Perspective: Beyond Repeal — A Republican Proposal for Health Care Reform

New Engl J Medicine ^ | March 6, 2014 | Timothy Stoltzfus Jost, J.D

[Pharmboy]

By voting repeatedly to repeal the Affordable Care Act (ACA) over the past 4 years, Republicans have risked being identified as a party without a positive health policy agenda. On January 27, 2014, however, three Republican senators — Orrin Hatch (UT), Tom Coburn (OK), and Richard Burr (NC) — unveiled a proposal that would not only repeal the ACA, but also replace it with comprehensive legislation based on Republican health policy principles.1 Although the proposal recycles long-standing Republican prescriptions, it also offers new ideas.

The proposal would not entirely repeal the ACA. Republicans seem to be coming to terms with the fact that the ACA has permanently changed the health policy landscape. The proposal would, for example, retain the ACA's Medicare provisions in recognition, no doubt, of the difficulty of rolling back all the ACA's provider-payment changes or reopening the doughnut hole in Part D coverage of prescription drugs but also apparently in order to use the ACA's $700 billion in Medicare payment cuts to finance Republican initiatives. The proposed legislation would retain popular ACA insurance reforms, including the ban on lifetime insurance limits, required coverage for children up to 26 years of age on their parents' policies, mandated disclosure of insurance benefits and limitations, and a ban on canceling an enrollee's insurance policy except in the case of fraud. It would retain limits on age rating of insurance premiums, but insurers could charge five times as much for an older as for a younger enrollee, as opposed to the three-to-one ratio limit in the ACA.

The proposal would, like the ACA, use premium tax credits to make health coverage affordable for lower-income Americans. Unlike the ACA's tax credits, which are available to families with incomes of up

[Pharmboy]

Full text is available at link. Remarkable that the VERY left-wing NEJM would even give space for this.

[Diogenesis]

[Graewoulf]

Thanks for this thread.

_______________

The reason that the Republicans lost in 2012 is because they nominated “Romneycare” Romney to fight “Obamacare” Obama.

The reason that the RINO Wing of the once great Republican Party is now Obsolete is because they want to:
* help Obama “fix” Obamacare;
* approve of Amnesty for 30 million Illegal Alien Invaders from Mexico;
* slightly reduce the rate of increased spending on some parts of some welfare debt programs; and
* otherwise be doormats to he who wants to “Fundamentally Change the United States of America.”

[expat2]

It doesn’t seem to solve any of the problems with ACA, except for the individual mandate (tho’ that is important), but jacks up the premiums older people pay.

[BenLurkin]

Here’s “ a positive health policy agenda”:

Keep the government OUT.

[Still Thinking]

The article says it also emphasizes HSA’s at the expense of scam coverage (standard insurance, only to get worse under FascistCare), which is the biggest conceivable plus. In fact, the ONLY change worthy of calling any proposal a “reform”.

[PubliusMM]

“Republicans seem to be coming to terms with the fact that the ACA has permanently changed the health policy landscape.”

Again confirming that the pubbies have morphed into dhimmicrap lite.

Getting closer to the ultimate reset.

[Hostage]

Why is federal government involved at all in healthcare?

Ans: Because a good portion of the Beltway grifter class specializing in ‘health policy’ look forward to pigging out at the federal trough.

[SuziQ]

...and a ban on canceling an enrollee's insurance policy except in the case of fraud.

Well we know that one's a lie, because folks have been losing their insurance all over the country.

I'd love for the Republicans to repeal Obamacare and NOT REPLACE it with Obamacare Lite. I want reforms that include getting government the hell out of mandating any coverage of any kind! That is what has caused so many companies to stop offering insurance at all. Larding policies up with all kinds of stuff only make them more expensive, and harder for companies to pay even part of the premiums. Folks will have to learn to pay larger co-pays, if they want the premiums not to go up. Health care is NOT free, and folks shouldn't look upon it as something they can get for free or cut rate, even with a health insurance policy.

Frankly, I like the idea of a Catastrophic policy option, which doesn't kick in until the family has reached $10,000 or so in expenses. That would keep a family from being wiped out with a major procedure for any member. Typical yearly expenses, like physicals, mammos, gynecological screenings, flu shots, and vaccines, could be paid for, before taxes, with a Health Savings Account that is set up and owned by the individual. If doctors know you're going to pay cash for their services, and not make them jump through hoops waiting for insurance payouts, they will likely offer reduced prices, which would make a family's Health Insurance Savings go much further!

[DoodleDawg]

The most controversial element of the proposal is its cap on the currently unlimited exclusion from an employee's taxes of the cost of employer-sponsored coverage. The proposal would cap the tax exclusion at 65% of the cost of an average health plan. The employer-sponsored coverage exclusion is currently the largest tax expenditure in the federal budget, and economists have long argued that it distorts the market for health insurance coverage and is more beneficial for higher-income than lower-income taxpayers.

In other words, the Republican plan involves raising taxes on many, perhaps the majority of Americans. No thanks.

[Amendment10]

Thank you for referencing that article Pharmboy. Please bear in mind that the following critique is directed at the article and not at you.

Noting that I'm way past the point where I would hesitate to question James Madison if he was aware of the constitutional clauses that delegate limited powers to Congress, it doesn't surprise me that a post-FDR era J.D. is overlooking a much broader constitutional problem with federal lawmakers trying to legislatively address a national public healthcare program.

As mentioned in related threads, not only did the Founding States make the 10th Amendment to clarify that the Constitution's silence about things like public healthcare mean that such issues are automatically uniquely state power issues, the feds having no constitutional authority to legislatively address such issues, but consider the following.

Regardless what activist justices want everybody to think about the constitutionality of constitutionally indefensible Obamacare Democratcare, previous generations of justices had not only clarifed that the states have never delegated to Congress, via the Constitution, the the specific power to establish a national public healthcare program, but also that Congress is prohibited from laying taxes in the name of state power issues, again, healthcare a state power issue.

”State inspection laws, health laws, and laws for regulating the internal commerce of a State, and those which respect turnpike roads, ferries, &c. are not within the power granted to Congress. (emphases added)” —Gibbons v. Ogden, 1824.

“Congress is not empowered to tax for those purposes which are within the exclusive province of the States.” —Justice John Marshall, Gibbons v. Ogden, 1824.

So the federal lawmakers mentioned in OP are either constitutionally clueless, or are wrongly deliberately ignoring the federal government's constitutionally limited powers.

[Linda Frances]

No, no, no! Repeal completely. We will forever have fights over what should and shouldn't be in it. We will be called heartless because we don't give everybody everything they want. It will be like the endless fights over the debt ceiling.

Put people who don't have insurance or who have pre existing conditions in Medicaid. Charge them according to their income. Help the insurance companies get back on their feet after obamacare.

Or

Make all ins companies share a certain percent of people with pre existing conditions. The low income should be in Medicaid. Everyone pay according to income.

[kvanbrunt2]

health insurance is now regulated by the feds good bye health care

[expat2]

HSA’s are nice, but not much use for folks just starting one who have lots of health issues, including the elderly and those with pre-existing conditions.

[Georgia Girl 2]

It’s a terrible plan. We pay these morons $174,000 per yr to come up with this carpola?

[Pharmboy]

It seems to me that if it can be constantly delayed—this last one for 2 years—that there is enough time to rip it out by its roots.