Jeb Bush Offers Both ‘Tricks’ and ‘Treats’

Justin Haskins Heartland Institute
Published October 15, 2015

Consumer Power Report #477

Republican presidential candidate and former Florida Gov. Jeb Bush released a two-page policy outline for repealing and replacing the Affordable Care Act (ACA) on Monday. Like many of the policy proposals offered by Bush, his plan to send Obamacare to the grave includes both “tricks” and “treats” that will leave many conservatives in his party unsatisfied.

Bush’s proposal includes a number of goodies for free-market health care advocates. First, Bush aims to end some of ACA’s highly unpopular mandates. “No employer mandate, no employee mandate, no mandated benefits,” promised Bush to a crowd of supporters in Iowa.

Second, Bush would hand back much of the regulatory power to the states, allowing each one to determine for itself the best way to tackle local health care concerns, including giving states the power to keep existing health insurance exchanges or remove them entirely. The plan also promises to put caps on federal payments to the states.

Third, Bush would help individuals without employer-based health insurance purchase health insurance plans by providing tax credits based on age – as opposed to an income-based credit – and expanding contribution limits for health savings accounts (HSAs) up to $6,550 for individuals, which Bush says could be used to cover growing out-of-pocket expenses. This would effectively double the current limit placed on HSAs today.

Fourth, the proposal, in vague terms, promises to enhance innovation, alter or replace regulations imposed on the health care industry by the Food and Drug Administration, require able-bodied Americans to work while receiving Medicaid, and limit damages in medical malpractice lawsuits.

Bush says the focus of his plan is to help every American afford a catastrophic health insurance plan and then let individuals determine how much more they would like to pay for additional benefits, a model many conservatives have espoused over the past six years.

Although Bush’s repeal and replace effort offers many positive reforms of the ghoulish Obamacare system that has kicked millions of Americans out of health insurance plans they liked and created countless regulatory nightmares that have kept small business owners up at night, there are many parts of Bush’s proposal that will likely frighten away conservative Republicans still looking to rally around one nominee in a crowded field of presidential contenders.

Bush’s plan would retain several important Obamacare provisions, including allowing children to remain on a parent’s health insurance plan until age 26. Bush would also keep Obamacare’s coverage guarantee provision for Americans with pre-existing conditions.

One part of Bush’s health care reform platform that’s sure to receive pushback from many conservatives is his plan to cap the value of the deduction allowed for high-quality employer-based insurance plans, essentially establishing a quasi-Cadillac tax, one part of Obamacare virtually all Republicans and many Democrats now oppose. However, Bush’s cap is much higher than the current, highly unpopular Cadillac tax threshold. The cap for individual plans would be $12,000 for individuals and $30,000 for families.

Bush’s plan, which will likely be revealed in greater detail over the next week, deserves praise for promoting innovation, removing onerous Obamacare regulations, and putting more power into the hands of states – precisely where it should be. However, Bush’s health care reform plan still leaves a lot to be desired.

Bush’s proposal doesn’t appear to offer the ability to purchase health insurance across state lines, one of the most popular conservative reform ideas that’s already been suggested by many of his GOP competitors, including Sen. Marco Rubio (R-FL) and Louisiana Gov. Bobby Jindal (R). Bush’s plan also fails to address the significant shortage of primary care doctors or the exploding debt held by medical students, both of which greatly contribute to rising health care costs.

Perhaps most importantly, Bush’s focus on government-created health insurance tax breaks is, as Jindal once said about similar proposals, “Obamacare lite.”

Although Bush’s plan does limit the role of the federal government in the health care industry compared to the monstrous, Frankenstein system put into place under the Affordable Care Act, it still maintains a great deal of centralized power for bureaucrats in Washington, DC, and it’s not difficult to imagine how Bush’s system could easily be transformed by future presidents into a system that closely resembles the disastrous one in place today.

Successful health care reform would fully embrace free-market principles, and Bush’s plan falls well short of that. It’s an improvement over Obama’s failed system, but it’s still a government-focused plan that refuses to exorcise the big-government demons that have prevented the United States from entering an era of unprecedented innovation that is well within the nation’s reach – but only if zombie bureaucrats and regulators get out of the way.

