Health Insurance (It’s Complicated): Lessons from the World on Healthcare


Guest Blog by Dave Dillon, FSA, MAAA

Since the 2016 election of President Trump, the debate about the Affordable Care Act (ACA) has intensified. There have been multiple legislative attempts to significantly modify or replace the approaches the ACA takes to address the healthcare needs of Americans. Even though legislative attempts have failed, the Trump Administration has enacted multiple executive rules that impact the ACA markets.

One example of this is the rule released on August 1st which would expand the use of short-term health plans as an alternative to ACA plans. Short-term plans – which are designed solely to provide temporary heath care insurance during unexpected gaps in coverage – are not required to meet most ACA standards—such as covering the ACA’s essential health benefits like maternity services, prescription drugs and mental health care. Short-term plans can often deny coverage or charge much higher prices to people with pre-existing conditions.

Another example was the rule published by the Labor Department in June, which modified the term “employer” to make it easier for small businesses to band together as “associations” to buy health insurance and is expected to increase enrollment in association health plans (AHPs). Under the new rules, these associations could sell coverage to small businesses and self-employed individuals without meeting key ACA standards. These include requirements to cover essential health benefits, prohibitions against charging higher premiums based on factors such as gender or occupation, and limits on charging higher premiums for older people.

Another key setback to proponents of the ACA was the Tax Cuts and Jobs Act of 2017. This tax bill repealed the enforcement of the penalty associated with the ACA’s individual mandate. Without a penalty associated with the mandate to purchase health coverage, it is expected that fewer healthy people will sign up for coverage. The Congressional Budget Office (CBO) estimated this would cause premiums in the individual market to rise by 10 percent and would decrease the number of people with health insurance coverage by 13 million.

With the U.S. midterm elections coming up in November, the healthcare reform discussion will only become more heated. Many Republicans are pushing for more changes to the ACA or even a full repeal. While some Democrats desire a re-establishment of the ACA, there are also some Democrats pushing for significant changes to the US healthcare system to create a form of “universal coverage.”

In the US, the term “universal coverage” can mean different things depending on a person’s point of view. Proponents may consider it to imply “universal access” to consumers while opponents may consider it to imply “socialized medicine”, which is basically the provision of medical and hospital care for all by means of public (taxpayer) funds.

What we do know is that there aren’t any other healthcare systems in the world like that of the U.S. Most Americans don’t realize that the ACA only covers about 10% of U.S. citizens. In actuality, the U.S. system covers its citizens through a combination of multiple international approaches to healthcare. Most Americans also don’t realize the full spectrum of international approaches to healthcare.

Join me as I present an ACTEX eLearning webinar, A World Apart: International Health Insurance Markets - Lessons from Around the World, on October 4th. As politicians and policyholders attempt to address the many challenges facing the U.S. healthcare system, this webinar will explain how we arrived at our current situation to provide you with a better understanding about the problems that remain to be solved.

Then, we will look at a detailed comparative analysis of the wide range of international approaches to healthcare. This analysis will allow attendees to assess what alternative approaches have—and have not—worked, and will also focus on the positive and negative consequences associated with the trade-offs made to address some of the challenges faced by other countries. We will finish with a discussion of what elements from international approaches could be used to improve the U.S. system.

Dave Dillon, FSA, MAAA

Dave joined Lewis & Ellis in 1999, specializing in health insurance and healthcare analysis. Dave currently focuses on product development, financial solvency and healthcare reform issues. Since the passage of the Affordable Care Act, Dave has assisted 15 states with health care reform issues. He currently serves nine states as their rate reviewer.

Dave is significantly involved in the affairs of his profession and the health insurance industry through his volunteer efforts. From 2015 to 2016, Dave served on the Society of Actuaries’ Health Section Council where he was Chair of the Council’s Strategic Initiatives committee. Since the beginning of 2017, Dave has led the SOA’s 2017 Strategic Initiative “Commercial Healthcare: What’s Next?”

In 2017, Dave was a recipient of the Society of Actuaries’ Outstanding Volunteer Award. Additionally, he was awarded Outstanding Session Awards for both the 2017 SOA Health and Annual Meetings.

Dave is also the Chair and Host for the SOA’s Health Section Podcast series.

You can find him on social media:

Twitter: LE_DaveDillon