Everywhere you turn, health markets are nearing collapse. It’s an unfortunate and catastrophic reality of too much federal intervention in our health care. From soaring deductibles and skyrocketing premiums to fleeing insurers, it’s no wonder patients are paying more out of pocket each year under the so-called “Affordable Care Act.”
Today, the Energy and Commerce Committee’s Health Subcommittee will examine four legislative solutions to help deliver relief. Together, the bills will play an important role in being among the first bricks placed in the rebuilding of our health care system. Collectively, they will give patients relief from the law’s soaring costs, tighten enrollment gaps, and protect taxpayers.
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Part of why Obamacare is so unpopular is that it is neglects the typical American.
Obamacare is bad for the typical—or median—American for a variety of reasons, including: its unprecedented individual mandate; its inept manner of dealing with preexisting conditions, which has sent premiums soaring (by 40% over the past two years); its roughly $2 trillion price-tag (over a decade); and its consolidation and centralization of power and money at the expense of Americans’ liberty and their wallets. Rather than offering overdue tax breaks to everyone who buys his or her own health insurance, Obamacare instead gives direct subsidies to insurance companies (falsely labeled as “tax credits”) on behalf of the select few.
As Republicans deliberate over an alternative to Obamacare, this provides a huge opening. A more consumer-friendly system will go a long way towards reducing costs for all and bringing down overall health care spending.
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Insurers are generally confident they could manage the transition away from Obamacare and into a new replacement plan, according to a survey from the Urban Institute.
The group interviewed executives at 13 insurance companies participating in the individual market in 28 states to ask them how they would respond in various repeal scenarios proposed by the new administration. While all insurers said that uncertainty regarding the future of Obamacare is bad for business and for the stability of the individual market, they were confident they could manage policy changes. They also expressed optimism about a replacement plan that offered continuous coverage, which many Republican plans include.
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President Donald Trump’s administration has promised to repeal and replace the Affordable Care Act and Congressman Darrell Issa is proposing a new health care plan to Congress.
In an interview Saturday, he told NBC 7 he calls his plan “The Access to Insurance for All Americans Act.”
The plan would give people access to the federal employee health benefit plan that government employees use. It calls for no mandates on businesses and individuals.
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Since its passage in 1965, Medicaid has expanded and contracted with the political tides. With concurrent Republican executive and legislative control in 2017, conservative policy makers have already declared their desire to repeal the Affordable Care Act (ACA) and its Medicaid expansion, which has been responsible for approximately 12 million of the 20 million individuals who became newly insured as a result of the ACA. But proposals for fundamental reform of Medicaid are even more far-reaching in terms of their consequences for the other 60 million low-income children, parents, the elderly, and individuals with disabilities who rely on the program. Understanding the rationale for and likely effects of these proposals is critical for physicians and patients alike.
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The strategy that Congress and the Trump administration will pursue to repeal and replace the Affordable Care Act continues to evolve. In early January, the favored strategy seemed to be to repeal as much as possible of the ACA through legislation, but to delay the repeal of key provisions, such as the premium tax credits and marketplaces, for two or more years and then begin work on a replacement. In mid-January, this seemed to be giving way to an approach, apparently favored by the Trump administration, under which replacement legislation would be adopted more or less simultaneously with repeal, although it was not clear how this could take place without cooperation from Democrats, which seemed unlikely.
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During the election campaign, Donald Trump promised to abolish Obamacare and replace it with better health reform that would not leave anyone behind. In order to understand what is implied by that promise, consider Figure I, which highlights three groups of people:
- About 11 million people are getting insurance in the exchanges and many of them are unhappy. In the words of former president Bill Clinton, many are “paying twice as much for half the coverage” they were previously enjoying.
- Another 11 million or so people are getting individual insurance outside the exchanges. These people have all the same problems as people in the exchanges. But, they receive no federal tax break for the purchase of insurance, even though a federal mandate requires them to buy it.
- In addition, about 29 million people are uninsured and that number is unlikely to change very much going forward. Polls show that the most important reason why so many people are uninsured is cost.
One way to think about Donald Trump’s campaign promise is to see that he wants to make health insurance less expensive and better for the first two groups without leaving the third group permanently uninsured. And he wants to do it with money that is already in the system. In other words, without raising taxes.
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The pre-existing conditions issue played a central role in the design of the Affordable Care Act, and dealing with this issue appropriately in any ACA replacement plan will be instrumental to the achievement of stable and sustainable individual and small group health insurance markets.
House Speaker Paul Ryan and House Republicans’ June 2016 Better Way health care reform proposals, supported by Representative Tom Price, President-elect Trump’s nominee to head HHS, will surely influence the development of replacement legislation. Consistent with the Better Way, there would appear to be fairly broad support among Congressional Republicans for a replacement plan that at a minimum (1) guarantees that people who maintain continuous coverage can do so at terms that do not reflect health status, (2) provides substantial incentives for people to purchase coverage before needing costly medical care, and (3) provides some form of safety net for those who fail to purchase and maintain coverage.
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The Republican congressional leadership has made a new timetable for gutting the Affordable Care Act, aiming to get legislation done by March or possibly April.
But that doesn’t give insurers much time to meet their first deadline for submitting plans for 2018 on the individual market, which includes the law’s exchanges.
A rule published four days before President Trump took office set the deadlines for insurers to sell health plans on the individual market, which is for people who don’t get insurance through their jobs. Democrats have charged that Republicans will throw the market into chaos by repealing the law without an alternative, with Republicans responding that the markets are already in turmoil.
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It’s an exciting time for our country. With a unified Republican government in place, the coming months are shaping up to be a busy time working to put real solutions in place to help the American people.
At the forefront of the agenda is repealing Obamacare and rebuilding our health care system in order to provide quality health care, at an affordable price, to the citizens of our country. It’s no small task, but one we are committed to doing — and doing right.
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