The House Republicans on Monday released their plan to reform the Affordable Care Act (ACA), also known as Obamacare. Among other features, the bill eliminates Obamacare taxes and the individual mandate, prohibits insurance companies from denying coverage or charging more money to patients based on preexisting conditions, and allows adults under the age of 26 to remain on their parents’ insurance plans.
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“The Affordable Care Act has been an unmitigated disaster. Americans have endured higher premiums and deductibles, fewer health insurance options, miles of red tape, broken health care exchanges, and additional taxes. The House Republican plan offers many important free-market reforms that will help to scale back some of Obamacare’s most egregious provisions, but it fails to address key parts of the ACA that must be phased out if Americans are ever going to have access to truly affordable high-quality health care, such as the pre-existing conditions clause. Americans deserve better than what the House plan offers.”
“House Republican leaders pride themselves on removing the individual mandate, but their latest draft bill mandates insurers ‘shall’ charge a 30 percent ‘penalty’ to buyers who fail to present ‘certificates’ proving continuous coverage. This is one of many examples of the House GOP plan doubling down on Obamacare’s intrusion in health care and health insurance markets.
“The new bill doubles down on Obamacare’s requirement insurers sell plans to patients with preexisting conditions. The bill will likely cause premiums to skyrocket as patients wait until they are sick to buy health insurance.
“Democrats are going to resist any plan the Republicans put forward, so instead of promoting more government-managed entitlements, Republicans should be promoting market-based health care reforms proposed by conservatives and libertarians in Congress.
“The House GOP leadership plan attempts to herd patients toward insurance markets, reinforcing the federal government’s confusion between ‘health insurance’ and ‘health care.’
“The latest plan does not appear to consider members of health care sharing ministries (HCSM), which Obamacare exempts from the individual mandate and tax penalty, as eligible for the health insurance tax credit or recognize them as having continuous coverage. This is backward, considering HCSM members have shared each other’s health care costs more efficiently and effectively than insurance markets for the last 25 years, and especially during the reign of Obamacare.”
“This bill represents the standard practice in Washington, DC: Democrats create a new entitlement, and Republicans figure out a way to pay for it. Guess who gets all the credit for the ‘free’ stuff and who gets blamed for the inevitable budget disaster?
“The Republican plan is a start toward a better way, but it omits important and desperately needed reforms. The tax credit approach and the per-capita Medicaid and health savings account elements are good reforms. However, the Medicaid number should be based on the state’s total population, not the state’s Medicaid population. Using the latter invites states to bloat their Medicaid rolls. Using total population would eliminate incentives to spread Medicaid around like Halloween candy.
“Retention of the preexisting-conditions provision sustains the Obamacare idea of health care as an entitlement and a right – to be fulfilled by confiscation of resources from other people – and it remains an exceedingly inefficient and wasteful way of solving the un-insurance problem. I also see nothing in the plan about reductions of mandatory benefits provisions nor repeal of McCarran-Ferguson to allow selling of insurance across state lines. Those are huge omissions.
“In sum, this bill is a good deal better than Obamacare at present, but it will leave a large amount of work to be done. If the alternatives are this or ACA, the obvious preference is this plan, of course.”
“I’m skeptical of the House Republican plan. It seems to be a modification of the ACA, keeping some of the Obamacare features and replacing the subsidies with tax credits. But the tax credits seem less than the likely premium increases, at least for older purchasers of insurance. It replaces the penalty for being uninsured with a penalty surcharge for the uninsured who eventually take up insurance. This seems like an incentive not to purchase insurance until one needs health care. I’m not sure why this plan would be more sustainable than the ACA.
“In my view, the real problem with all the plans cooked up by Washington D.C. are that they focus almost entirely on the demand side, on how to help people pay for health care. They also impose complex schemes, rather than market-based approaches. While the health insurance market is a mess that needs fixing, the real gains that might be made are on the supply side. These insurance fixes – the ACA and the Republican proposal – do nothing for the supply of health care. At best what they can do is increase demand for health care services while doing little to promote innovation and entrepreneurship in health care, pushing prices up. The entire approach is wrong. What’s called for is a free market in health care.”
“The current plan does some things that are crucial. Eliminating preexisting conditions and preventing them from precluding coverage as well as prohibiting lifetime limits were some of the most positive aspects of the Affordable Care Act. At the same time eliminating the mandates and penalties and restoring patient choice and freedom through expansion of health savings accounts (HSAs) is an encouraging step forward. This allows patients to choose their own physician and seek out affordable options that improve quality like direct primary care. The phase out of subsidies and preventing loss of coverage for the most vulnerable needs to be handled carefully so that patients do not lose access to health care.”
“Where’s the repeal of Obamacare? The only thing the American people actually asked for in the last three elections is a repeal. And repeal isn’t even in this bill, except from the individual and employer mandates and all the taxes. This bill is not written for the American people. It’s written for health insurers. Nothing about the Republican bill is going to speak to the hearts and minds of the American people hurting from impossibly high premiums and dangerously narrow networks. Americans voted for Republicans because they wanted repeal. This is a replacement bill that looks and feels like the Republican version of Obamacare. Republicans should put forward and push to pass a real repeal bill, or they’ll find themselves on the losing end of this debate, along with the American people.”
“The Republican plan on repealing and replacing Obamacare is a good start on doing precisely that. The plan repeals the individual mandate, the employer mandate, and all of the Obamacare taxes. It phases out the Medicaid expansions and gives more control over Medicaid to the states, though it falls short of true block grants, which is a disappointment. It also phases out Obamacare subsidies (welfare), in favor of tax credits that effectively expand the tax preference for employer health insurance to everyone. The plan also expands health savings accounts.
“This Republican plan replaces government central planning and control in health care with consumer choice and competition. It will consequently receive broad public support from a strong majority of Americans. It is not perfect, but those concerned about that should get to work on reforms of the reforms to achieve more perfection.”
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