tag:blogger.com,1999:blog-8512362.post8451799865942459945..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: What if all the ACA "options" were "public"?Andrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-8512362.post-77262814977200009492016-02-17T05:24:49.691-05:002016-02-17T05:24:49.691-05:00Great suggestion on a buy-in program for Minnesota...Great suggestion on a buy-in program for Minnesota Care. (I have favored a Medicare buy-in for persons over 55 all along. Jeff Goldsmith had an article about this in 2009 in Health Affairs.)<br />We might have to create a Berlin Wall along the Wisconsin border if we did that. Wisconsin premiums on and off the exchange are grotesquely high, due in part to Scott Walker's blowhard opposition to Medicaid expanson. The cheeseheads might want to move to MN just to get into MinnesotaCare.bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-10251823197489968632016-02-16T13:27:56.111-05:002016-02-16T13:27:56.111-05:00I've always wondered why this sort of solution...I've always wondered why this sort of solution hasn't gotten more attention. Probably on cost grounds, but it seems like the more obvious advance on ACA isn't single payer but a move to *merge* Medicaid and the exchanges into a single public product that still allows private payers a la Medicare Advantage. This would move the system towards something like what Nixon proposed, or something close to the German system. <br /><br />I wonder if a state like Hawaii, where the uninsured pool was already quite small, could implement something like this. I'd like to see this done nationally in conjunction with federalizing the entirety of the Medicaid funding stream (and also making a federal fallback for Medicaid administration, as the exchanges currently work). AkshIyehttps://www.blogger.com/profile/12730641500508595371noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-6163807875794410712016-02-16T09:32:49.642-05:002016-02-16T09:32:49.642-05:00Thanks, Bob, and point taken about those over 275%...Thanks, Bob, and point taken about those over 275% FPL not getting a good deal. My point was that there's few people in subsidy range over 275% FPL, so going that high in MinnesotaCare serves about 90% of the ACA target market -- but it would also probably further raise prices for those left in the individual market. What about allowing buy-in to MinnesotaCare at all incomes, e.g. at cost with no subsidies? I know the MN legislature is not going to go there, but on the merits? <br />Andrew Sprunghttps://www.blogger.com/profile/17601269968798865106noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-84098355512613014162016-02-15T21:27:41.525-05:002016-02-15T21:27:41.525-05:00great piece! I have been saying this for months on...great piece! I have been saying this for months on any blog that will have me, namely that the same insurers who avoid the exchanges are eager to participate in public programs....and those public programs have guaranteed issue, no exclusions, and community rating, all the things that insurers hate about the exchanges.<br /><br />Just one objection to your great post.....I live in Minnesota, and taking Minnesota Care to 275% of poverty is fine but no solution to anything. 275% of poverty is about 29,000 of income for a single person. I think it is great to have a low premium, low deductible plan for this group, but this leaves out the entire middle class (in terms of the income it takes to be middle class in the Twin Cities or St Cloud or Duluth. Andrew, you do your best to be even handed but often you praise a program that only captures a slice of the near poor.bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.com