The Republican Alternative To Obamacare Always Has And Always Will Be, Personal Responsibility

Trump voters don't like the Obamacare subsidies or the Medicaid expansion because they help the undeserving. Consequently, they are okay with repealing and replacing Obamacare with something better, and they believe Trump can provide it because he is a businessman. Yeah, they believe that. And while I play around with the idea that Trump will surprise Republicans by proposing single payer health care so that he can brag about accomplishing something President Obama could not, the realist in me expects a plan similar to the alternative "plans" already offered up by Republicans. And the overarching theme of all of these plans is, personal responsibility and nothing says personal responsibility like putting aside your money to pay for your out-of-pocket health care expenses. You don't need subsidies. You just need a good tax deal to help you better use the money you should have. And that's why Republicans love health savings accounts (HSAs) so much.

Health savings accounts (HSAs) allow individuals to set aside money in tax-favored accounts to pay for medical care and prescription drug expenses. So, in addition to paying health insurance premiums, deductibles, coinsurance and copays, you can put some "extra" money in a tax-free HSA account. Think of HSAs as the health insurance version of the 401(k) retirement savings plan. Before 401(k) plans, employers provided pension plans to workers and their retirement benefits were pretty much guaranteed. Employers typically financed these plans but some plans required small employee contributions—it was an employer responsibility or a shared responsibility between the employer and employee. Then came the 401(k) plan with its risk of losing money, high finance fees, and employee-only or employee-mostly contributions. Responsibility shifted.

And how has the retirement income responsibility shift worked out? Well, just the other day, the Wall Street Journal reported that many supporters and early adopters of 401(k) plans acknowledge that they were mistaken in its benefits. You see, they expected 401(k)s to supplement real pension plans, not replace them. But ask any Republican lawmaker what she or he thinks about 401(k) plans for workers, and you'll probably get the thumbs up. These plans fit neatly with their personal responsibility philosophy and have the added benefit of making the financial services industry wealthier by taking a piece of your retirement savings away in the form of fees and low returns.

But using more of your money to pay for your health insurance via an HSA isn't the only personal responsibility mantra you'll hear this year from your friendly Republican legislature, expect their message to be even more personal. House Speaker, Paul Ryan's Better Way Obamacare alternative plan has a not so subtle message for you sick, old, chronically ill, excessive smoking, drinking fatties—no one should have to subsidize you or your lifestyle. He wants the young and healthy to pay way less for health insurance than you, and under his plan, they will.

With Republicans, you don't just have a responsibility to pay for most of your health insurance and health care costs; you also have a responsibility to fully understand the complexity of it all. Why don't you understand balance billing, and no, they won't write a law forbidding it. Capitalism, people!

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