Innovation usually counters change and nothing happens in a vacuum unless you are the only provider in town. What’s next could rival the change from cost-based insurance to Federal DRG’s in the early 1980’s.

The Affordable Care Act has been in place long enough to prove what works well and what needs to be strengthened. Giving consumers a plan based on “one size fits all” has driven up costs and is a fundamental flaw.

It has made affordable health care virtually out-of-reach for many, including self-employed individuals and small business employers. The ACA also provided subsidies to make individual coverage affordable for those who do not have employer insurance.

Many of these people are younger adults who generally do not need comprehensive health care coverage as older adults do, but the ACA forces them to take it.

ACA exchange plans vary from state to state, and many states only offer one or a few insurance plans. Fixing this means recognizing the ACA failed to deliver on its pledge to lower health care costs and allow consumers to “keep their doctor”.

The ACA subsidies were sent to the insurance companies with the expectation they would be applied to individual policies, but this was not done uniformly. Also, the subsidies grew each year and widespread fraud occurred.

Payment of any subsidy should go directly to the individual with the proviso he would use it to open a Health Savings Account. This would eliminate fraud and give the individual more control of his own health care.

No, this is not an attempt to re-litigate SCOTUS’ decision that the ACA is a tax even though the Solicitor General argued that the ACA was not a tax. No, unless the ACA is repealed, every adult must have some insurance via his employer or one of the exchanges.

Will an ACA reset include a wellness component consistent with a free market model? Will we have a marketplace of many different plans designed to meet differing needs of each demographic?

Removing restrictions on state exchanges and opening the exchanges across state lines is a must. This will stimulate more competition and create innovation.

All options should be on the table provided they satisfy four absolutes:

1) Changes to the ACA should include free market solutions that give the consumer more choice for insurance at a lower cost

2) Hospital providers must get paid for treating illness and disease

3) The ACA modifications should reward hospital providers who cure and prevent disease

4) The ACA modifications should incentivize and reward consumer wellness

Sharing risk with select third party payers is one way to earn more reimbursement and improve patient outcomes, but this primarily manages disease more effectively rather than curing or preventing it.

You have the data – so do the payers. We know there are health differences among age demographics and within each age demographic. Also, we know all of us are unique and do not age the same way.

Researchers have isolated the aging molecule and tested it in rats. Anti-aging integrative MDs have discovered protocols and specific foods that extend telomeres, our DNA strands.

Biological age testing is now a reality, plus there is a renewed interest in physical, medical, and spiritual wellness.

Is it a good idea to measure wellness individually and adjust insurance premiums?

This is an underwriting function, but it also is an important step towards preventing disease, something former CEO Michael Dowling calls “Upstream Medicine”.

Are we ready for this kind of change?

Whether the near future involves a tweaking of the ACA or a data-driven, free market solution with many plans and a wellness component, we can do better than the original ACA model.