The Republican Caucus in the U.S. Senate released today yet another bill aimed at repealing and replacing the Affordable Care Act (ACA), often called Obamacare. The bill, called the Better Care Reconciliation Act (BCRA), would allow the sale of less-generous insurance plans currently outlawed by Obamacare, offer Medicaid block grants to the states, retain many of Obamacare’s tax hikes, and provide subsidies for Americans to purchase health insurance.
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“What is most amazing about many of the changes to the Better Care Reconciliation Act is that they would expand liberty, add new choices for millions of Americans, improve health savings accounts, and provide lower-cost alternatives for working families. Maybe the most important change remains the historic reform of Medicaid, which would give greater control to the states and spur competition and innovation.
“Yes, the compromise is spending lots more than before to purchase compromises, but that is how Obamacare was passed in the first place.
“The worst part of this legislation is that it would keep high Obamacare tax rates in place. However, Republicans in Congress know this problem will be addressed when they tackle tax reform – which this does make harder, in some respects – in the coming months. Still, as a package, it is an enormous reduction in the burden of government and is now very likely to pass.”
Mr. Ferrara is the author of Power to the People: The New Road to Freedom and Prosperity for the Poor, Seniors, and Those Most in Need of the World’s Best Health Care (2015), and The Obamacare Disaster (2010).
“The Better Care Reconciliation Act (BCRA) is hardly perfect or even a repeal of Obamacare. However, given the political realities facing the nation and the dire state of the health care market under the Affordable Care Act, the BCRA would be a positive step forward.
“The BCRA’s health savings account (HSA) provisions are particularly exciting. By dramatically expanding the amount of money families can contribute tax-free and allowing people to pay health insurance premiums with HSA funds, the BCRA could effectively serve as a substantial tax cut for millions of Americans who take advantage of these important reforms.”
“Under the Better Care Reconciliation Act many people would benefit from using their health savings account (HSA) funds to pay for their health insurance premiums, which are insufferably expensive under the Affordable Care Act. Unfortunately, the Senate bill continues to tie HSA advantages to insurance plans, shutting out people who reject the insurance system as the least efficient health care payment model in existence.
“If this bill brings HSAs further into the mainstream, it will be a step forward. Congress should go even further, however, and extend HSA advantages to members of health care sharing ministries, the responsible fraction of their constituents Republicans always seem to forget.”
“The devil is always in the details, and we haven’t yet had time to analyze the details. But, as with all efforts to reform bad legislation, the reform itself has both good and bad to offer. On the ‘bad’ side: The way to slay high premiums still relies far too much on taxpayer buy-downs in the form of subsidies. Taxpayer subsidies have a long-proven record of driving up prices and spending, no matter the program they fund. On the ‘good’ side: The benevolent federal government will allow us to purchase ‘lower-premium plans.’ While it is good that federal law could recognize more health insurance options, it remains dispiriting the federal government is the agency to decide this, rather than a marketplace.
“The bill does seem to set in motion the first steps in disarming the Medicaid financial time bomb, and this absolutely must be done, but low-income, disabled, aging adults and those with long-term care needs will continue to be protected.
“Perhaps under the provisions in the Better Care Reconciliation Act states will be encouraged to reevaluate the idea that every possible form of medical and mental health care should be paid for by taxpayers, while encouraging able-bodied individuals to get a job.”
“The only way to make insurance affordable is through competition with products free of absurdly expensive mandates. Such products must actually be insurance, rather than a third-party prepayment plan for over-consumption of over-priced products that most would decline if spending their own money. The market must also be free of government price-fixing, which effectively taxes the young, healthy, and responsible people who maintain continuous coverage.”
“At the risk of abusing an overused cliché, I’d call this bill the ‘Good, Bad and the Ugly Reconciliation Act.’ It’s good from the standpoint it would boost health savings accounts (HSAs), slow the growth of Medicaid, and allow consumers to buy affordable health insurance plans if they prefer. It’s bad from the standpoint it does not repeal the Obamacare Medicare taxes and taxes on capital, something that harms economic growth in the long run. It’s ugly because it does not do more to repeal Obamacare. The compromises strike me as just postponing the inevitable debate required to repeal and replace the Affordable Care Act.”
“I think the proposed changes are moving the bill closer and closer to a workable solution. Allowing HSAs to be used for paying the premium on insurance policies would be the most significant improvement in health care finance since 1942 when health insurance became linked to employment by allowing for the purchase of insurance with pre-tax dollars.
“This would allow people on the individual market to purchase insurance at the same tax advantage as their peers who obtain their insurance through their employer. This could free employers from functioning as pseudo healthcare providers and instead allow them to focus on their core business.”
“The only additional aspect that I would like to see would be to allow people to have the ability to have a HSA without a traditional insurance plan – currently dependent upon having traditional insurance – and the ability to pay for health sharing programs with HSA dollars. That would bring the coverage options of health sharing and traditional insurance to tax parity. It’s not ideal, but is a whole lot better than the existing law.”
Dr. Chad Savage, M.D.
Founder, YourChoice Direct Care
Policy Advisor, The Heartland Institute
“This bill would take the country a few small steps in the right direction while refusing to take any big steps that way. More consumer choice is always a positive, but this legislation would still leave us vastly short of where we were a decade ago in plan flexibility and would require us to spend significantly more on government health care than we did a decade ago.”
“The new version of the Senate health care reform bill would offer some improvements to the Affordable Care Act, but it would not be a full repeal. If it passes, the Senate’s bill will offer patients greater choices regarding how they get their health care and from whom. It would also allow them to avoid being restricted by narrow networks. Eliminating the mandates to buy an insurance product that contains the current minimal essential coverage mandates would offer more freedom for many patients and help families have access to plans with reduced costs.
“Protecting pre-existing conditions is important and must be part of the final bill. The bill saves billions of dollars that could be used in other ways to make health care more affordable and reduce the deficit. However, it is important to guarantee that at least basic catastrophic coverage is affordable for those who would lose their insurance under the current model. The increased subsidies to help people afford health insurance is also a significant change to the previous version of the bill.”
“Subsidies that have to be applied to purchasing insurance is a shell game. It takes dollars from taxpayers and requires that they be used for insurance, rather than health care. Level the playing field by granting our citizens, who accept responsibility by earning the money needed for their care, the same tax advantage as employers in purchasing care.
“The Common Sense Health Care Tax Policy with health finance accounts accomplishes that goal and makes as much as $200,000 available to the middle class to apply toward their health care needs than health savings accounts (HSAs) would – without having to earn one penny more. Government micro-management over the past 70-plus years has been a dramatic economic failure, with health care costs increasing at four times the rate of inflation.
“Only restoring a free market will control costs. Providing equal opportunities for our citizens would shrink the number needing or qualifying for Medicaid. Public assistance dollars should be block-granted back to the states so they can decide how to obtain the best value for the money spent.”
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