Why a Nationwide Non-Profit Public Network Should Be Featured in Any Upcoming ObamaCare Repeal and Replace Plan

We explain why a nationwide non-profit public network should be included in any future health care reform plan that seeks to repeal and replace ObamaCare. We also explain how it could pair with a public option to fix most of the ACA’s sticking points.

Bernie Sanders first introduced his Medicare-for-All bill (the American Health Security Act, S. 1782) to the Senate in 2013. While many still question whether a single-payer healthcare system is right for the US, there are some of the well-written elements of the bill that could work in future “non-single-payer” “mixed-market” healthcare reform plans such as “TrumpCare.”

TIP: Pair these ideas with our An HSA-Eligible Public Option and our Alternatives to the GOP’s Pre-Existing Conditions “Fix.”

The Gist of the Non-Profit Public Network

One of the most potentially useful parts of Bernie’s bill is a nationwide non-profit public network designed to keep public healthcare costs down by replacing the current fee-for-service model with a reimbursement model. NOTE: this model only affects non-profits who take public insurance, it doesn’t influence the private market directly.

Instead of reimbursing a non-profit for care such as a Medicare claim being made to Medicare by a local non-profit provider, the non-profit provider is fully funded to provide patients with public health insurance services as needed. From a provider’s standpoint, the ability to focus on care instead of billing and administrative duties can’t be understated.

TIP: Non-profits can still make a profit. People who work for them can be paid well and get benefits. The corporation itself may not operate “for profit.”

TIP: The term “public network” refers to a public insurer’s ability to network with non-profit providers. In this model, providers could choose a bulk funding reimbursement model rather than fee-for-service. This could be applied only to Medicaid and Medicare, but we go a step further and suggest Medicaid and Medicare and all public insurance could be fused, and all Americans could be given an opportunity to buy into that plan. We then suggest it is this plan that should utilize the public network. This would all exist alongside, and compete with, the private market. It would make sense to structure it like Medicare Part C where private insurers could take on contracts and sell supplemental plans. It should be paired with the ideas on our “fix” page for preexisting conditions. All of these ideas should be cherry-picked in a plan that uses only the most workable ideas.

Pairing A Non-Profit Public Network it With a Public Option

As attractive as this is alone, it could be even more effective if paired with a public option alongside programs like Medicaid/CHIP and Medicare.

We could combine public programs into a “single plan” and then network with “a nationwide non-profit network.” Fusing several programs could create a network of pre-funded non-profit health providers set up to administer care. It would also create a network of public insurances attached which could leverage a sizable group power in the private market as well. In this, it could not only keep administrative costs down but also start curbing public and private insurance costs, drug costs, device costs, etc.

A nationwide non-profit network of healthcare providers could also service things like L&I, Native Health, and Public Employees Benefits building a robust public health risk pool.

By combining public programs into a single “public option” and coordinating with non-profit providers, we could embrace the primary cost curbing aspects of Sanders’ bill without going into a full single-payer system or directly touching private insurers or providers. Some of the current public funding that goes into the private market would be redirected, although even non-profits purchase private products. However, if we had a robust public option for care and coverage, private providers and insurers would face reduced red-tape and could make up the money elsewhere (such as via supplemental insurance).

More Benefits of a Public Network

Additionally, non-profit network related provisions could:

  • Provide billing and records services on behalf of those network providers.
  • Negotiate reimbursement rates from private insurers on behalf of those network providers.
  • Give states the authority to negotiate prescription drug prices for those enrolled.
  • Reduce the administrative barriers for getting medically necessary care within the national public network even across state lines.
  • Include state level funding for expanding access to private non-profit care that everyone can access to address unique public health issues (like lead poisoning) directly.

These things alone would reduce the cost of healthcare for everyone, even for those who are privately insured because they would also have access to the non-profit health network. It would address an issue underlying frustration for many taxpayers: public funds going to for-profit entities and the resulting lack of competition.

By separating the public and private market, we can zero in on non-profit models and increase competition to ensure more affordable care for all, a strong public option, and a market-based system. The non-profit provider network is key to all this.

TIP: A public network works whether or not we combine it with a public option that consolidates all the public insurance types. For example, a non-profit health network could charge sliding scale fee for services for uninsured. However, a public option fixes significant problems such as the preexisting conditions problem. So it is an option worthy of serious consideration, but like most reform ideas, it is only one of many choices.

Conclusion

As someone who works in healthcare in the non-profit sector, I can attest, the bill describes the most efficient and accessible non-profit public healthcare model I have seen.

The reimbursement model would relieve non-profit healthcare providers from administrative duties, allowing them to focus on providing care rather than balancing books and seeking payments for claims.

I strongly suggest applying this idea and more to any future healthcare reform plan that includes public funding for healthcare.

How Does Bernie Sander’s Non-profit Network Work?

The network is created through a unique provider network with an efficient administration and reimbursement model. You can read the details in Title III of Bernie’s bill just keep in mind that this was written as part of a single-payer plan, so the language would need to be adjusted to fit a different reform structure. I summed up the key elements below.

Obligations of Participating Providers or Network Providers:

  • provide care without discrimination
  • not charge additional fees for services other than that which is reimbursed by the public health network
  • must participate in annual quality and improvement assessment at the state level

Reimbursement Options for Network Providers:

Under Bernie’s Model providers can choose to participate in two reimbursement methods.

Fee for Services – Providers can accept an annually negotiated rate schedule for specific services at the state level. This is the way all insurers, both public and private, reimburse now.

Annual Negotiated Budget – Providers can also choose to negotiate an annual budget which is paid in monthly installments. This would likely be an incredibly advantageous and stabilizing for providers, but there would need to be stipulations if you want to participate in this bill’s funding model.

  • must be deemed a Comprehensive Health Service Organization “including at least hospital services and physicians services” as well as services in areas where primary health care is critically low in providers
  • must be either a public or private non-profit provider

It’s not hard to see the value of cutting medical administration costs nationwide, and it would also expand access to primary and critical care. Pairing this with a public option and the non-single-payer plan requires adding billing and records administration for when the Public Non-profit Network providers see patients who are insured by other insurers.

What do you think?

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