Giving Compass' Take:

• Professor J.B. Silvers argues that common healthcare reform positions of politicians are often over-simplified and miss major factors and lays out the challenges of defining successful healthcare reform. 

• How can funders help to develop through and nuanced healthcare reform policy? 

• Learn how one foundation is working to increase access to healthcare coverage


Politicians have been talking mostly about pre-existing conditions as the way to ensure access to health care. But as a former health care insurance company CEO who now studies health care finance, I see this view as too simple. There are multiple levels of access relevant here – availability of insurance, affordable premiums, limited cost-sharing, sufficient number of providers and freedom of choice.

Republicans generally define access in terms of insurance coverage, at low premiums. And this election cycle, many of them have professed their support for coverage of pre-existing conditions. But they haven’t said how insurers would do this. However, many believe that the full coverage plans required by the Affordable Care Act overshoot the mark, as they drive premiums up.

Stripped-down plans recently allowed by the Trump administration, under their definition, provide sufficient access and will cost less since they cover less. Unfortunately, someone with a prior history of cancer will be able to purchase one of these, but the actual treatment for a recurrence may well be excluded to make the plans financially viable. Although we have not seen much detail, it is clear that they will offer significantly lower coverage leaving consumers on the hook for many expensive treatments.

Those other than invulnerable millennials would not consider this sufficient access. Even worse, many purchasers of these stripped-down plans may not understand this until it is too late (even though disclosure is required in large print).

To the extent that these low-priced policies attract a healthier population, they also will indirectly drive up premiums for everyone else. People bet against the insurers when they can, choosing more coverage when they are likely to need it and less when they think they will be healthy. This natural incentive, while largely based on self-delusion, leads to policies that financially penalize those who need coverage the most. This was the impetus behind the ACA individual mandate that everyone must buy a policy that meets minimum coverage requirements. Having healthy people in the pool spreads around the costs of covering sick people – including those with pre-existing conditions.

Of course, conservatives have sought to eliminate the mandate and pushed policies that give as many options as possible to consumer. But this fracturing of the insurance market is exactly what created the original dysfunctional situation limiting access to many people with the most need. A narrow definition of “access,” coupled with ideological commitment to completely unfettered markets, even if they fail many potential customers, leads to this dilemma.

Read the full article about the challenges of defining successful healthcare reform by J.B. Silvers at The Conversation.