Our health-care system is experiencing rapid, powerful change, far more consequential than is generally recognized. Although these changes are welcomed by many in the health-policy community (see our assessment a year ago), even those who applaud them have been surprised at their speed and impact.
What follows is a brief overview of what the Trump administration has done to reform the health-care system — in some cases, with the compliant help of Congress. The vision behind the Trump reforms can be found in Reforming America’s Healthcare System Through Choice and Competition. This 124-page Health and Human Services document from 2018 argues that the most serious problems in health care arise because of government failure, not market failure.
In pursuing its vision, the administration has aggressively pursued its options under current law. We now need Congress to make the revolution complete.
Virtual Medicine. The ability to deliver medical care remotely is growing by leaps and bounds. It promises to lower medical costs, increase quality, and reduce the time and travel cost of patient care. For example, most people in hospital emergency rooms don’t really need to be there. With a phone or a computer and an app or two, many of them could be examined and triaged in their own homes.
The benefits of telehealth have been known for a long time. Yet as we entered 2020, it was illegal (by act of Congress) for Medicare doctors to consult with their patients by phone or email, except in rare circumstances. Even non-Medicare patients were constrained. For example, it wasn’t clear if visual communication by Zoom or FaceTime satisfied the federal government’s privacy regulations. While some state governments were clearing away barriers, progress was incremental and uneven.
Two things made radical change possible: COVID-19 and the Trump administration. Sweeping away the regulatory barriers to telehealth was not a simple act. There are roughly 7,500 procedures that Medicare pays doctors to do. The Centers for Medicare & Medicaid Services (CMS) had to sort through those and determine which were candidates for virtual medicine and which were not. There were also the questions of whether a virtual visit would pay doctors the same as an office visit, and whether an audio visit would pay the same as an audio/visual visit.
Fortunately, CMS had already been sorting through those problems in the first three years of the Trump administration, for example allowing Medicare patients to use telehealth to determine if an office visit was necessary and allowing patients to send medical pictures to their physicians electronically. CMS also allowed great leeway for telehealth in the Medicare Advantage program. So when COVID struck, the administration was ready. Congress was only too willing to let the administration do what it had wanted to do all along. State governments also got on board, not only loosening prior restrictions but also, in many cases, allowing doctors to practice across state lines.
The take-up by doctors and patients has been nothing short of breathtaking. According to
If you take medication regularly for a chronic condition, she added, make sure the plan’s prescription benefit covers it.
If your employer offers multiple plan choices, Ms. Watts of Mercer said, you should take the time to compare the total cost of coverage for each option — don’t just look at the premiums. She advises taking the total premium and subtracting any contributions made by your employer, such as to a health savings account, to compare the cost of different plans.
“Do the math,” she said.
To see your total potential financial exposure, add the plan deductible. If you are generally healthy and don’t take regular medication, a plan with a higher deductible may save you money. If you can’t afford unexpected costs, a lower deductible — typically with a higher premium — may be the best option. The average deductible for an individual is $1,644, Kaiser found.
Theresa Adams, senior knowledge adviser at the Society for Human Resource Management, said many workers didn’t take enough time to evaluate benefits. She encouraged them to make use of online tools offered by their employers to help choose options and to reach out with questions.
How much can I contribute to a health savings account in 2021?
Contribution limits ticked up for next year, the Internal Revenue Service announced. The maximum contribution is $3,600 for an individual and $7,200 for family coverage. (People 55 and older can save an extra $1,000.) H.S.A.s, however, are available only with specific types of health plans with high deductibles — at least $1,400 for individual coverage and $2,800 for family coverage for 2021. Typically, your employer will specify if a plan is H.S.A. qualified.
Some plans have a different option, called a health care flexible spending account. You can contribute to it before taxes, via paycheck withdrawals, to pay for care and products that your health plan doesn’t cover. Contribution limits are lower than with an H.S.A., and if you change jobs, your flexible spending account doesn’t go with you, as an H.S.A. does.
When is open enrollment for the Affordable Care Act marketplace?
According to Healthcare.gov, open enrollment for coverage starting on Jan. 1 runs from Nov. 1 through Dec. 15. Open enrollment for state-run marketplaces may vary.
The legal challenge before the Supreme Court isn’t expected to affect this year’s open enrollment, as the court’s decision would probably come before next summer.