Nevada’s two Republican representatives to the 115th Congress, Senator Dean Heller, and Representative Mark Amodei (R-NV2) are now proposing not to have town hall style sessions with constituents until they have something to say. We might assume this applies to the threats to repeal the Affordable Care Act, without having something concrete to say to the voters. Representative Paul Ryan is touting the GOP “Better Way” (pdf download) as a set of talking points for Republican members of the 115th.
First, there isn’t anything really new here. It’s the same proposal a person might have downloaded last June (June 22, 2016). The foundation is Unleashing the power of choice and competition is the best way to lower health care costs and improve quality. One way to immediately empower Americans and put them in the driver’s seat of their health care decisions is to expand consumer-driven health care. Consumer-driven health care allows individuals and families to control their utilization of health care by providing incentives to shop around. This ultimately lowers costs and increases quality.”
Problem: “Consumer-driven health care” makes for lovely free market rhetoric, but it boils down to the same old High Deductible Health Policy/Health Savings Account proposal the GOP has rolled out since time out of mind.
“This insurance arrangement— in which a person is protected against catastrophic expenses, can pay out-of-pocket costs using tax-free dollars, and in turn takes responsibility for day-to-day health care expenses—is an excellent option for consumers. HSAs tied to HDHPs are popular tools that lower costs and empower individuals and families. This type of coverage also helps patients understand the true cost of care, allows them to decide how much to spend, and provides them with the freedom to seek treatment at a place of their choosing.” (page 13)
This is an elegant way to tell people (1) you’re on your own; (2) that you might expect some tax credits, but the expenses are going to come immediately out of your pocket; (3) and you’ll be able to address ‘catastrophic’ illness or injury expenses out of what you’ve put into an HSA. Good luck with that. Health Savings Accounts are great for the healthy and wealthy, for everyone else – not so much.
Worried about those expenses out of your pocket? Well there are HRA’s on offer and more “defined benefit” possibilities. In short, instead of having several comprehensive health care plans to choose from, a person could also ‘choose’ to be involved in HDHP/HSAs and HRAs and other privatization schemes.
Question for Congressional Representatives: What in this plan insures that the health care insurance will be truly comprehensive? Affordable? Affordable for those families having Nevada’s median income around $50,000 per year?
Secondly, there is still the question of what portability means in practical terms.
“…our proposal is like a health care “backpack” that provides every American access to financial support for an insurance plan chosen by the individual and can be taken with them job-to-job, home to start a small business or raise a family, and even into retirement years.”
Problem: What’s going to be “portable?” If a health care plan is to be truly national, then does this mean that there will be a lowest common denominator for all health care insurance plans? Will the plan acceptable in a state with little or no oversight and consumer protections become the national standard? And, if not, then what IS the standard supposed to be?
Another problem: What elements of a health insurance policy must be included for the plan to be acceptable? One of the advantages of the ACA requirements is that some coverages (mental health, pregnancy, etc.) don’t apply to all consumers – however, if we start cutting out elements of comprehensive coverage where does it end?
Questions for Congressional Representatives:
(1) If a health care plan is portable across state lines, then do the consumer protections in place remain enforceable?
(2) If a health care plan is considered “junk insurance” in one state can it be enforced in another state with higher consumer standards?
Third, there’s the Medicare, Medicaid issue.
Depending on who is doing the talking from the Republican side these programs are either failed or failing. Neither is true. However, nothing is preventing Speaker Ryan from offering Coupon Care in place of the Medicare program, and from proposing turning the Medicaid support into a block grant program with formulaic funding.
Questions for the Congressional Representative:
(1) The ACA actually extended the viability of the Medicare program, what in the GOP plan will insure this viability is extended?
(2) If funding for Medicaid is turned into a block grant program what provisions in your plan would prevent this funding from being cut?
Senator Heller and Representative Amodei may be waiting for the GOP to come up with a rational and comprehensive plan to replace the ACA and Patient’s Bill of Rights – I’d advise them not to withhold breathing. Or, if they are assuming there’s nothing on offer from the GOP side since June 2016 – sort of a budget without numbers in health care terms – they may never have to have anything to say to their constituents.