Skip to comments.How Republicans Could Replace Obamacare: Plan begins by repealing Obamacare in its entirety
Posted on 01/29/2014 7:17:40 PM PST by SeekAndFind
What is the GOPs health care plan? For years, this has been the rejoinder from supporters of Obamacare whenever asked to confront the flaws in their own legislation. It was an attack line, but also a question worth asking: For the last five years, Republicans have spent plenty of time bashing the presidents health law, but far less time describing what they would do instead.
A new proposal from Republican Sens. Coburn (Okla.), Burr (N.C.), and Hatch (Utah) represents a tentative attempt to respond substantively to the question. Its called The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act, and its not intended to be the answer, but one possibilitya first step toward a Republican vision for reform. Its less radical in scope than Obamacare, and more modest in its aims: The goal isnt to rethink the health care system. Its to make it better, cheaper, and more accessible for the majority of people.
The plan begins by repealing Obamacare in its entirety: No more exchanges, no more individual mandate, no more federal benefits requirements. From there, it works from a simple understanding: Most Americans already have health coverage, and the large majority of them say they like it. The biggest complaint about the system is cost. Accordingly, thats where the plan devotes much of its focus.
Gone are Obamacares raft of expensive health insurance mandates, as well as its restrictive age-rating rules. Those rules prohibit insurers from charging older adults more than three times what they charge young adults in premiumsin effect, forcing the young to subsidize the old. In place of those rules, the GOP proposal would set a looser federal age rating benchmark, one that states could alter or eliminate if they wished. Much of the plan involves returning insurance regulation to the states. Without the heavy hand of the federal government directing health plan design, insurers would be able to design a wider array of cheaper plans tailored more to consumer demand than government rules.
Thats not to say that the plan would impose no restrictions on the health insurance market, however. Most forms of rescission, in which insurers unilaterally terminate coverage, often when expensive treatments begin, would be prohibited. (Insurers could still cancel plans in instances of clear-cut fraud.) The proposal would continue to allow dependents up to the age of 26 to stay on their parents health plans. And it would eliminate medical underwriting for the continuously insured; those switching plans, even from employer coverage into the individual market, would not have to worry about being denied coverage due to preexisting conditions. If you have a plan, you can keep your planor get another one.
For those who dont already have insurance, the proposal envisions a one-time open-enrollment period, in which the currently uninsured can sign up regardless of health status. Everyone, even the sick uninsured, would have an opportunity to buy in. But unlike Obamacare, no one would be required to do so.
The plan would set up a system of targeted tax credits to help those who wanted coverage afford it. The credits would be available to individuals and families up earning up to 300 percent of the poverty line, and would increase with age, so that older individuals with more expensive coverage would be given more assistance.
Those credits would be advanceable and refundable, and thus would cost money to offer. The proposal doesnt offer a dollar figure for how much the credits would cost, but it does suggest a way to pay for them: capping the tax exclusion for employer provided care at 65 percent of an average plans cost. None of the taxes that Obamacare relies on to pay for its coverage expansion would remain.
The combined effect of its changes, the plans authors say, would be revenue neutral and competitive with Obamacare in terms of coverage. No independent entity has scored the plan, however, and a reasonable assumption is that in the long run, the plan would leave more people uninsured than Obamacare.
By design, the plan is less ambitious than Obamacare. And it is less ambitious than a Republican plan that might have been proposed had Obamacare never passed: It leaves the tax exclusion for employer-sponsored coverage in place, capping it rather than ending it. And it does away with most of the health care payment and delivery system reform that Obamacares authors and supporters hoped would slowly reshape the system.
What the proposals authors are betting, however, is that at this point the public does not want grand ambition so much as attainable, practical improvement. And they are willing to bend, if necessary, to get there. The plan has not yet been turned into legislation, and at least some of its details remain subject to change and negotiation. Its designed as a conversation starter rather than a final proposal, a starting point meant to build consensus rather than the final word.
Because the conversation is happening now, following years of blistering attacks on Obamacare, the plan works within the confines of the GOPs criticism of that law: For political and practical reasons, its designed to minimize disruption to the health system rather than transform it, even where bigger disruptions might make for better policy. Its a necessary and productive starting point, but it also reveals how much the Republican party has limited its options by waiting so long to start talking about its own ideas. The plan sheds some light on Republican ideas about health policybut also serves as a reminder that those ideas remain in Obamacares shadow.
Repeal and do not replace.
No more incrementalism. You can't fix stupid.
