GOP health fixes fall short
September 23, 2009
BY HARRIS MEYER
The late Mayor Richard J. Daley used to chide his critics by asking "What trees do you plant?" Similarly, President Obama recently challenged Republican foes of his health-reform plan by asking, "What's your solution?" Then he answered his own question: "They don't have one."
Obama was wrong. Some Republicans agree with the president that reform is needed to give all Americans access to affordable health coverage and control soaring medical costs. They've proposed several different plans, which they call "common sense" reforms. But would their ideas work?
The congressional Republican bills seek to apply free-market principles that do work for selling cars and computers to the business of health insurance. But there's a hitch: Unlike with autos and computers, the surest way for health insurers to make money is by selling to younger, healthier customers and turning away older, sicker ones.
That's known as risk selection -- or cherry-picking. It's bad for society as a whole because it forces people with pre-existing medical conditions to pay a lot more for coverage, if they can get insurance at all.
GOP plans don't cover costs
There are also pocketbook problems with how the Republicans propose to expand insurance coverage. The three main GOP bills -- the Patients' Choice Act, the Health Care Freedom Act and the Empowering Patients First Act -- would give people refundable tax credits to buy private insurance-- about $2,000 a year for individuals and $5,000 for families.
The Patients' Choice Act would pay for this by eliminating the tax exclusion for employer health benefits, not a popular idea. The Health Care Freedom Act would fund the subsidies by repealing the financial industry bailout and requiring prompt repayment of those loans, though that would be only a one-time money pot. The Empowering Patients First Act would impose a 1 percent a year cutback on non-military, discretionary spending, which could whack popular programs such as medical research, school aid, road funding and food and drug safety.
The GOP subsidies would cover less than half the cost of a comprehensive health insurance policy; they might barely pay for a high- deductible policy, leaving people exposed to steep out-of-pocket costs. A family earning $40,000 a year would receive no more help than a family earning $200,000. The GOP proposals would encourage people to start tax-free health savings accounts to cover these expenses, but don't explain where families would find the money.
All comers if all buy
Under the Patients' Choice Act, individuals and families could buy a private policy through state-run health insurance exchanges, which Obama also proposes. Plans in the exchange would have to offer coverage to all comers, regardless of age or health status.
But health insurers are unlikely to participate in the GOP version of the exchanges. That's because unlike the Obama plan, the Patients' Choice Act (and the other GOP bills) would not require Americans to obtain coverage. The insurance industry has stated it will only agree to accept all comers if everyone is mandated to buy. Otherwise people could buy coverage at the point when they need care. That's a sure way for insurers to lose money.
Instead of exchanges or take-all-comers rules, the Health Care Freedom Act and Empowering Patients First Act bills hope to make coverage affordable by letting insurers sell policies across state lines. These policies would not have to comply with the rules in the state where the customer lives. Thus, insurers could offer cheaper, stripped-down plans, for instance, by not having to cover mental health conditions, maternity care or well-child care.
But state insurance commissioners say this would leave consumers vulnerable to abusive out-of-state insurers who can't or won't pay claims, which has happened in the past. It would encourage cherry-picking of healthier subscribers and hurt people with medical conditions that states now require insurers to cover. Insurers likely would set up shop in states with the loosest coverage and consumer protection rules.
On top of that, consumers might face higher medical bills because out-of-state insurers wouldn't necessarily have locked-in fee agreements with local doctors. So doctors could charge patients whatever they wanted.
GOP plans hit seniors
Republicans accuse Obama of proposing to cut Medicare and reduce care for seniors. But the GOP bills rely heavily on trimming Medicare and Medicaid and requiring seniors to pay more. The Patients' Choice Act would require private Medicare plans to submit competitive bids, to force them to reduce their premiums -- and benefits. It would raise Medicare Part B and Part D premiums for more affluent seniors. The Empowering Patients First Act would require Medicare cuts if costs rose above a certain threshold.
Another way the Republicans say they'll make health care more affordable is by limiting medical malpractice lawsuits and establishing special health-care courts to handle malpractice claims. The Empowering Patients First Act would cap pain and suffering awards at $250,000 and also cap fees for plaintiff attorneys.
But pain-and-suffering caps in states such as California, Texas and Florida have failed to slow runaway medical costs. Last year, a University of Alabama study of caps in 27 states found they did not produce savings for consumers.
The Republican bills show that thoughtful conservatives recognize there are major problems with the U.S. health-care system -- and that addressing those problems requires big changes in how Americans get coverage and care. There are no easy answers.
Let's hope that over the next few months, GOP lawmakers put aside their often disingenuous attacks, acknowledge the tough issues they've tried to grapple with in their own proposals, and join with Democrats in a constructive process to pass needed reforms.
Harris Meyer is a veteran health policy journalist living in Yakima, Wash.
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