Medisave Accounts in Singapore | Health Policy Blog |

If the United States adopted a similar approach to public policy, there would be no deficit problem in this country.

How the system works. In Singapore, people are required to save for health care, retirement income and other needs. They can use their forced saving to purchase a home, pay education expenses, and purchase life insurance and disability insurance. For individuals up to age 50, the required saving rate is 36% of income (nominally divided: 20% from the employee and 16% from the employer). Of this amount, 7 percentage points is for health care and is deposited in a separate Medisave account. Individuals are also automatically enrolled in catastrophic health insurance with a deductible of about US $1,172, although they can opt out. When a Medisave account balance reaches about US $34,100 (an amount equal to a little less than half of the median family income) any excess funds are rolled over into another account and may be used for non-health care purposes.


In 1984, Richard Rahn and I wrote an editorial in The Wall Street Journal in which we proposed a savings account for health care. We called it a Medical IRA.

Source: Medisave Accounts in Singapore | Health Policy Blog |

Components of Optimal Health Insurance: # 3 – Uninterrupted Ownership | Robert Nelson, MD | LinkedIn


Robert Nelson, MD

Installment #3 of Components of Optimal Health Insurance will discuss how regulatory and tax policy has contributed to the health care insurance crisis by promoting “job-lock”.  Tax laws and insurance regulatory policy need to change in order to affect real health insurance reform. 

via Components of Optimal Health Insurance: # 3 – Uninterrupted Ownership | Robert Nelson, MD | LinkedIn.

How Direct Primary Care Is Serving as a Health Care Solution

5901759_9cfaa50cf7_oOn Sept. 9, Colbeck and Sen. Mike Nofs, R-Battle Creek, introduced Senate Bill 1033, which clarifies the Michigan Insurance Code by clearly stating that, in Michigan, this arrangement is not health insurance and these practices are exempt from insurance regulations.

The legislation has cleared two committee votes and now awaits a third reading in the state Senate.In addition, the Michigan Senate Health Policy Committee passed Senate Concurrent Resolution 23, which goes to the floor of the state Senate for a vote. This resolution asks the federal government to implement the four federal reform recommendations on Direct Primary Care cited in the Heritage Backgrounder.

via How Direct Primary Care Is Serving as a Health Care Solution. |Examining Private Exchanges in the Employer-Sponsored Insurance Market

Prepared by:
Alex Alvarado, Matthew Rae, Gary Claxton, and Larry Levitt
Kaiser Family Foundation

Separate from the ACA, so-called “private exchanges” have also started to emerge as an option for employers
providing coverage to their workers. These private exchanges do not provide access to premium subsidies like
the public exchanges, nor do they necessarily involve standardized coverage tiers. But, they do have the
potential to reshape the employer-sponsored health insurance, which covers 149 million people, or nearly 56%
of the U.S. non-elderly population. We conducted interviews with more than fifteen private health insurance
enrollment platforms, as well as several employers and health plans moving in this direction, to create a picture
of this quickly growing landscape. We identified ten of the platforms we interviewed as full private exchanges
(based on the definition described in the next section) and have profiled those in the appendix.

Many approaches are sold as “private
exchanges” since the concept is now in
vogue. In profiling these efforts, we have
sought to define what differentiates the
new, more competitive approaches
analogous to the ACA’s public exchanges
from the traditional technology platforms
that simply provide online enrollment.
Also, what we describe here as private
exchanges are targeted at employers,
which eliminates many of the “e-brokers”
selling directly to the individual market.
Characteristics that exemplify a private
exchange include:

HSAs vs. HRAs: Which is Better? | Health Policy Blog |

I had a conference call this week with the commissioners of a county who are considering adopting Health Savings Accounts for their employees. They said their current broker has been discouraging them from doing so in favor of a Health Reimbursement Accounts instead. They wanted to pick the brain of someone who has no axe to grind.

I told them that HRAs are fine, but not as effective as HSAs in most situations. I explained that the American Academy of Actuaries AAA has long held that the economizing behaviors depend largely on to what extent employees view the money as their own. HSA funds clearly belong to the employee and to no one else. HRA funds are always the employer’s money and may be spent solely on services that are covered by the employer’s health plan.

via HSAs vs. HRAs: Which is Better? | Health Policy Blog |

Let’s Add Some Cash to the Copper and Other Plans | Health Policy Blog |

However, as long as the federal government is subsidizing insurers billions of dollars in these exchanges, it should offer some of the money for beneficiaries’ direct use, via deposits in Health Savings Accounts, Health Reimbursement Arrangements or Flexible Spending Arrangements, instead of handing it over to insurers.States have improved Medicaid with innovations such as Health Opportunity Accounts HOAs, which allow Medicaid dependents to control some Medicaid money directly. Disabled Medicaid beneficiaries have benefited tremendously from “cash and counseling,” which gives them money to hire home-health aides directly, instead of passively accepting whomever the county bureaucracy sends over.Obamacare beneficiaries should have the same power as these Medicaid beneficiaries. By all means, let’s have a copper plan, but let’s give some Obamacare cash to people, not just insurers.

via Let’s Add Some Cash to the Copper and Other Plans | Health Policy Blog |

The Inevitable Shift to Defined Contribution | The Institute for HealthCare Consumerism

Frank B. Mengert, Partner and Director of Private Exchange Technology, ebenefit Marketplace

The health care industry has been through the biggest change in history, with an impact some say is even greater than ERISA, Medicare and Medicaid. The current trends in the business and regulatory environment are leading to more creative ways to continue offering employee benefits. One of those methods has taken the industry by storm with the reinvention of the defined contribution plan.

This can be done in a variety of ways depending on how crafty the employer wants to get in their delivery. In most instances, defined contribution is being brought on with the implementation of a private exchange. This allows an employer to provide a comprehensive suite of products including several medical plan choices, CDHP options, life, disability, voluntary and non-traditional offerings like pet insurance, identity theft and more.

The Inevitable Shift to Defined Contribution | The Institute for HealthCare Consumerism.