John Jacobi over at HealthLawProfBlog is going over some interesting future implementation challenges with PPACA. One of the reforms that he sees as a critical piece of the puzzle is the expansion of Basic health plans:
First, and most obviously, states and advocates should be examining the Basic Plan Program, which will finally be ready for roll-out in 2015. The Program, authorized by § 1331 of the ACA, is a public health insurance program intended to bridge the gap between Medicaid and subsidized private insurance for people with income between 138% and 200% of FPL. It could serve two purposes: It could reduce “churn” between Medicaid and private insurance as insureds’ income fluctuates in the low range, therefore minimizing disruption in ongoing access to providers. It could also improve the affordability of coverage by allowing states to piggy-back on their Medicaid provider networks and premium structure, allowing Program participants rich coverage with little or no out-of-pocket cost. There are downsides: the Program would reduce the exchange’s pool, perhaps increasing per-enrollee costs and threatening actuarial destabilization of the individual plan market; and Medicaid provider networks are already fragile in many states. But faced with the risk of cost-based attrition and/or low service utilization by low-income exchange enrollees, states will want to consider this option.
From a mechanical point of view, Basic plans have significantly more flexibilty than Medicaid in benefit design and implementation choices, and providers may be more willing than the professor thinks to join the Basic networks.