the people of the United States are dealing with on the healthcare front is to live it.

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