TPM: New GOP Plan Makes Everything They Hate About Obamacare Even Worse

[highplainsdem]

http://talkingpointsmemo.com/dc/gop-obamacare-alternative-disruption

For the last couple months, the Republican critique of Obamacare has been founded on President Barack Obama's broken promise: "If you like your health plan, you can keep it." It was a pledge that the health care reform law wouldn't disrupt the existing insurance system, that those satisfied with the status quo would be protected from any unwanted intrusion.

It's been an effective line of attack, given the sinking approval ratings for both Obama and his eponymous insurance expansion. Which makes the new GOP alternative to Obamacare, proposed Monday by three Republican senators, a bit baffling. Because the bill seems to based on another fundamental disruption of the individual insurance market -- and on top of that, it could upend the employer insurance universe, through which most Americans receive health coverage, forcing many to either pay more or lose their coverage.

That was the conclusion of several health policy wonks who spoke with TPM about the new proposal, put forward by Sens. Richard Burr (NC), Tom Coburn (OK) and Orrin Hatch (UT). One way or another, millions of people would likely lose the plan they already have.

The GOP's plan starts with repealing the Affordable Care Act, and it seems explicit that everything must go: "The first step toward achieving sustainable, affordable, patient-centered health care is to repeal the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA)." The only items untouched would be changes to Medicare, which weren't related to covering the uninsured anyway, according to a footnote.

-snip-

[MrsKirkley]

1. Their plan would bring back preexisting condition clauses

and they're stupid enough to think continuing to allow young adults to remain on their parents' policies until age 26 somehow makes up for that. They also plan to make Americans responsible for MORE of their medical costs..... because the ACA is too expensive

[Swede Atlanta]

2. The plan is seriously flawed......

1. Eliminating the pre-existing condition prohibition would mean millions of persons with pre-existing conditions would be either uninsured because no insurance company would insure them or their premiums would be so high they couldn't afford to carry coverage.

Remember that a pre-existing condition can be anything a private insurer stipulates. If you had a history of seizures as a child but grew out of them they could be a reason to deny coverage. Virtually anything from having flatulence to ALS can be classified as pre-existing conditions.

I had colon cancer 4 years ago. We monitor the situation with annual colonoscopies but so far it does appear they were able to rid my body of the cancer. I would fall into this bucket unless my employer-provided insurance plan covered me. We could see even those plans begin to weed out those with pre-existing conditions.

2. Eliminating subsidies and expanding use of medical savings accounts would return millions of Americans to the ranks of the uninsured. If MSAs had been effective before we wouldn't be having this discussion. The problem is the Americans in the greatest need of subsidies are those that already cannot afford coverage. These are often those working one or two minimum wage jobs or who cannot find more than part-time work. Since the GOP has no interest in even having a minimum wage this change would doom many Americans.

3. Capping deductibility for company-provided insurance would mean one of several things. Companies that truly value the benefits they provide to employees (and those companies do exist) would continue to provide insurance without any significant changes to employee contribution and would "eat" the tax liability. That would increase their costs and could have the net negative effect of increasing the cost of goods and services or reduced employment. Another outcome that would happen would be companies, free of an Obamacare mandate, would simply drop insurance. Some would undoubtedly give employees a lump sum to go out on the open market to purchase insurance with all of its issues of annual caps, pre-existing conditions, etc. Others would continue to provide it but significantly increase employee contribution to cover the tax liability.

4. Goal of increasing the amount the individual pays underscores how little the GOP understands the pre-Obamacare system. The single most common reason for personal bankruptcy has been the inability to pay medical bills. And often this is by individuals who had insurance. They may have had the crappy policies that were a bad deal all around that the GOP so loves or they may have been hit by annual caps.

I agree that individuals needs to take more responsibility for health generally. But to get there you don't stick them with more of the costs of care. You increase incentives to be healthy by doing things like providing free preventive care and allowing insurance companies to charge more for individuals who do not take advantage of preventive care or address conditions that cause chronic conditions - smoking, substance abuse, obesity, etc.

Any way you look at it as long as you continue to depend on for-profit insurance companies as the basis for your system you will have these "market-driven" issues. That is why a single-payer "Medicare for all" would be so much more efficient. I am sensitive to the concerns of having bureaucrats making healthcare decisions but we have that today when a clerk at an insurance company denies your claim. We do need to insure there continues to be improvement in health care outcomes but that is not necessarily achieved by the number of procedures a doctor performs or the number of prescriptions a doctor writes. We also need to insure there is sufficient incentive to continue to develop new drugs, medical procedures and instruments, etc. But we don't need to be paying for a prescription or procedure many times what someone in Canada pays for the same.