Repealing the ACA

As a former Medicaid Director for a large eastern state, I would like to make the following recommendations on how to repeal and replace the ACA, ObamaCare, (Yes, Virginia, in a press conference our current President actually said he likes that the ACA is called Obamacare, "I do care." August 2011).

Here are my suggestions for how to succeed.  These and $5 may get up a cup of coffee at Starbucks.

On Medicaid Expansion:

• Discontinue marginal adjusted gross income (MAGI) for eligibility,  This income test requires a look back to confirm the income, and does not consider assets in the calculation,  One could literally have $1M in an trust account that pays all ones bills, but only yields $1000 per month spending change and qualify for Medicaid,
• Do not return to the days of requiring that a person live in a family with children to recieve Medicaid,  Income and assets should be the only determinate of eligibility (Prior to the ACA, single adults and couples without children could not qualify for Medicaid unless aged, blind or disabled).
• Allow tailoring of benefit packages to meet the needs of eligibility groups.

On Insurance purchases:

• Allow purchases across state lines
• Create pools or other mechanisms that guarantee issue for those in good health with preexisting conditions
• Do not reinstate lifetime/annual maximum benefits
• Allow individuals and groups to have more tailored benefit packages (i.e.--really I don't need or want to pay for transgender surgery or abortions) If contraceptives are important to you then buy a rider
• Discontinue high deductible plans unless the individual has the ability to participate in a Flexible Spending Account or Health Saving Account 
• Allow copay health plans again
• Define preexisting conditions by health status not by diagnosis

Just some thoughts.  Know that if the pricing is fair and weird requirements such as no plan can cost more than 4 times the lowest cost plan, more young people would buy in at a reasonable rate. As person with a preexisting condition, married to a person with a preexisting condition...I am anxious to see what comes out, but I understand the need for some ability for costs to reflect the health status of the individual.