Republicans Propose a New Healthcare Vision

 

An ideal healthcare system should take care of sick people. Seems obvious, but sometimes you just have to get back to basics.

Republicans in Congress have reached just that conclusion and have put forth a new congressional resolution to make this point. House Resolution 1089, introduced by Rep. Pete Sessions (R – TX) and Rep. Mark Meadows (R – NC) gives states broad authority to reform their own insurance markets with certain provisions:

  • Pre-existing Conditions – must provide for:
    • Lower premiums
    • Lower out-of-pocket costs
    • Greater accessibility to in-network providers
  • Workers who lose their job due to illness – must have:
    • Have access to individual health insurance similar to their group plan

 

John C. Goodman, healthcare economist writing in Forbes, says the resolution lays out a vision of what state reform should aim for. People who pay premiums to employer plans for many years and then become too sick to work should have access to individual health insurance coverage that is similar to group insurance “in price, quality, and access to care, regardless of any pre-existing condition.”

But that’s not all. The resolution also calls for something that is explicitly outlawed under ObamaCare: a market in which health plans specialize in certain diseases and compete to enroll and solve the problems of patients who have those conditions, such as cancer, diabetes, and heart disease.

Democrats are pushing the false narrative that Republicans can’t govern on healthcare due to their failure to repeal and replace ObamaCare as they promised in the 2016 election. This conveniently dismisses the fact that Democrats failed to support Republican efforts with a single vote.

But more important is the Republican track record on Medicare. Though passed during the Democratic administration of President Johnson, it was Republicans who steered this new healthcare legislation for seniors through Congress. More recently, it was Republicans who created the Medicare Advantage program during the Bush presidency that today insures one out of every three seniors.

Goodman says when it comes to healthcare legislation we have Medicare (created by Republicans) which works, and ObamaCare (created by Democrats) which has been a disaster.

To reform ObamaCare, using principles that work so well for seniors in Medicare Advantage (MA), Goodman says there are three principles needed:

  • Fair Prices for Sellers – In MA, enrollees pay a community rated premium. Medicare tops up those premiums so that health plans receive compensation that reflects the expected cost for each enrollee. That means insurers benefit from taking care of the sick as well as the healthy. ObamaCare is the opposite – it incentivizes insurers to avoid the sick and attract the healthy. The result is most plans exclude the best doctors and hospitals.
  • Fair Prices for Buyers – ObamaCare has allowed group plans to dump their most expensive patients on this market – which drives up the price of premiums for everyone. By ending state risk pools, even more sick patients were dumped on the exchanges. Therefore, it is no surprise that individual premiums have skyrocketed. The solution is re-establishment of risk pools in the states, and a small employer fee to subsidize insurance for workers who lose their job due to illness. The net result will be lower premiums for everyone.
  • No gaming – Today there are about 30 million Americans who don’t have health insurance. But as soon as they get sick they can purchase health insurance at the same premium amount as those who are currently insured. This “gaming” of the system increases the price for everyone. This is not allowed under Medicare – there is a penalty for failure to enroll when you are eligible. By eliminating “gaming” more will be insured and everyone will pay less.

 

What could be more sensible?

As the Mid-term elections approach, many Democrats are claiming that Republicans want to “do away” with protections for Pre-existing Conditions. In reality, they want to improve on the protections that currently exist in ObamaCare – and provide them at a lower cost to everyone.

 

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