Access to affordable healthcare is a critical need in our society. Health issues represent more than a simple cost, but a risk: at any moment, anyone can face insurmountable expense, regardless of their lifestyle or level of income. Healthcare insurance provides necessary stability to the American household.
More-Affordable Employee Healthcare Benefits
The ACA requires applicable large employers (ALEs) to provide essential health insurance covering full-time employees and their dependent children for 60% of standard medical expenses for less than 9.69% of the employee's household income. This leaves spouses, employees of non-ALEs and their families, and part-time workers without coverage. Low-income employees may still pay a large proportion of their income to healthcare costs.
We must amend the Affordable Care Act to cover more employees and their families at a cost they can afford, and to fit their maximum out-of-pocket costs within their means. Large employers can scale their employee costs by income across a wide spread. A partial subsidy for part-time employees and small businesses will protect those entities while ensuring healthcare for their employees.
To accomplish this, the ACA should specify that the total of premiums plus medical expense cannot exceed a certain percentage of an employee's paycheck. Lower-wage employees must be based on higher-tier plans—Silver instead of Bronze—at discounted premium prices, and with adjusted out-of-pocket maximums.
A Public Healthcare Option to Cover All Americans
We need a Federal public healthcare option to cover all Americans who cannot access affordable care. The public option should be a Federally-administrated health insurance program, providing ACA Bronze-level coverage with a tax-funded premium. Higher coverage must be available with an out-of-pocket premium, and baseline coverage should increase with lower incomes. Like other Americans, Congress will receive ACA Bronze unless they buy up.
The public healthcare option must represent the most-efficient insurance in the market. To accomplish this, we should use the lowest 2.5% of remittance rates between each provider and private insurer in a well-regulated private insurance market as our cost benchmark. This automatically places the Federal health insurance plan among those with the lowest cost per claim, for each individual claim.
Healthcare Price Transparency
Insurers generally negotiate down from the advertised healthcare prices at each provider, which are legally-required to be non-discriminatory. With the public option based on the lowest negotiated rates, we can publish a standard of actual care costs at first-tier providers in an area. This provides the public—and insurers—with a fair-market price for each service and a list of providers charging near that price to insurers, regardless of their advertised prices.
Greater price transparency will put pressure on negotiated rates, lowering the costs to all insurers and passed to consumers. This downward pressure will also further pressing healthcare prices toward costs, encouraging providers to seek competitive suppliers to lower their own prices—a counterweight against consumers effectively purchasing healthcare before seeing the price.
Better Addiction Treatment
Maryland needs stronger addiction management programs, including needle exchange programs (NEPs) and research into safe and effective anti-addiction drugs. Addiction management is about more than just getting people off drugs: NEPs prevent injury and the spread of disease among people as they struggle to come to terms with, battle, and ultimately escape their addictions. We cannot expect people to escape this debilitating condition without stumbling, and so we must help them every step along the way of treatment.
Expansion of Generic Drug Availability
Today, researching a new drug in a way that avoids putting Americans at risk costs over $300 million. This price tag precludes any chance of cost recouperation for FDA approval of generic drugs available in other countries.
We can't offer Americans access to the best medicines in the world if profitability prohibits making new, low-cost generic drugs available for prescription by medical professionals. To offer greater healthcare and lower costs, we must provide an FDA program to fast-track research on drugs used safely in other countries, and to provide grants covering the cost of research necessary for basic FDA approval.