I've been pretty critical on this forum of the House and Senate health plans, but I've not offered my own so I thought I would checklist some things that I would like to see and why. First though, I think the GOP needs to abandon two ideas: 1. The health bill can’t be a tax cutting bill. Republicans want to get rid of a lot of the Obamacare tax increases, and it’s true that many of them were pretty poorly thought out, but we’re not going back in time to 2009, we’re stuck with the conditions that Obamacare left in the health care market and the expectations that people have from their healthcare plans. The taxes can be rejiggered any way you want, but it should remain revenue neutral. 2. The Medicaid cuts can’t be part of the bill. I get what the House and Senate are trying to do, and I have to raise a glass to their under cover of darkness attempt to do something about one leg of our multi legged stool of entitlements that are crushing our long term budgetary outlook. I’ve seen barely a mention in the media (too busy chasing Russian ghosts I guess) of the fact that the Republicans are trying to remove Medicaid as an entitlement program by limiting its federal contribution, pushing ever greater costs, as well as the freedom to design their own programs, to the states. But that has sabotaged doing anything else with healthcare. If that’s something that can be put down in a reconciliation bill then it’s something the Democrats can easily change the next time they’re in power, so why waste political capital on a plan that can (and will) be totally reversed with 51 Democratic votes? The Actual Plan: A. Tax Credits available for purchasers of independent health insurance plans that are actually equivalent as a consumer to the employer health plans being covered by private companies. And that would be pricey, something along the lines of a $5000.00 tax credit for individuals and $10,000.00 for families. This would come close to paying about two thirds of the premium cost of the average group plan. B. But wait you ask, that doesn’t do anything about medical inflation, that encourages people to seek out the most expensive plans they can afford with their tax credit. Not so fast… Any leftover amount from their tax credit would be rolled into a Health Savings Account (HSA). So say you find a family plan that only costs $8,000.00 per year, and then $2,000.00, the balance of your unspent tax credit, can be rolled into an HSA account to be used to pay co-pays, and deductibles. That’s a big incentive to be a smart consumer. C. Of all of the Obamacare Mandates, the one on Preexisting Conditions is the most popular, and the one that is most likely to survive in any future health bill. I’ve already described in detail how to have pre-existing conditions paid as a secondary payer via Medicaid. D. The other Obamacare mandates are mostly idiotic. Pediatric dental care? Come on! But none are probably more idiotic the requirement to cover “children” up through age 26. Of all the mandates, that probably had more to do with the collapse of the Obamacare exchanges than any of the others since they took the young and healthiest group out of the exchanges and put them mostly under their parent’s employee group plans. That should simply be reduced to 21 or 22. Otherwise it mainly benefits upper class kids in graduate school. However I recognize that there are constituencies for all kinds of nonsense, so to borrow from Cruz and Lee’s amendment, require that each state have one plan that has one of those mandates. Let there be one plan that really does have pediatric dental care, and if you really want that, that’s the plan you get. I think the market would provide those options anyway, but one mandate per plan, rather than all of the mandates in one plan, like the Consumer Choice Amendment has, should be affordable. Of course the priciest mandate, for Pre-existing conditions, would be applicable to all plans but wouldn’t affect the price because they would be covered by the secondary payer. E. Of course the media and CBO crying jag over people losing their health coverage due to the elimination of the Medicaid Expansion can be avoided by simply allowing those currently under Medicaid Expansion to keep their plans. I elaborated on this back in June, but if the 14.5 million people currently covered by Medicaid Expansion know they won’t lose their plans (even if no new people are added to the program) that takes a lot of wind out of the sails of the opposition, and as I noted last month, those numbers will only decline over time. F. There are other smaller fixes that will help things, many of which I’ve mentioned before, but are not by themselves game changers, such as: a. A federal cap on non-economic malpractice damages. b. Allow purchasing pools of small employers and nonprofit associations and clubs (think the Elks Club). c. Allow consumer purchase of health insurance across state lines. There is some question on whether this will actually increase competition and reduce prices but hey, we allow it for employer health plans, so why not? d. Allow doctors and other health providers take a tax deduction for indigent care. For some doctors, taking a deduction on the cost of service based on Medicare rates might be a better value than simply being paid for the service with Medicaid rates. It’s not a fully realized health bill, but I think it’s a good outline that most of the right could agree with. If not this, it has to be something, and I mean something that won’t continue to wreck the health care market like the current House and Senate versions will. The clock is ticking.
Two things that you need to clarify. 1) what exactly do you mean by independent health insurance plans? 2) what exactly do you mean by tax credits. Since most poor and many middle class people pay no tax a tax credit as classically defined will be of no benefit.
What good are your ideas (which aren't all bad) if they never see the light of day? Turtle Man McConnell will likely ram thru something that violates either one or both of your #1 and #2 items. They have not given a rat's patootie about the average person so far, why would they start to care?
