Comment by Don McCanne
Dhruv Khullar has provided us with an important policy lesson. He seems to be amongst
those who believe that we should accept Obamacare (ACA) as a given and build on it through incremental reform. Amongst the multitude of problems with ACA, he has selected as an example the issue of churning in and out of Medicaid and the private ACA exchange plans. What does he
propose?
those who believe that we should accept Obamacare (ACA) as a given and build on it through incremental reform. Amongst the multitude of problems with ACA, he has selected as an example the issue of churning in and out of Medicaid and the private ACA exchange plans. What does he
propose?
He suggests reducing churning by offering twelve-month eligibility for Medicaid, and he suggests aligning benefits and provider networks between Medicaid managed care and private ACA exchange plans - a proposal with obvious profound administrative complexity. Further, when these anti-hurning measures are implemented, he concedes that “the patchwork of health care in the United States may make some amount of churning unavoidable.”
This is the policy lesson. Our fragmented, dysfunctional financing infrastructure is so highly flawed that patches to it will have very little impact in moving us closer to the ideal of a quality health care
system that serves all of us well. In contrast, the patches themselves lead to further administrative waste with associated higher costs.
The obvious answer to churning is to have a single, well-designed Medicare for all program in which individuals are enrolled for life. That would also take care of most of the multitude of other health care financing problems that Dhruv Khullar nor I could address here.
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