5 Winners! Physicians' Best Ideas to Replace the ACA

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May 15, 2017

In This Article

Winners of the ACA Repeal-and-Replace Contest

Here are the five winning entries of the ACA Repeal-and-Replace contest.

Ron Ron Cheng, MD, Neurosurgeon
Charleston, South Carolina

Ron Ron Cheng, MD

Ron Ron Cheng earned his MD from the University of Mississippi School of Medicine before entering residency in neurologic surgery. He is currently a PGY-5 resident in the Department of Neurosurgery at the Medical University of South Carolina in Charleston, South Carolina. Highlights of Dr Cheng's plan include:

  • Pricing transparency

  • Different forms of coverage for different types of healthcare

  • Health savings account programs with fewer restrictions

  • Primary care coverage, specialist care/surgical procedures coverage, and emergency/catastrophe coverage

Dr Cheng's Plan:

Healthcare pricing transparency and preservice cost quotes:

In almost every other industry, there is either clear pricing or estimates itemizing charges to expect. This allows patients to choose and prioritize providers and services depending on personal preference, affordability, and expected quality of care. Eliminate different pricing models depending on insurance carrier vs self-pay. Maybe a sliding scale would be appropriate depending on ability to pay, but this would have to be up to individual institutions or at most a state-by-state regulation.

Ease regulations regarding (or eliminate entirely) in-network/out-of-network providers for private insurance carriers. This will give patients more choice in a "free market" healthcare landscape.

Stratification of different types of healthcare and allocation of funding from various sources depending on the specific program:

A primary care visit to check vital signs and basic lab work costs much less than a 2-week hospital stay for subarachnoid hemorrhage from a ruptured aneurysm. Instead of separating out coverage by patient demographics (eg, children vs elderly vs individuals in poverty), we should focus on having different forms of coverage for different types of healthcare.

My suggestion would be to have primary care coverage, specialist care/surgical procedures coverage, and emergency/catastrophe coverage. Expansion of Medicare to cover primary/preventive care services for all adults and similar changes to Medicaid for wellness visits for children.

Make primary care services available to everyone, regardless of ability to pay. Perhaps instead of a "deductible," there can be a charge for overuse of services (eg, pay out of pocket/with supplemental insurance after the fourth visit in 1 year). No mandate needed because everyone has bare minimum coverage.

Private insurance with public option for specialist care, surgical procedures, and/or emergency care. There should be a public option for those who don't have coverage otherwise or prefer this option due to competitiveness of pricing or plan coverage. Public option should be managed by states with federal oversight/assistance.

State- and federal-supported medical expenses loan programs to help cover costs for catastrophic events (emergency surgery, prolonged intensive care unit [ICU] stays, etc.):

This would need to be managed by the government, as this is likely a risky investment for private lenders.

Accessible health savings account programs with fewer restrictions, ability to save for short- and long-term care:

You should be able to have a tax-beneficial savings plan to pay for both anticipated and unexpected expenses. This should roll over from year to year, have high limits, and have minimal administrative fees.

With transparent pricing, people can even save ahead for tests or procedures they know they will have to have.

We need to have resources to better educate and support end-of-life and palliative care patients and families and to give them alternatives to costly ICU care, which may or may not be helpful. Pricing transparency can help with this too.

Policy changes to increase number of qualified nurse practitioners and physician assistants to be able to see primary care patients.

Changing incentive programs and loan pay-back programs to increase number of primary care physicians.

Leverage technology, such as email and telemedicine, to allow more physicians to see more patients with limited time.

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