Thanks to our Dear Leader for the link to the Republican’s health reform proposal, cutely called PCARE. Professor Wright is the expert and will look through it carefully and give you the real scoop. I’ll be the opening act. I’ve read through it, and there are some good things in it, although you have to skip the rhetoric spouted in the first few paragraphs of every section. To wit: “Despite promises that Obamacare would lover health care costs, costs continue to skyrocket for patients, families, taxpayers, and businesses.” Actually, the Kaiser Family Foundation says that Medicare spent $1000 less per person last year, and is projected to remain steady at 14.5% of the federal budget and 3% of GDP. Non-partisan this treatise is not.
1. There is a proposed provision for extending health insurance policies across state lines. This would certainly help equalize coverage quality and could promote competition. It is worker-friendly and makes sense. Medicare is already nationwide, although the private insurance companies that actually provide a lot of the policies are not. So, OK. I wonder, though, since as I point out below the plan lays an awful lot of the responsibility for all of this stuff on the states.
2. The republicans like health care savings accounts, or HSAs (personal responsibility and all that) and would like to expand this option. Great as long as you have two coins to rub together at the end of the month.
3. They want to keep the coverage for kids under their parent’s plan ’til age 26. I guess that one polls well.
4. Tort reform. Amen. Caps on non-economic damages and limitations on attorney’s fees.
5. Transparency. “…health insurance plans would be required to disclose covered items, drugs, and services, any plan limitations or restrictions, potential cost sharing, the actual cost of services (my boldface), the claims appeal process, as well as the providers participating in the plan.” Some of this is already required, but some real information about cost would be welcome.
1. The plan throws out the rule that insurance companies cannot charge elderly patients more than 3 times what it charges a young person. This is considered “too restrictive” and the new proposal ups the number to 5 times. This is supposedly better because premiums would go down for millions of Americans. That it will also go up for millions of Americans is not mentioned.
2. The proposal seems to throw the ball back into the state’s courts. States can opt out of the coverage for kids under age 26, they can adjust the amount the elderly pay in comparison to the elderly, re-using the high-risk pool idea within states, and making the states negotiate the terms of cross-border agreements. Perhaps most oddly, it asks the states to designate health plans that would be the default coverage for people who don’t choose a plan. Wait, weren’t most states perfectly happy to let the federal government set up the health insurance exchanges?
3. The republicans also really like using tax credits, which I think have already been tried. Many times.
4. Here’s the part that makes me nervous. I quote:
“Under our plan, no one can be denied coverage based on a pre-existing condition. To help consumers with pre-existing conditions our proposal would create a new ‘continuous coverage protection’. Under this new protection, individuals moving from one health pan to another could not be medically unwritten and denied a plan based on a pre-existing condition if they were continuously enrolled in a health plan. This new consumer protection helps incentivize responsible behaviors by encouraging consumers to keep their health coverage.”
Those italics are not mine. People with pre-existing conditions who have been uninsured would supposedly get a grace period in the form of a one-time enrollment period in which they could not be denied for a pre-existing condition. So people who are not “responsible” (here read “poor”) aren’t entitled to this so-called consumer protection. I could be wrong about this, but I need a much better explanation about why the ACA’s rule that you can’t turn anyone down for a pre-existing condition at any time is so bad.
So there you go! The real health policy expert will now take the podium…