The one thing we can say for certain is this plan will cost more than the Affordable Care Act.(ACA)  Wait didn’t we say that Government support would be based on Medicaid  and the subsidies current on the ACA .  Why should it cost more?  Simply because it covers more people.  Even under the supposedly universal ACA, millions remain uncovered.  Our plan covers everyone.  No ifs, and or buts about it.  However, this should be cheaper than covering everyone under the ACA if it could ever get there.   Helping offset the increased cost would be lower overhead and insurance costs.  Expansion of the IRS, of course will cost more, mainly for its computing capacity to process the additional filings and routing Medicaid or subsidies to the eligible recipient’s  PBA.  Nothing new here.  The IRS has been making refund and EITC  direct deposits for a long time.  Just greater volume.  The Government should already be compiling costs of Medicaid and subsides by age and income.  If not they need to start  All that is needed is to integrate these into the IRS’s disbursement program and year to year adjustment of the disbursement levels for healthcare inflation.

An agency or quasi bank would be set up to administer the first $10,000 in each PBA.  This huge sum would be used to subsidize state-run high risk pools for those with pre-existing conditions, provide overdraft protection for medical charges and smooth the transition from employer-provided plans to the PBAs.  Possibly the agency would provide a 100% subsidy to the lowest cost state. 95% for those within 5% of the lowest state and so on. This would encourage reasonable costs and uniformity as states emulate the lowest cost state.  The coverage in any case should equal the care of normally covered patients. Given most employer plans already have a favorable health balance they should be able to move as groups to individual policies. Still, there might be some situations that may need a little “grease” from the agency to smooth the way.  Medicaid as a state-federal partnership, would have to be negotiated over who pays what and how or if to use the high risk pools for Medicaid preexisting conditions. Again the financing agency should stand ready to smooth the way. In any case this needs done in such a way to that these conditions cease to exist in the future just as they will in all other cases.  The high risk pools may grow in the first couple years as previously undiagnosed illnesses are uncovered with expanded access.

As we have said, our plan by providing universal coverage will be more expensive. Offsetting these costs, no exchanges, no promotion expenses and no expanded bureaucracies.  Just some public service announcements informing people that they are required to file their income tax form. Time will work in the government’s favor.  As those with preexisting  move on to Medicare or sadly pass on, the pools and their costs will disappear. Workers will have had more years to bank savings to create ever greater stability in the system..  Innovation and competition will have had a chance to take hold.  All this should mitigate future costs.

If nothing else everything would be simpler.  Mistakes could be simply be corrected by adjusting future payments.   People not filing?  No healthcare credit card.  Everyone would have a great incentive correctly file their tax return.