If These dumb assholes would have taken this on way back when, we wouldnt have this crap we have now. All they would have had to do is limit tort and make it so insurances would be offered across state lines. And No mandate. Your choice, you get insurance or not. If you dont have insurance, you pay for the services if you get hurt or sick. A lot of insurances took pre existing conditions anyway and if they didnt, you could get on a PCIP plan that covered your pre conditions-it was like a high risk pool.
GD shyster lawyers and all.
First, you have to have a GOP with balls.
That’s impossible because they don’t have any.
How about tort reform and buying insurance across state lines? They also need to get rid of all pre-authorization requirements for outpatient services,eliminate networks and get rid of those ridiculous erecord requirements for outpatient services. If you eliminate networks insurance carriers can a percentage and the patient can pay the balance. Rather like going back to the 80/20 plan which worked quite well for years.
Doctor’s offices are drowning in paperwork and a solo practitioner cannot operate without spending a lot of money on clerical assistance so they end up either taking no insurance at all or going out of business. Regardless of what is done with insurance, there has to be some incentive for doctors to stay in practice. Great insurance without any doctors to see patients is worthless.
Just repeal it.
Saying the government is going to make healthcare less expensive is just plain stupid. If the government can do that, then go ahead and make food, cars, clothes, housing and utilities less expensive. Hell, make it all free! Oh, wait! That can’t be done unless someone is paying for it.
Right now food, cars and housing are all subsidized one way or the other. If the government would get the hell out of the way costs would go down on everything.
The federal government does not need to be involved in healthcare period.
Nowhere in the Constitution is there any mention that the federal government has a mandate to be involved in what essentially a matter between a patient and their doctor.
The only plan that should exist is a plan that a patient and their doctor agree to.
“How about tort reform...”
Texas did medical tort reform several years ago and my friend was on the state medical board when that happened. She told me so many doctors from other states started moving into Texas that the state had to hire more people at the state medical dept. in order to handle all the doctors’ applications coming in.
If you do that with no transition so people can keep the policies they got with Obamacare, these people would have no insurance. There would be no rules and insurance companies could drop every policy they issued. A law repealing would have to include a cure for the ills caused by Obamacare so people wouldn't lose their policies.
Millions would have no insurance if you just repealed and didn't fix the damage Obamacare caused. You have not thought this through if you just want to repeal. The insurance industry has been turned upside down and you have to put it right again for people to have coverage.
Every state has an insurance watchdog agency. That is there to keep a watch on insurance companies so they don't sell insurance trash policies to customers in their state. All insurance companies must register with the state. Complaints about insurance companies go to this department for investigation. These state agencies would be involved to keep watch if MEDICAL insurance regulation was given to the states instead of the federal government.
Why do states regulate any type insurance companies? Because in earlier days, any person could say they had an insurance company and they would sell policies. In reality, they could just take your money and when you had a claim, they wouldn't be there, would be gone. Now, insurance companies must be viable with enough money to pay claims and they cannot rip off their customers. The state keeps them honest or they lose their right to sell policies in that state.
Also, how about letting a doctors’ office offer its own health maintenance plans to a clientele without needing to participate in externally managed health plans. That’s worked pretty well where it has been tried. The insurance company overhead falls to zero.
There are some pretty concerted technical attempts to reduce the overhead and it can help. More power to them. But a bazaar of free possibilities is the only thing that can bring excellence to the picture again.
Some sort of reconstruction is needed. The GOP appears to be trying a soft landing approach. Maybe that’s the best that can be tolerated by an equally soft people. We’re not God. We can’t say shove people out onto the streets until we have robust enough charities again. (Which leads me to another suggestion. Make charitable contributions tax creditable, not just tax deductible. Now watch charity participation take off like a rocket.)
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You are thinking instead of having a knee jerk reaction. More people need to be like you and “think”. Something vital (medical insurance) but very imperfect (Obamacare) can't be destroyed and leave a blank space. That space must be, as you say, “reconstructed”, so it works again in an easier, less expensive, non-forced method for policy seekers. It just is the truth that some people will NEVER, EVER, want a policy. That is their choice, so be it.
We have lots and lots of new doctors in our area. Seems most of them have last names that are not Smith or Jones though - so not sure tort reform is what is bringing them. LOL. The Houston area would be a wilderness though if the medical community ever left or the federal government quit funding research. Just wish Texas would also ban advertising by attorneys. Seems to be split between doctors handling auto or big rig injuries or class action suites against drug companies.
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