The plan, titled “A Framework for Personalized, Affordable Care,” is based on months of discussions with experts and stakeholders and has two parts: an overview of the current health care landscape and 11 policy prescriptions to improve health insurance portability, protect the vulnerable, and expand access to innovative care. The group, led by Rep. Mike Johnson (R-LA), plans to present additional recommendations.
The report calls for a health care system “that can refocus on care” and states Congress “has a responsibility to fix this mess.”
“We present this conservative framework as an alternative to more, destructive government interference,” the report states.
Critical of ACA
The plan describes how the United States has fared under the “inaptly named” Affordable Care Act since it was signed into law in 2010. The ACA was a response to the two to four million Americans who did not have health insurance before getting sick, the report states.
The ACA, designed to “expand, subsidize and guarantee coverage,” was a “short-sighted approach” to help an “important but relatively small number of Americans,” the report states. Premiums in the individual market soared. Even fines under the since-repealed individual mandate were not enough to prevent the exodus of healthy individuals. The ACA created “a perverse incentive for people to forgo insurance” until they got sick, the report states.
As a result, health insurance premiums for individual coverage on the ACA exchanges more than doubled between 2013 and 2017. Deductibles increased by 212 percent from ACA’s implementation in 2014 to 2017, while worker earnings increased by 26 percent and inflation was 17 percent.
As examples of how the ACA has failed to benefit many of those it was intended to help, the report includes case studies of individuals and families whose care for people with disabilities was significantly disrupted by Obamacare.
“The ACA decimated our satisfactory health care coverage and left my family in a state of concern that one or more of us would become sick and have little financial protection,” Melissa Davert, who is featured in the study, told Health Care News.
Davert and her husband and two young adult children have significant disabilities. A link to a video showing their plight is featured below.
“The benefits of the ACA plans we do choose constantly change or the plans actually get cancelled, causing us each year to reconsider a new plan,” Davert said.
The report states Medicaid expansion is putting enormous strain on not just state and federal budgets but also on Medicaid providers struggling to keep up with new demand. Finally, it summarizes “the disaster of a single-payer” system, referring to the dysfunction in the government-run Veterans Health Administration.
If you like your plan, “you will definitely not be able to keep it” under a “one-size-fits-all approach,” the report states.
Portability, Expanded Access
The RSC proposes a three-pronged solution involving health insurance portability, protection for vulnerable populations, and expanded access to innovative care.
The RSC plan would eliminate the health insurance mandate for employers with 50 or more employees, creating insurance portability, the ability to move in and out of insurance plans without losing coverage. Employees would no longer have to exhaust COBRA before entering the individual market. Coverage under COBRA is often more expensive than a consumer might want. Individuals with preexisting conditions would be able to enter the individual market with a waiting period of 63 days or shorter, depending on how long they were in a prior plan.
The plan would provide federal funding for states to set up risk pools to cover higher health care expenses and take pressure off the individual market so more people could afford to participate. States could design these “guaranteed coverage pools” as they saw fit, determining which individuals would be covered by them, the plan states.
Equal Tax Treatment
One of the most significant changes in the plan is that it would give individuals in non-employer plans the same tax advantages as individuals using employer health insurance, for whom premiums are exempt from income taxes. The RSC plan would allow use of health savings accounts (HSAs) to pay for premiums in the individual market and expand HSA funding limits to $9,000 for an individual and $18,000 for a family. Individuals could also use the plans to pay for direct primary care.
The plan also addresses short-term limited duration insurance, association plans, telemedicine, and certificate of need laws.
“The new report by the RSC gives us hope that there will be some creative solutions to the insurance crisis facing special-needs families, like ours, who fall through the cracks,” Davert said.
The Texas Public Policy Foundation’s Right on Health Care director, David Balat, says the plan is a good first step toward improving health care.
“This framework is a great start to protect everyone in the health care system and puts the focus on health care rather than health insurance,” Balat said. “We applaud the RSC for communicating with stakeholders and including patients in the design of their health care framework.”
Goodman Institute for Public Policy Research founder John Goodman wrote in an October 22 column in Forbes, “the proposals are bold, impactful and easy to understand.”
AnneMarie Schieber ([email protected]) is managing editor of Health Care News.
Republican Study Committee, “A Framework for Personalized, Affordable Health Care,” October 26, 2019: https://heartland.org/publications-resources/publications/a-framework-for-personalized-affordable-health-care
The Mackinac Center, “Obamacare Causes Disabled Family’s Insurance Bill to Increase 300 Percent,” January 8, 2014: https://www.youtube.com/watch?v=ShDg7uUx_dY