The Big Fix

The Big Fix – Three Steps to Health Care Reform

-by Bobb Joseph


Executive Summary

Many today think that the USA needs comprehensive health care reform, but that Obamacare (The Patient Protection and Affordable Care Act) is the wrong solution. That there are more effective ways to reach the goals of lowering the cost of healthcare and health insurance, protecting consumers, and covering the uninsured. To that end, here is a blueprint for reform that seeks to build on some of the best ideas put forward (e.g., The Patients’ Choice Act, The Protecting Access to Healthcare [PATH] Act, et al.), using public‑private partnerships and state-based solutions with a federal framework.


First, we need to establish a federal framework, or foundation. Rather than a comprehensive national reshaping of health insurance and the health care industry, we need to set some fundamental, basic national guidelines as a framework for health care reform. The components of a new federal law – or federal framework around state-based reform (as was done for Small Group Reform in 1992 – e.g., California) would include the following:

-minimum benefits (exceptions: school plans, Basic Coverage [e.g., Idaho HRP], faith-based coverage, short-term plans)

-guaranteed-issue and portability provisions

-no cancellation without third‑party review

-rate bands

-federal tax credit

-facilitate establishment of Health Innovator (HI) reward program for up to $1 million to individuals or groups who provide creative solutions around lower cost, increased transparency, and consumer engagement; examples:

-“Groupon” concept by insurers

-bottom-up “eBay” solutions for provider/illness shopping

-consumer data-chip option for health history

-multiple ease-of-shopping portals – e.g., kiosks/terminals in hospitals, doctors’ offices, malls/shopping centers, financial institutions, airports, etc. (both Medicaid and traditional insurance)

-financial or tax credits for wellness, smoking cessation, weight-loss, etc.

-pursue out-of-state insurance shopping

-fully-funded shopping exchanges/coops

-promote insurer startups – with full bonding/funding


Second, using states as what some have referred to as the “laboratories of democracy,” facilitate and support state-based solutions around health care reform. Since each state is unique, with its own needs and issues, allow states to put forward best solutions to meet their health care coverage needs. The state insurance commissioner would submit a roadmap or blueprint for reform, along with a request for a block grant for up to $1 billion, funded by a public-private partnership, to fully cover its population. Some components of such a proposal might include:

-“All Covered” requirement – everyone must provide proof of insurance or bonding

-Medicaid to cover 100% of the Federal Poverty Level (FPL)

– Basic Coverage plans [e.g., Idaho HRP]) for the working poor above FPL

-state tax credit

-tort reform

-mandate reform (strip out state mandates and allow carriers to offer them under optional provisions)

-participate in federal Health Innovator (HI) reward program.

Finally, establish a Health Reform Commission to provide ongoing review and recommendations. This would be made up of the federal government agency Health and Human Services (HHS), the National Association of Insurance Commissioners (NAIC), industry trade groups such as the Association of Health Insurance Plans (AHIP) and the National Association of Health Underwriters (NAHU), and other professional and industry leaders. The Commission would meet annually to review state and federal status, and recommend changes and best practices for continued innovation. And as states develop successful models for health insurance reform, best practices would emerge, which could then be shared nationally for adoption.



The essential components of comprehensive, strategic health care reform are fundamentally simple, while the implementation relies on the political will to come together with bipartisan consensus sans inveigle on a national level to provide a federal foundational framework for reform. This would be followed by state‑level reform, guided by national modeling, funded by block grants, and executed locally. Finally, as best‑practice solutions emerge, states would share these and provide continuous improvement to lower the cost of care and insurance and cover the uninsured.



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