As the old saying goes, if it ain't broke, don't fix it. However, many people agree that the the U.S. health care system might be due for a major overhaul—or at least a good tune-up.

“The renewal season this year has been challenging,” says Susan Rider, a consultant for Gregory & Appel in Indianapolis. “Carriers in the small-group market are issuing double-digit increases and limiting plan options. As a consultant, it is my responsibility to help ensure decision-makers and their employees understand the benefits that they are selecting to help meet their family's financial needs.”

From market-based reforms to a single-payer system, there is no shortage of opinions and recommendations on potential health care fixes.

According to the National Association of Health Underwriters, “our top priority should be improving private health insurance markets and creating a more patient-centered system that adheres to the key principles of affordability, accessibility, quality and innovation.” The challenge, of course, is how to accomplish this objective, especially in a contentious election year.

The political landscape seems more unpredictable than ever, but many pundits agree that Republicans will continue to try to do something—anything—to appear to be keeping past promises to dismantle the ACA, while Democrats will do their best to preserve the status quo and wield failed reform efforts as a campaign issue.

Congress has summoned a parade of economists, physicians, insurance agents and others to Capitol Hill to offer their opinions about how to reform health care. But why not also ask the people who work most closely with consumers and employers—the brokers?

Seven-point plan

Wayne Sakomoto, president of Health Insurance Interactive Inc. in Naples, Florida, has thought long and hard about this topic. He has come up with a practical, seven-part plan:

• “Embrace a reference-based pricing model for individual and group health plans, and not require insureds and employees to use their health plan's network if they can negotiate a better pricing arrangement with their own preferred medical providers,” he says. “Reference-based pricing apps and resources should be provided to all insureds.”

• Allow states to expand health insurance options and competition to their respective marketplaces. States would define the basic essential benefits.

• Allow insurance companies to create new health insurance options, without most mandated federal and state benefits, but offering them as riders.

• “Allow insurance companies to offer consumer-choice health plans in regard to the amounts of coverage they would like to purchase,” Sakamoto says, “from $100,000 to $1 million and unlimited lifetime coverage. These plans can be offered year-round but can be underwritten when purchased outside open enrollment.”

• Encourage health plans to integrate telemedicine, urgent care and walk-in clinics (such as “minute clinics”) to be offered with all health insurance plans.

• Expand the 2018 individual open enrollment to January 31 or February 15.

• Encourage industry and associations to promote the value of licensed health insurance agents with consumers through the media; health insurance companies; local, state and federal regulators and legislators; the Centers for Medicare & Medicaid Services; and the Department of Health and Human Services.

Differing needs

Rey Velasco works with businesses of all sizes as a benefits consultant with Associated Benefits and Risk Consulting in Minneapolis. Small and large companies face different challenges, he says, which result in different priorities for health reform.

Many small employers that are relatively low health-care utilizers now pay significantly higher premiums than before the full enactment of the ACA, he points out.

“Granted, this has helped spread risk among the small-group pools, but I would like to see small employers more directly rewarded for being good stewards of their health and their health plans,” Velasco says. “There has also been compression in the costs between the youngest in the population and the oldest in the population, and frankly, that compression has hurt the younger employees who we want in the system.”

He also recommends a thorough review of the impact of the so-called Cadillac tax on large employers.

“The name is really a misnomer, since the tax is not based on the richness of a plan at all, but on the cost of that plan,” he says. “This means that an unhealthy group with a high-deductible (bronze level) plan would be subject to the tax, while a very healthy group with a rich plan and low premiums would not be subject to the tax.

“This is probably the easiest of reforms to make in 2018, and one that would help preserve employer-based medical insurance.”

One common thread is to offer customers as many choices as possible and to provide the information they need to choose wisely.

“Most employers want to give employees choices,” says Tracy Watts, Mercer's leader for U.S. health care reform in Washington, D.C. “For many employees, enrolling in a high-deductible plan with an HSA is a smart financial move, but it takes some education. Decision-support models and other resources can help employees reach that comfort level, and most employers would rather go that route than take away other plan choices.”

Consumers weigh in

What do health care consumers think about these and other options? The recent Kaiser Health Tracking Poll found the public divided largely along party lines on potential reforms.

• Greater state flexibility. Several Republican lawmakers propose changes to the ACA that would increase the role of states in running their own health insurance programs. Sixty-three percent support this concept in general.

• Medicaid opt-in. The majority of people—and nearly 80 percent of Democrats—support government subsidies to purchase health insurance through state Medicaid programs instead of from private insurers.

• Single-payer. Senator Bernie Sanders (a potential 2020 presidential candidate) has proposed “Medicare for All,” in which all Americans would obtain health insurance from a single government-run, national health plan. Seventy percent of Democrats support this idea, with the same percentage of Republicans opposing it.

What now?

No one knows how these various options will play out in 2018, so how can brokers serve their customers and remain profitable amid such uncertainty? Rider encourages them to be proactive in taking care of their customers so they can thrive, regardless of what Washington does.

“Employers are aligning themselves with strategic brokerage firms that listen to their needs and help them establish a multiyear strategy that aligns with their organization's mission and goals,” she says. “Our focus is reducing health care costs through effective benefit plans, HR strategy, compliance, population health management, communications and employee engagement. We support our clients with up-to-the-minute legislative updates and ongoing educational seminars to stay informed and compliant.”

Terry Stone, managing partner, health and life sciences for Oliver Wyman in New York City, agrees that now is not the time for brokers to be passive.

“One thing that this whole debate has reminded me is that we are still failing, as we're not providing the quality care our nation needs at an affordable cost,” she says. “Many will be tempted to sit on the sidelines until 2019 or whenever the next major legislative attempt occurs, but that's not our mission or responsibility as industry leaders.”

Stone offers four broad recommendations:

• Engage consumers in a meaningful way.

• Accelerate the shift to value.

• Improve the quality of care.

• Drive and catalyze innovation.

“Transforming health care is a long road,” she says, “but the efforts that we make each day will make it a little better.”