Health insurance is currently structured in a manner that discourages utilization, while premiums, deductibles, and copays continue to rise, making healthcare increasingly inaccessible, even for those with insurance coverage. Additionally, prior to meeting an individual’s yearly deductible, they are required to pay pre-negotiated insurance rates for services and medications—often two to three times higher than the corresponding cash price.
The affordability metrics used to determine whether an employer offers reasonably priced health insurance fail to account for yearly deductibles. This omission exacerbates the problem, as it disqualifies many individuals from eligibility for government-subsidized healthcare tax credits. Consequently, people are left with the difficult choice of either paying unrealistic premiums and deductibles while still covering 100% of their healthcare expenses or forgoing insurance altogether and paying for services out of pocket.
To address these challenges, I propose the following reforms:
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Reduce the caps on yearly deductibles to ensure affordability.
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Cap insurance premiums according to service tiers (bronze, silver, gold) and impose penalties on insurers that raise rates to exploit government tax credits.
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Require insurers to accept cash price receipts for qualifying services and medications, and apply these costs toward meeting the yearly deductible.
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Revise healthcare tax credit laws to factor in yearly deductible amounts when determining the affordability of employer-sponsored health insurance.
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Mandate that healthcare providers and pharmacies offer significantly reduced cash prices without requiring discount cards or additional stipulations.
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Reform hospital pricing practices and impose penalties on hospitals that exploit government funded Healthcare.
These changes would ensure that healthcare is both more affordable and accessible for individuals, particularly those who are currently burdened by the rising costs of insurance and out-of-pocket expenses.