— Justin Haskins



Acknowledging at least tacitly the difficulties of some health care consumers, the Obama administration plans major changes to this year to make it easier for shoppers to find health insurance plans that include their doctors and to predict their health care costs for the coming year. …

With the Affordable Care Act’s third open enrollment season starting Nov. 1, new features of will allow consumers to type in the names of their doctors, prescription drugs and preferred hospitals, and see which plans cover them, administration officials said.

The effort to ease the consumer experience is driven by the administration’s push to reach the 10.5 million people who Sylvia Mathews Burwell, the secretary of Health and Human Services, says are still uninsured but eligible for marketplace coverage.

SOURCE: By Robert Pear, The New York Times


Anyone who has given two seconds worth of thought to it knows that school shootings are not occurring because we have a gun problem. They are occurring because we have a mental health problem. So what are we doing about that? Not much. Despite several mental health parity laws, government regulation is one reason why so little is being done. ObamaCare is probably making things worse.

If the market for medical care worked like a normal market, providers would specialize, advertise and actively recruit patients who have problems that need to be solved. But standing between the patients and the providers are third-party payers (employers, insurance companies and government). And in direct response to government regulations, these payers have no interest in solving the problems of the mentally ill. …

As the chart below shows, more than one in five patients with private health insurance cannot find a mental health provider in their health plan’s network. In the (Obamacare) health insurance exchanges, things are even worse: More than one in four cannot find a provider.

Just because a health plan lists providers in its network, doesn’t mean patients will actually have access to them. A study by the Mental Health Association of Maryland found that only 14% of the psychiatrists listed in the Maryland exchange health plans were actually accepting new patients and available for an appointment within 45 days.

SOURCE: By John C. Goodman, Forbes


For nearly 18 million Americans, the Affordable Care Act spelled an end to months, years or sometimes even decades without health insurance. But for half of the 32.3 million Americans who remain uninsured after the law went into effect, key provisions of Obamacare won’t help them, an analysis published Tuesday showed.

In the U.S., 16.6 million people do not qualify for health insurance under the provisions of the Affordable Care Act, the Kaiser Family Foundation found, just as the Obama administration and insurance advocates are gearing up for a new push to encourage uninsured Americans to sign up for insurance during the next open enrollment period, scheduled to begin Nov. 1. The administration has said it will focus those efforts on areas where uninsured rates are highest, but the new report underscored significant barriers remain in reaching those who, for one reason or another, still do not have healthcare coverage.

SOURCE: By Elizabeth Whitman, International Business Times


The United States continues to lead the developed world in per-capita healthcare expenditures while trailing other countries in results, according to a new study by the Commonwealth Fund.

It determined that per capita spending in the U.S. reached $9,086 in 2013. That’s nearly 50 percent higher than Switzerland, the second-ranked country in terms of spending. Most of the other industrialized countries, such as Australia, Denmark, Germany, France and Canada, keep their per capita spending below $5,000. Some countries, such as Japan – which has the world’s highest life expectancy – the United Kingdom and New Zealand, have per capita costs below $4,000.

The average American spent $1,074 for out-of-pocket costs in 2013, with Switzerland the only country that was higher at $1,630. Many other countries were well under $300.

SOURCE: By Ron Shinkman, FierceHealthFinance


… Although the University of Oklahoma graduates nearly 160 medical doctors a year and Oklahoma State University graduates about 100 osteopathic physicians, Oklahoma ranks 45th in the nation for total active physicians per capita.

“If you look at the number of physicians in the state, most of them are in the five most populous counties,” Fosmire said. “Oklahoma really has a rural shortage issue.”

Outside of the Oklahoma City and Tulsa metro areas, most Oklahoma counties are classified as areas with a shortage of primary medical care providers by the U.S. Department of Health and Human Services’ Health Resources and Services Administration. Out of Oklahoma’s 77 counties, 64 area classified as having a primary medical care provider shortage.

Those numbers don’t even tell the whole story, Pettit said, because most rural doctors skew older.

“It’s an older workforce that is taking care of a larger land area,” he said.

SOURCE: By Brianna Bailey, The Oklahoman