By independent health insurance plans, I'm referring to the individual plan marketplace; the plans that are now currently being sold on the Obamacare exchange. I probably could have worded that better. Tax credits pay even if you owe no tax, like the earned income credit tax for low income workers. So they are a benefit to low income people who might otherwise have little in the way of taxable income. At some point though, the higher up the income chart you go, they would fade off into mere deductions.
Well there are other ideas out there. Some of these ideas, or at least some version of them, were in earlier GOP healthcare reform proposals, although I think the idea of using Medicaid as a secondary payer for pre-existing conditions, and just keeping the Medicaid expansion for current recipients, are my original ideas. Or at least I've not seen them anywhere else. But that's what makes what the GOP is doing right now so hard to understand. The House and Senate bills are unlike any other Republican reform plans. They basically are Obamacare Lite plus getting rid of Medicaid as an entitlement. So they do nothing to stabilize the exchanges other than restoring the risk corridor subsidies...an Obamacare feature that Republicans successfully got rid of. So I don't have any idea what McConnell and Ryan are trying to do, but it's not to actually have a workable healthcare bill.
Those are the plans that are already in trouble because healthy prople don't buy them so they will even under your plan be astronomically expensive assuming any company will write them since they can all compete across state lines for the less risky policy buyers. Those are already part of the ACA. And you can't cover preexisting conditions as a secondary payer under Medicaid when your plan is going to eliminate Medicaid with the exception of those who are currently on the plan. Or are you only covering pre existing conditions that people currently have and not covering them in the future.
They already are as witnessed by the increase in the cost of the plans on the insurance exchanges as opposed to group plans. And if you eliminate the requirement for everyone to have insurance or pay a penalty this cost discrepancy will get even worse as more and more healthy young people drop out of having insurance.
Those costs are driven by the Obamacare requirements. We had a healthy individual insurance market before Obamacare. The problem then wasn't getting people to buy insurance, it was that people with pre-existing conditions mostly couldn't afford the plans that were available, and young people who wanted insurance bought high deductible plans on the individual insurance market. Now those young people are shunted into their parents employer group plans until 26.
We have a healthy individual insurance market now. It is the exchanges that are in trouble but individual insurance is easily available for those who can afford to shop outside the exchange system. And no I can tell you that prior to the ACA you could not get insurance thst would cover preexisting conditions at any price. You could by health insurance but it would not cover the pre existing condition.
I've already acknowledged that the issue with pre-existing conditions was one of the big flaws of the pre-Obamacare health market, but buying individual insurance outside of the exchange means you are not eligible for the subsidy, but your choice of plans is still limited by the ones that Obamacare allows you to sell.
The situation isn't really that complicated. If you want the markets to remain stable, fund the CSRs and signal that the individual mandate will be enforced. If you want to lower premium levels in the exchanges (even though comparable coverage is still cheaper in an exchange than in ESI), put in place a permanent reinsurance program. If you want to attract more insurers to the generally low population density counties that have only one seller, consider making exchange participation a condition of participation in Medicaid managed care and/or Medicare Advantage. Nothing elaborate is needed here.
No the choice is limited by the fact that all plans have to cover the same things. That was required to eliminate the phony plans that existed prior to the ACA.
The ongoing legal dispute is over whether they need a separate legislative appropriation or can be funded at the discretion of the executive branch. Easy fix: pass a separate legislative appropriation for them. Then the question goes away and Trump can no longer hold the markets hostage, driving up premiums and driving out insurers. See how easy it is?
So...right now you're arguing for something that isn't even currently legal. Passing anything to do with healthcare hasn't turned out to be an "easy fix."
I'm arguing the CSRs need to be funded. Because objectively they do. I'd much prefer the decision-making be taken out of Trump's hands. Congress should assert its authority and fund them itself. I'm not confident the GOP could pass gas at this point. Doesn't mean the situation at present is all that complicated.
Well...since CSR's were not provided funding in the original Obamacare legislation, and the Obama administration funded them anyway, and therefor the courts ruled the funding was illegal....you are basically talking about an issue that doesn't really exist in legislation. Maybe if there is some bipartisan legislation the Democrats can throw that in, but right now, you're talking about a proposal that doesn't have a legal funding mechanism, so it doesn't look like it's going to happen.
Yes, CSRs exist in legislation. They're authorized. 42 U.S. Code § 18071 - Reduced cost-sharing for individuals enrolling in qualified health plans As a policy matter they need to remain funded.
The exchanges are sinking because the Trump administration has made the future incertain and reimbursement of the insurance companies uncertain. Trump has repeatedly said his goal was to sink Obamacare and he is doing everything he can do to make it happen.
I said the funding was not provided for in legislation. That's why the court ruled the funding of them illegal.
