High-Value Health Plans May be the Future of the Affordable Care Act

A pair of researchers recently created a proposed new healthcare law to replace the Affordable Care Act (ACA) that may win bipartisan support, something that Republican lawmakers have failed to do thus far.

This high-value health plan framework was published by JAMA Internal Medicine, and has also appeared in a US House bill that was introduced in the last Congress.

The ACA repeal is a big topic of conversation among government officials, lawmakers, advocacy groups, and individuals, as well. While Republicans are pushing for a swift repeal and replacement, various factors may prevent this from becoming a reality.

Currently, lawmakers have yet to announce a new plan, but continue to push forward with repealing the law. Creating a law that wins bipartisan support has proven difficult, but the study authors believe that high-value health plans may be the key to a successful health law.

The proposed health law includes input from certain aspects of high-deductible health plans joined with health savings accounts, with exemptions that improve the coverage of clinical services that benefit patients.

Currently, high-deductible plans must cover preventive services without cost-sharing, but the ACA does not remove cost sharing for chronic disease management services. Due to this factor, patients with chronic diseases are responsible for paying for physician’s visits, tests, prescriptions, and other services, until they meet their deductible, according to the study.

Unfortunately, many of these services prevent disease progression, and can lower total healthcare spending, but some individuals may not be able to afford the out-of-pocket costs.

Approximately 40% of Americans are enrolled in high-deductible insurance plans that require thousands of dollars in out-of-pocket costs before their benefits are implemented, which has been named as a major issue with health insurance.

Republican lawmakers have voiced support for health laws that increase the use of health savings accounts, but these accounts have been criticized by Democrats as being most useful for those with high incomes, according to the study.

The new High Value Health Plan proposes a change in tax code that will allow health insurance companies more flexibility when it comes to designing high-deductible plans.

"Allowing health plans the flexibility to voluntarily cover more services outside the deductible would enhance consumer choice," said researcher Mark Fendrick, MD.

This may also lead to increased competition between insurance plans, which would result in lower prices.

Although a high value plan would require a bump in monthly premiums compared with high-deductible plans, these costs would still be lower than traditional health plans.

"The next generation health plan should be affordable, cover essential health care, and better engage consumers in their health care decisions,” Dr Fenrick concluded.