By Grace-Marie Turner
So what’s your idea?
Conservatives are being challenged to come up with their own alternative health policy plan to replace Obamacare as it becomes quite clear that government cannot centrally manage a vast part of the largest economy in the world. Democrats, the media, and many others are demanding that Republicans get behind their own “unified bill.”
But the fact is, conservatives don’t have a better idea of how to spend $2.6 trillion, raise $1 trillion in new taxes, impose a slew of mandates on citizens and businesses, and still leave at least 30 million people uninsured. We don’t have a better idea of how to do that.
What we need is a new conversation. The hubris of Obamacare was that Democrats thought they could re-engineer one sixth of the economy with one bill. After 2,800 pages of legislation and more than 20,000 pages of regulation, it is clear that this approach is wrong for America.
House Speaker John Boehner gets it right when he says we need a “step-by-step approach to common sense reform.” Republicans have introduced more than 200 bills in the current Congress to address different aspects of health reform.
What is needed most is for leaders to paint a picture of how their approach to health reform would differ from what the Democrats have offered through Obamacare. If Republicans were to back one unified bill before explaining their vision and principles, we would get bogged down in legislative details, and the American people would become more confused than ever. And that, of course, is exactly what Democrats want to see to take the focus off of ObamaCare’s failures.
Our proposal to help people: First, we need to explain to the American people that we hear them. We know they want health insurance that is secure and that they want to decide what their policy covers. Americans also continue to be altruistic, despite the comments from one California woman who said, “I was all for Obamacare until I found out I was going to have to pay for it.” They want to make sure that people with pre-existing conditions get coverage and that we expand health insurance to the growing legions of uninsured. But they don’t want to have government dictate what the policies have to cover and how much of their income they can afford to pay for health insurance. That’s a decision for citizens to make, not government. And of course, they want coverage that’s affordable.
Restoring lost coverage. It’s crucial to create a safety net for people who are in serious trouble right now because of Obamacare’s cataclysmic failures. Millions of people are losing policies that they want but which are being canceled because they don’t meet the law’s requirements. President Obama attempts to rescue them by ordering health insurance companies to pay for care even if people haven’t completed enrollment or paid their first premium. Health insurance companies aren’t being giving much of a choice in this assault, given the menacing language in the HHS regulations which says HHS may throw otherwise-qualified health plans off of the exchanges next year if they don’t comply. These are illegal thug tactics. Real solutions are needed.
The Senate must take up the Keep Your Health Plan Act passed by the House in November so that people can keep their plans even if they are not grandfathered and also allow others to purchase the same policies. Individuals lost policies in the first wave. Small business health plans are next. They need the same protection.
Second, Congress needs to make sure those with pre-existing conditions and high health costs can continue to get coverage through high-risk pools. People may be in the midst of chemotherapy, have a chronic health condition, or need other treatment that cannot be interrupted. Many of the estimated 100,000 people on the federal Temporary High Risk Program haven’t been able to get through their state or the federal websites to enroll in an exchange plan. The president has ordered the federal high risk pool to continue to provide coverage through January, even though the health law says the program expires December 31.
In addition, as many as 200,000 more high-risk people are losing their coverage through state plans, many of which are being canceled because of ObamaCare. Congress needs to act quickly to protect all of them.
Third, conservatives can begin to chart a path for real reform. Targeted solutions are needed around a new vision, one aligned with a 21st century economy in which the American people, rather than government bureaucracies, have control over their own resources. People who are uninsured, those on Medicare and Medicaid, and workers and families with employer insurance all have separate needs for reform that require targeted solutions. The only way to get reform right is to address them carefully in a targeted way like a skilled surgeon wields a scalpel.
Let’s define consumer choice. Ironically, supporters of ObamaCare argue that their plan builds on the free-market and consumer choice and that their law absolutely, positively is not a government takeover of health care.
Democrats did take some of the names of sensible concepts and ideas that free-market analysts have been advocating for years. For example, they agreed that, in our increasingly mobile economy, Americans should have portable insurance that they can take with them as they move from job to job. They also agreed that you should be able to pick your own health insurance, just like you pick other types of insurance. Democrats gave a rhetorical nod to these ideas by providing tax credits to help people afford premiums and by creating exchanges where people can shop for portable insurance policies.
But ObamaCare took these market-based ideas and twisted them beyond recognition into a bureaucratic knot. The exchanges are weighed down with rules, regulations, and government restrictions, and are crushed under a mountain of bureaucracy. Health plans offered on the exchanges are all from the same government cookie cutter. The only things that remain of free market ideas are the labels – tax credits, portability, and consumer choice. We need to peel off these labels and put them on the right policies.
It will be hard to convince independent voters that a sweeping repeal of ObamaCare is a good idea until they see better ideas being offered. Free-market reformers must offer positive solutions, not a return to the status quo before ObamaCare.
Conservatives would start by getting the incentives right with policies that reward people for making good choices and that provide a strong safety net to help the most vulnerable people.
Free-market pillars: The fundamentals: Refundable tax credits for the uninsured. Tax deductions for people in higher income categories. Medicaid and Medicare modernization. Medical malpractice reform. Allowing people to purchase insurance across state lines. Allowing pooling of small companies to get the benefits of a larger pool by spreading risk more broadly. Insurance reform that guarantees people who pay their premiums can purchase a new policy at an affordable price.
In a properly-functioning market, millions of people make billions of choices every day about what they do, where they go, and how they spend their money. Everyone offering a service or a product in the market gets these signals, and the market responds by providing consumers with more of what they want and less of what they don’t. Why on earth would Americans want a system, especially with something as personal as health care, where all of these market signals are lost, and doctors and patients are responding to regulators, not consumers?
While health care is different than other sectors of our economy and requires special consideration, there are many areas where consumers can and want to have more control over their health care choices – especially around the kind of health insurance policy they want and how much they are willing to pay.
Competition could work if consumers were truly engaged as partners in getting better value for their health care dollars.Government needs to get out of the way, not build more barriers.
All of these ideas need to be explained in more detail, but here’s our basic checklist for a Step-by-Step Approach to Health Reform:
- Provide those at the lower-end of the income scale a tax credit to purchase coverage, either on their own or through an employer
- Allow those with higher incomes to deduct the cost of their health coverage, whether they receive it through their employers or purchase it on their own
- Allow greater flexibility in health benefits: Consumers, not regulators, should decide what their health plans cover and not be forced into government-set benefit standards
- Provide portability of health insurance and greater competition by allowing cross-state purchase of health insurance which will, in turn, incentivize states to lighten regulation
- Allow states to develop or authorize pooling mechanisms where consumers can spend their credits or deductibles to find and enroll in the insurance that best meets their needs
- Allow secure renewal of health insurance that is guaranteed so people who have health insurance can keep it and not see premiums soar if they get sick
- Provide financial assistance to the states to create more functional high-risk pools or state risk-transfer pools that allow people with pre-existing conditions to purchase health insurance
- Reform the medical malpractice litigation process at the state level.
- Provide more options for Medicaid recipients, Medicare beneficiaries, and others on public programs to escape the restrictions that inevitably come from price controls
- Protect and improve the Medicare Advantage program that gives seniors the option of private plans in Medicare
- Allow people to escape Medicaid by allowing them to assign the value of their Medicaid benefit to private coverage of their choice
- Provide more flexibility to the states in running their Medicaid programs so they can adjust payment rates to encourage physician participation and cut red tape that drains taxpayer dollars from delivery of care.
Posted on Forbes, December 18, 2013