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 systemmight be due for a major overhaul—or at least a good tune-up.

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“The renewal season this year has been challenging,” says SusanRider, a consultant for Gregory & Appel in Indianapolis.“Carriers in the small-group market are issuing double-digitincreases and limiting plan options. As a consultant, it is myresponsibility to help ensure decision-makers and their employeesunderstand the benefits that they are selecting to help meet theirfamily's financial needs.”

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From market-based reforms to a single-payer system, there is noshortage of opinions and recommendations on potential health carefixes.

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

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The political landscape seems more unpredictable than ever, butmany pundits agree that Republicans will continue to try to dosomething—anything—to appear to be keeping past promises todismantle the ACA, while Democrats will do their best to preservethe status quo and wield failed reform efforts as a campaignissue.

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

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Seven-point plan

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

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

  • Allow states to expand health insurance options and competitionto their respective marketplaces. States would define the basicessential benefits.

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

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

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

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

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

Differing needs

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Rey Velasco works with businesses of all sizes as a benefitsconsultant with Associated Benefits and Risk Consulting inMinneapolis. Small and large companies face different challenges,he says, which result in different priorities for healthreform.

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

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“Granted, this has helped spread risk among the small-grouppools, but I would like to see small employers more directlyrewarded for being good stewards of their health and their healthplans,” Velasco says. “There has also been compression in the costsbetween the youngest in the population and the oldest in thepopulation, and frankly, that compression has hurt the youngeremployees who we want in the system.”

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

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

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

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One common thread is to offer customers as many choices aspossible and to provide the information they need to choosewisely.

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

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Consumers weigh in

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

  • Greater state flexibility. Several Republican lawmakerspropose changes to the ACA that would increase the role of statesin running their own health insurance programs. Sixty-three percentsupport this concept in general.

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

  • Single-payer. Senator Bernie Sanders (a potential 2020presidential candidate) has proposed “Medicare for All,” in whichall Americans would obtain health insurance from a singlegovernment-run, national health plan. Seventy percent of Democratssupport this idea, with the same percentage of Republicans opposingit.

What now?

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No one knows how these various options will play out in 2018, sohow can brokers serve their customers and remain profitable amidsuch uncertainty? Rider encourages them to be proactive in takingcare of their customers so they can thrive, regardless of whatWashington does.

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“Employers are aligning themselves with strategic brokeragefirms that listen to their needs and help them establish amultiyear strategy that aligns with their organization's missionand goals,” she says. “Our focus is reducing health care coststhrough effective benefit plans, HR strategy, compliance,population health management, communications and employeeengagement. We support our clients with up-to-the-minutelegislative updates and ongoing educational seminars to stayinformed and compliant.”

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

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“One thing that this whole debate has reminded me is that we arestill failing, as we're not providing the quality care our nationneeds at an affordable cost,” she says. “Many will be tempted tosit on the sidelines until 2019 or whenever the next majorlegislative attempt occurs, but that's not our mission orresponsibility as industry leaders.”

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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 theefforts that we make each day will make it a little better.”

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